Parkinson
Parkinson’s disease is a chronic progressive neurological disease that affects nerve cells (neurons) in an area of the brain near the neck, known as the substantia nigra. These cells normally produce dopamine, a chemical (neurotransmitter) that transmits signals between areas in the brain.
These signals, when working normally, coordinate smooth and balanced muscle movement. Parkinson’s disease causes the loss of dopamine that leads patients to lose the ability to control their body movements.
What causes Parkinson’s disease?
There is increasing evidence that Parkinson’s disease may be inherited. Men after the age of 60 (average age for the onset of symptoms) are more likely to develop the disease than women. However, 10 percent of patients are diagnosed before age 40.
What are the symptoms of Parkinson’s disease?
The most common symptoms are tremor that is confined to only one body part, such as the hand or foot. However, it may spread as the disease progresses and it can worsen with stress. Tremor rarely disables a patient and often disappears during sleep and when the arm or leg is being moved.
Main symptoms include: muscle stiffness (rigidity), tremors, bradykinesia (the slowing down of movement and the gradual loss of spontaneous activity), changes in walking pattern and posture, changes in speech and handwriting, loss of balance leading to an increased number of falls. Other symptoms are: decreased facial expressions, changes in speech and handwriting, urinary problems, constipation, skin problems and sleep disorders.
It is important to note that the symptoms of Parkinson’s disease can be highly variable between patients and, in fact, as many as 25 percent are misdiagnosed.
How is Parkinson’s disease diagnosed?
Diagnosing Parkinson’s disease is sometimes difficult, since early features may be difficult to assess and may mimic other disorders. For example, tremor may not be apparent as a person is sitting at rest, or posture changes may be written off as osteoporosis or simply a sign of aging.
There are currently no sophisticated blood or laboratory tests available to diagnose the disease. Given these circumstances, a physician may need to observe the patient over time to recognize signs of tremor and rigidity, and pair them with other characteristic symptoms. The physician will also compile a comprehensive history of the patient’s symptoms, activity, medications, other medical problems and exposures to toxic chemicals. This will likely be followed up with a rigorous physical examination with concentration on the functions of the brain and nervous system, including reflexes, coordination, muscle strength and mental function.
What does treatment involve?
There are many treatment options:
- Medication: there are drugs that mimic the role of dopamine in the brain and work by stimulating certain parts of the brain and nervous system. However, other drugs are used to treat the symptoms of Parkinson’s disease; they block an enzyme that breaks down levodopa and dopamine.
- Surgery: Older surgeries required the purposeful destruction of parts of the brain and had a higher risk of complications. They are rarely done today.
Generally, surgery is only considered when medication cannot provide adequate control. Deep brain stimulation has many significant advantages to other new treatment options. With this technique, a permanent electrode is deeply placed in the patient’s brain. The electrode is then connected to a type of pacemaker implanted under the skin on the chest. Once activated, the device sends continuous electrical pulses to the targets, blocking the impulses that cause tremors.
It does not require purposeful destruction of any part of the brain and therefore, has few complications. It is also adjustable and can be changed as the patient’s disease or response to medications change. If deep brain stimulation is causing excessive side effects, the stimulator can be turned off and the effects reverse, which is not the case with older destructive surgeries.
