Introduction
Parkinson’s disease is a disorder of the nervous system that affects movement. The disease begins to develop slowly but does gradually become incredibly significant. In the beginning, a very slight tremor may start on one hand. The face may not be able to develop expressions and arms may not swing while walking. Speech may become slurred and soft. The disease also causes stiffness and slowed movement. These symptoms may worsen over time as the condition continues to progress .
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There is no cure for Parkinson’s disease, but medical therapies can maintain and even improve the symptoms associated with it. Surgical intervention may be necessary to regulate certain areas of the brain and to improve symptoms .
Background information
Nerve cells or neurons, in the brain, break down over time during Parkinson’s disease. Many of the symptoms that are associated with the disease are due to the lack of dopamine which is produced by neurons. When dopamine levels are too low abnormal brain activity occurs and this in turn creates the signs that are so common with Parkinson’s disease .
The exact cause of Parkinson’s is still unknown, but doctors have determined that there are specific factors which can influence the disease. Genes and genetic mutation can cause the disease, but this is rare but widespread throughout the family. Certain toxins and other environmental factors increase the risk of Parkinson’s in later life .
Mechanism of Action
The cause of the breakdown of the neurons which produce dopamine is unknown. A selective substance in the brain destroys them by stopping the energy cycle within the cell. Postmortem studies indicated that there could be an ongoing toxic process, and Parkinson’s disease allows this relationship to go unchecked and uncontrolled . There is also the possibility that proteins can become folded and accumulate and therefore cause problems in the brain .
Symptoms
Symptoms vary from patient to patient. Signs early in the disease can be very mild and may not even be noticed. Symptoms usually start on one side of the body and remain worse on that side as the disease progresses .
Tremors or shaking being on a limb, hands or fingers, especially when the hand is relaxed. Bradykinesia, or slowed movement is common but can make even simple tasks difficult and time-consuming to complete. Steps may become shorter, and it could become difficult to get out of the chair. Muscle stiffness can occur in any part of the body. This can cause a limit to a range of motion and cause pain. Posture and balance can be affected. A stooped posture is often indicative of Parkinson’s disease. The condition can limit the ability to do unconscious movements such as blinking, and smiling. Gesturing when talking may be restricted. Patients with Parkinson’s disease often have speech problems. Speaking softly, quickly, slurring, or hesitation before beginning to talk are common .
Secondary symptoms include small, cramped handwriting, slight foot drag when walking, a tendency to fall backwards, depression, excess anxiety, hallucinations and psychosis, disturbances during sleep, constipation, pain, and an increase in dandruff .
Diagnosis
Scientists are working to create some kind of blood test or radiography scan to diagnose Parkinson’s disease accurately. Currently, the best method to determine if Parkinson’s is, in fact, the ailment, is a specialized technique for brain scanning. This method can measure the levels of dopamine and brain activity. These scans are very expensive and can only be performed in a limited number of facilities .
There is no one particular test to diagnose Parkinson’s disease. A doctor trained specifically in the nervous system will review the patient’s medical history, signs, and symptoms, in conjunction with a thorough physical and neurological exam. This information will help him to make a diagnosis. The doctor may request specific tests to rule out other conditions .
Treatment
While there is no cure for Parkinson’s disease, there are many options available to manage the symptoms. Most of the drugs available work by increasing the supply of dopamine in the brain. Dopamine cannot be given directly because it is unable to enter the brain. Medications can offer relief from Parkinson’s symptoms but over time the effects of the drugs may wear off. As symptoms progress of the consistency of relief changes, your doctor may choose to change the prescriptions or dosages that you are on .
Carbidopa-levodopa is often considered the most efficient medication for Parkinson’s disease. The levodopa portion of the medication is a naturally occurring chemical that readily passes into the brain. Once in the brain it converts into dopamine. When combined with caribdopa it is protected against converting into dopamine too early. It also helps to protect the body from side effects like nausea. Side effects of carbidopa-levodopa include lightheaddeness Levodopa is especially prone to wearing off over time. If you find that this medication is no longer controlling symptoms as it once did, talk to your doctor. Higher doses of this drug may lead to involuntary movements. Lessening or adjusting the dose may be necessary. Always report side effects or any concerns to your doctor .
Another class of Parkinson’s disease drugs are dopamine agonists. These drugs include pramipexole, ropinirole, and rotigotine. While levodopa actually converts into dopamine, dopamine agonists mime the effects of dopamine in the brain. While these drugs aren’t as effective as levodopa, they do tend to last long and can be used in conjunction with other drugs to smooth a turbulent off-and-on effect that can be seen with levodopa. Some side effects are similar to carbidopa-levodopa, but dopamine agonists are also known to cause hallucinations, swelling, sleepiness, as well as compulsive hypersexuality, gambling, and eating. If you feel that you are behaving in any way that is out of the ordinary for you while taking dopamine agonists, consult a doctor immediately .
MAO-B inhibitors include selegiline and rasagiline. MAO-B inhibitors assist in preventing the breakdown of dopamine in the brain by not hindering a particular enzyme in the brain. This brain metabolizes dopamine in the brain under normal conditions, but the inhibitor prevents this process from occurring. MAO-B inhibitors are associated with nausea and headaches. Hallucinations are more frequent when these drugs are combined with carbidopa-levodopa. The combination of MAO-B inhibitors and most antidepressants or some narcotics can cause possibly serious, but reactions and therefore are not typically combined. Always check with your doctor when combining any drug with an MAO-B inhibitor to prevent any drug interactions .
Catechol O-methyltransferase (COMT) inhibitors are another option for the control of symptoms of Parkinson’s disease. Entacapone is the most frequent medication from this class. This drug acts to prolong the effects of levodopa by obstructing a particular enzyme that breaks down dopamine. COMT inhbitors do include side effects as well. There is a risk of involuntary movements, diarrhea, and even stronger levodopa side effects. Another COMT inhibitor is tolcapone, but this drug has a risk of severe liver damage and failure and therefore is rarely prescribed .
Anticholinergics have been widely used for many years to treat the common tremors associated with Parkinson’s Disease. Benztropine and trihexyphenidyl are two of the most common anticholinergics prescribed. While these drugs do treat the tremors they come with their own side effects including memory impairment, confusion, hallucinations, dry mouth, constipation, and even problems urinating .
Amantadine, another anticholinergic, can be used alone during the early stages of the disease, or in conjunction with carbidopa-levodopa during the later stages. Purple mottling of the skin, swelling of the ankles, and hallucinations are side effects of Amantadine .
A surgical procedure is available to help stimulate the brain and therefore reduce the symptoms of the disease. In deep brain stimulation, electrodes are implanted in the brain, and a generator is implanted in the chest. By connecting these two devices, electrical pulses are sent to the brain .
Conclusions
Parkinson’s Disease affects movements of the body due to the degeneration of neurons in the brain. The symptoms of the illness beings slowly but do progress to more extreme symptoms. Hand tremors can progress to the lack of facial expressions and a shorter, slower gait. While Parkinson’s disease is not curable, there are many excellent pharmaceutical treatments to lessen the effects of symptoms.
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- Mayo Clinic Staff. (2014, May 28). Parkinson’s Disease. Retrieved from Mayo Cinic: http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/causes/con-20028488
- National Parkinson Foundation. (2014). What are the symptoms of Parkinson’s disease? Retrieved from National Parkinson Foundation: http://www.parkinson.org/Parkinson-s-Disease/PD-101/How-do-you-know-if-you-have-PD
- Parkinson’s Disease Foundation. (2014). Diagnosis. Retrieved from Parkinson’s Disease Foundation: http://www.pdf.org/en/diagnosis
