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Definition:

• Parkinson’s disease is a progressive neurological disorder primarily affecting the substantia nigra and striatum portions of the brain. Cells in the substantia nigra are responsible for producing dopamine, a neurotransmitter. Dopamine is sent to the striatum, which is an area of the brain that controls movement, balance and walking. In the Parkinson’s patient, about 80% of the dopamine-producing neurons in the substantia nigra have been destroyed by the time the first symptoms have been noticed.

Causes:

There is no known cause of Parkinson’s disease (PD), and, as yet, no cure. Scientists theorize that the cause of Parkinson's Disease in most patients is a combination of genetic and environmental influences.
Environmental factors currently being studied:

• Use of herbicides
• Use of well water
• Exposure to certain pesticides
Genetic factors currently being studied involve the understanding of two types of genes. To understand how genes are linked to Parkinson’s, begin by thinking of them in two categories.
• The first, “causal genes,” actually cause the disease. A causal gene alone, without the influence of other genes or environmental factors, guarantees that a person who inherits it will develop Parkinson's Disease. This kind of genetic Parkinson’s is very rare, accounting for perhaps one to two percent of people with Parkinson's Disease.
• The second category of genes, “associated genes,” do not cause Parkinson’s on their own, but increase the risk of developing it. A person may have these genes and never develop Parkinson's Disease, while people who do not have these genes can still end up being diagnosed with Parkinson’s. However, those who have the gene are more likely to develop Parkinson's Disease than those without it. In order for associated genes to trigger Parkinson's Disease, they probably need to be combined with other genes or environmental factors. (Gwinn)

Characteristics:

Parkinson’s disease is characterized by four primary motor symptoms:

• Tremor (shaking in a hand or foot when it is at rest)
• Rigidity (inflexibility of muscles resulting in decreased range of motion)
• Bradykinesia (slow movement)
• Postural instability (impaired balance and coordination)
• Diminished automatic movement
Additionally, there are several secondary motor symptoms that can be experienced by patients, although not all symptoms will be noticed by every patient. These can include:
• Dystonia (involuntary spasms of muscle contraction which cause abnormal movements and postures)
• Impaired motor dexterity and coordination
• Speech problems (low volume or slurred speech)
• “Masking” (loss of facial expression)
• Micrographia (small, cramped handwriting)
• Difficulty swallowing
There are also a number of non-motor symptoms associated with Parkinson's Disease. For many patients, these can be as troublesome as the primary motor symptoms.
• Dementia
• Sleep disturbances
• Depression
• Urinary problems
• Constipation
• Cognitive changes (memory difficulties and slowed thinking)
• Compulsive behaviors (sex and gambling, for example)
Symptoms of Parkinson's disease increase gradually over the course of time for people with this disease.

Statistics:

Parkinson’s disease is believed to affect one million people in the United States, and six million world-wide. (“What is Parkinson’s?”)

“The likelihood of developing Parkinson's Disease increases with age. Parkinson's Disease typically begins in a person's 50s or 60s, and slowly progresses with increasing age. The average age of onset is 62.4 years. Onset before age 30 is rare, but up to 10% of cases begin by age 40.” (“Introduction”)

Prevention:

Since scientists and doctors do not know what causes Parkinson's disease, they do not know yet how to prevent it.

Researchers are looking to see if there is biochemical abnormality with those who have Parkinson's disease that one might in the future be able to take a screening or chemical test to see if there is a diagnostic tool for Parkinson's disease.

"Using PET, research scientists can study the brain's dopamine receptors (the sites on nerve cells that bind with dopamine) to determine if the loss of dopamine activity follows or precedes degeneration of the neurons that make this chemical." ("Preventing Parkinson's Disease")

"Some researchers believe that free radicals may be one of the causes of Parkinson's disease. Antioxidants may help protect cells from free-radical damage and, thereby, reduce the risk of developing Parkinson's disease, however, more research is necessary to support this claim." ("Preventing Parkinson's Disease")

Awareness:

Viewpoint

• Each person's journey with Parkinson's Disease is unique; symptoms should not be generalized or predicted.

On-Line Discussion

Needs and Solutions

Treatment and Rehabilitation

Treatment options for Parkinson’s Disease include widely accepted use of medication, surgery, as well as complementary and alternative options. It is always best to discuss treatment with the movement disorder specialist or neurologist.

Medications

The “gold standard” of medications is carbidopa/levodopa (marketed as Sinemet).
Levodopa is converted in the brain into dopamine, the same chemical created by substantia nigra cells and used to control movement. Levodopa was introduced as a Parkinson's Disease therapy in the 1960s, and remains the most effective therapy for motor symptoms. It lessens and helps to control all the major motor symptoms of Parkinson's Disease, including bradykinesia, which is generally the most disabling feature of the disease. Carbidopa is included in the standard oral formulation to increase the effectiveness of a dose of levodopa and minimize side effects such as nausea and vomiting. (“Dopaminergic Agents”)

70-80% of patients regularly take some form of levodopa. There are some side effects, however, that come with increased dosage and long-term use. These can include dyskinesias (spontaneous, involuntary movements) and “off” periods when the medication suddenly and inexplicably stops working.

Dopamine agonists are drugs that directly stimulate dopamine receptors in the brain, and provide relief of symptoms. Some currently marketed are Apokyn, Mirapex, and Requip. Side effects can include drowsiness, and patients may experience sudden sleep onset. There have also been reports of these agonists causing compulsive behaviors such as increased gambling or intense sexual urges. (“Requip,” “Mirapex FAQs”)

Other classes of medications: COMT inhibitors (Comtan and Tasmar) have been shown to extend a dose of Levodopa and decrease the length of an “off” period. MAO-B inhibitors (Azilect and Selegiline) slow the breakdown of dopamine in the brain. Anticholinergics are effective in treating tremor and rigidity, but may have significant side effects, such as memory loss, sedation, and hallucinations.

 

Surgery

“Brain surgery is an option for advanced Parkinson's Disease patients whose symptoms can no longer be adequately managed with medications. The best surgical candidate is someone who responds well to dopaminergic therapy, has motor complications (off periods and dyskinesias) that are limiting factors, [and] is otherwise healthy and a good surgical risk.” (“Surgery”)

Deep Brain Stimulation (DBS) uses implanted electrodes to stimulate the subthalamic nucleus, interfering with abnormal activity. The electrical impulses can have a positive effect on areas of the brain that control movement and can improve tremor, stiffness, slowness, and dyskinesias.

Complementary and Alternative Treatments

• Physical therapy, goals of which are decreasing rigidity and bradykinesia, and improving balance and motor coordination.

• Occupational therapy, which focuses on improving fine motor coordination and making the home and workplace safer.

• Speech therapy, which concentrates on increasing voice volume;

• Acupuncture

• Massage therapy

  Not every therapy helps every child or adult.

Nutrition and Diet

Researchers are studying the effects of natural and nutritional supplements to evaluate their success in slowing the progression of Parkinson’s disease and managing its symptoms. Some that have shown positive results are CoenzymeQ10 (CoQ10), Vitamin E, Vitamin C, creatine and glutathione.

Any use of over-the-counter supplements should be discussed with the neurologist first.

Learn more about Parkinson Disease Spectrum Disorders

There are countless web sites available with answers to many questions and where you can learn more about Parkinson's Disease.

Here are just a few:

References