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Jun 16, 2006
Parkinson's Disease: Treatment Options
by SirGan
 Parkinson's disease is a specific movement disorder characterized by muscle rigidity, tremor, a slowing of physical movement, and in extreme cases, a loss of physical movement. What is causing all these disorders? Well, the primary symptoms are caused by excessive muscle contraction, normally affected by the insufficient action of dopamine, which is produced in the dopaminergic neurons of the brain.History and incidence of Parkinson’s diseaseParkinson's disease was first formally recognized and its symptoms documented in 1817 in An Essay on the Shaking Palsy by the British physician Dr James Parkinson; the associated biochemical changes in the brain of patients were identified in the 1960s. After Alzheimer’s disease, Parkinson disease is the most common neurodegenerative disease. There are estimated to be around 4 to 6 million people that have been diagnosed with Parkinson's disease. There are over 1.5 million in China alone. The greatest prevalence of any country is the U.S.A., with between 100 and 250 cases per 100,000.
Pathophysiology of the conditionWhen we are talking about Parkinson disease, then we should know that we are in fact talking about damages of the dopamine pathways in our brain! There are four major dopamine pathways in the brain;
These pathways are associated with:
So, it is reasonable that reduction in dopamine along the non-striatal pathways is the likely explanation for much of the neuropsychiatric pathology associated with Parkinson's disease.
Symptoms of Parkinson’s diseaseBecause Parkinson disease affects primary movement, in most cases, we are talking about motor symptoms. However, there are many other non-motor symptoms such as disorders of mood, behavior, thinking, and sensation.
Motor symptoms
Non-motor symptoms
Possible causes of Parkinson’s diseaseNo one really knows exactly what the main cause of Parkinson’s disease is. Experts have determined that many of the signs and symptoms of Parkinson's disease develop when certain nerve cells in an area of the brain called the substantia nigra are damaged or destroyed, but what is the trigger?
Several researches done in the past have proven that there is a genetic link between some cases of Parkinson’s disease. Although the risk among relatives is small- it nevertheless suggests a genetic etiology.
Several studies have proven that somehow people with unusual exposure to herbicides and pesticides are more likely to develop Parkinson's disease.
A number of drugs taken for long periods of time or in excessive dosages can cause symptoms of Parkinson's disease. These include medications such as haloperidol (Haldol) and chlorpromazine (Thorazine), Metoclopramide (Reglan, Metoclopramide HCL). Patients should understand that these medications do not cause Parkinson's disease, but symptoms disappear when the drugs are stopped.
Risk factors for developing Parkinson’s disease
Although, many don’t think about this- age is still one of the main risk factors for Parkinson's disease. Therefore, the risk continues to increase with age.
Having one or more close relatives with Parkinson's increases the chances that you'll also develop the disease, although your risk is still less than 5 percent.
Men are more likely to develop Parkinson's disease than women are.
There is no doubt- exposure to herbicides and pesticides puts you at slightly increased risk of Parkinson's.
Several studies done recently have proven that reduced estrogen levels may increase the risk of developing Parkinson's disease. This means that menopausal women or the one with hysterectomy done may be at higher risk.
Diagnosis of Parkinson’s diseaseThere are big problems in diagnosis of Parkinson’s disease because no definitive tests exist. That’s why the disease could be difficult to diagnose, especially in the early stages. All the cardinal symptoms of Parkinson may be dismissed as the effects of aging.
A diagnosis of Parkinson's disease is based on three things:
After a thorough neurological exam and medical history, the neurologist may order CT scan or MRI scan to meet the other criterion for a diagnosis of Parkinson's disease: ruling out disorders that produce similar symptoms.
Complications if left untreated
Nearly 50% people with Parkinson's disease develop depression. In some cases, depression may occur months or even years before Parkinson's disease is diagnosed.
Some people with Parkinson's disease develop dementia, a condition that can include memory loss, impaired judgment and personality changes.
The muscles patient’s use to swallow may be affected, making eating and speaking more difficult.
It is proven that Parkinson's disease may cause either urinary incontinence or urine retention.
Many patients develop constipation because the digestive tract works more slowly.
Although the right cause still remains unclear – the fact is that people with Parkinson's disease often have trouble falling asleep and may wake up frequently throughout the night.
Decrease in sexual desire is very common symptom.
Treatment for Parkinson’s diseaseUnfortunately, there is no cure for Parkinson's disease. Treatment centers on the administration of medication to relieve symptoms.
Physical treatmentPhysical therapy, especially, can be extremely helpful for people with Parkinson's disease — both in the early stages and later, as the disease progresses. It can help improve mobility, range of motion and muscle tone. Although specific exercises can't stop the progress of the disease, improving muscle strength can help you feel more confident and capable.
Medications
Levodopa is medications that has been considered the gold standard drug therapy for Parkinson's disease. What exactly is Levodopa? It is a natural substance found in plants and animals. It's a precursor to dopamine that, when given to people with Parkinson’s is converted into dopamine.
Treatment with dopamine isn't possible, because it doesn't cross the body's blood-brain barrier.
These medications mimic the effects of dopamine in the brain and cause neurons to react as though sufficient amounts of dopamine were present.
These drugs were the main treatment for Parkinson's disease before the Levodopa was found! They help control tremor in the early stages of the disease.
Surgery
It involves the destruction of small amounts of tissue in the thalamus
During the procedure, an electric current is used to destroy a small amount of tissue in the pallidum (globus pallidus), a part of the brain responsible for many symptoms of Parkinson's disease.
It consists of a pacemaker which transmits electric impulses through a wire to tiny electrodes inserted deep within the brain.
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