Parkinson's disease introduction

Parkinson's Disease
Introduction

Thanks to outspoken celebrities such as Muhammad Ali and Michael J. Fox, Parkinson's disease has gained widespread attention in recent years. Both men have Parkinson's disease, and both have focused their efforts and used their celebrity status to raise funds for research and increase awareness about the degenerative nerve condition.

What is it?
Parkinson's disease is a chronic neurological condition named after Dr. James Parkinson, who first identified and described the syndrome in 1817. The disease progresses slowly, affecting a small area of cells in the mid-brain known as the substantia nigra. Degeneration of these cells causes a reduction in the chemical called dopamine, and this reduction results in the signs and symptoms of Parkinson's disease.

Although Parkinson’s disease can occur at any age, it rarely occurs in individuals younger than 30. Rather it often occurs between the ages of 50 and 80 years, with the most common age of first symptoms being 60 years. Typically, risk increases with age. Parkinson’s Disease is not inherited. Early symptoms are generally subtle, occurring gradually. Although Parkinson's disease is a chronic illness, medication and the support of friends and family can help relieve many of the symptoms, enabling affected individuals to maintain a reasonable quality of life. The disease is not fatal.

What causes it?

The cause of Parkinson's disease remains a mystery. The consensus among medical professionals is that it probably results from a combination of genetic and environmental factors. Idiopathic Parkinson's disease is caused by the gradual loss of neurons in the substantia nigra (the region of the brain that controls movement, particularly automatic movements such as arm swinging while walking). When nerve cells in this area become impaired and die, production of a chemical in the brain called dopamine, which aids in transmitting signals, decreases and the result is impaired movement.

Although Parkinson's disease is caused by degeneration limited to the substantia nigra, other degenerative diseases and some medications can produce secondary parkinsonism. Medications that can cause symptoms of Parkinson's disease include antipsychotics (mesoridazine [Serentil], thioridazine [Mellaril], chlorpromazine [Thorazine], perphenazine [Trilafon], fluphenazine [Prolixin], trifluoperazine [Stelazine], haloperidol [Haldol], thiothixene [Navane], risperidone [Risperdal]), antiemetics (prochlorperazine [Compazine]), gastrointestinal antimotility drugs (metoclopramide [Reglan]), and drugs that lower blood pressure such as reserpine (Serpasil). Drug-induced parkinsonism must be ruled out before the diagnosis of Parkinson's disease is made.

Who has it?

It has been estimated that as many as 1.5 million Americans are affected by Parkinson's disease, and about half of these individuals have not been diagnosed with the disease. At this time, it's impossible to predict who will get Parkinson's disease and there is no known prevention.

What are the risk factors?

Currently, it is impossible to predict who will get Parkinson's disease and there is no known method for preventing its occurrence. The disease is believed to affect both men and women almost equally. Currently, age is one of the main risk factors for the disease. Most of those affected do not experience symptoms until after age 50. However, a subset of Parkinson's disease called young-onset Parkinson's disease, affects those under age 40. Two gene mutations have been identified in patients with this type of Parkinson’s Disease. Although the condition is clinically the same, treatment options may differ.
The disease is thought to result from a combination of genetic and environmental factors. Exposure to pesticides and other toxins has been suspected but has not been proven to be a causative factor.

What are the symptoms?

Symptoms of Parkinson's disease appear when the amount of dopamine in the brain is decreased. They often appear gradually, yet with increasing severity. Because the initial symptoms are similar to those of other neurological conditions, diagnosis can be difficult.
Some individuals have few symptoms, whereas others suffer more severe, debilitating symptoms in a short period. Common symptoms include the following:
Resting tremor on one side of the body
Stiffness of limbs (often referred to as rigidity)
Generalized slowing of movements (known as bradykinesia) and gait
Gait or balance problems
Small, overcrowded handwriting (called micrographia)
Lack of arm swing on the affected side of the body
Less frequent blinking and swallowing
Increased dandruff
Increased oily skin
Depression
Anxiety
Decreased facial expression
Episodes of feeling "stuck in place" when initiating a step (called freezing)
Lowered voice volume
Foot dragging on the affected side
Changes in posture
Feeling more tired
Weight loss

How is it treated?
Currently, there is no cure for Parkinson's disease. The goals of treatment are to minimize disability, reduce the possible side effects of drug therapy, and help the patient maintain the highest possible quality of life.
Mild symptoms that don't interfere with daily activities or disrupt work duties may not require medication.

When prescription drugs are needed, they help to manage symptoms, but they can't stop the disease from progressing. Often when a drug no longer effectively controls symptoms, another drug may be added to existing therapy. Optimal management is highly individualized and is best determined by a doctor who specializes in the treatment of Parkinson's disease.

Surgery remains the only option for those patients with severe or fast-progressing Parkinson's disease who have failed all other therapies. In a surgical technique called pallidotomy, an electric probe is used to destroy a small portion of the brain that is overactive and is thought to cause the symptoms of Parkinson's disease.

A thalamotomy is the removal of the thalamus region of the brain. (The thalamus is responsible for involuntary movements; destroying it prevents involuntary movements.) Although this type of surgery is rarely performed, it can be a last resort for patients who have disabling tremors in the hand or arm. However, the procedure does not relieve other symptoms of Parkinson's disease.

Thalamic stimulation is another type of approach in management of Parkinson's disease. In this procedure, an electrode wire is inserted into the thalamus. The other end of the wire is connected to a pulse generator, and the generator is placed under the skin in the chest area.
This device can produce the benefit of thalamotomy without causing wound or scars on the skin and has shown to be very effective in management of tremor in Parkinson's disease.
Deep brain stimulation (DBS) is a new, alternative procedure used to destroy small regions of the brain. A thin electrode implanted into the brain blocks brain waves that can cause uncontrollable movements. This procedure must be continued lifelong. It is especially useful in patients that have severe symptoms associated with tremor, involuntary movements (dyskinesia), and problems with gait.

Helping Yourself

Parkinson's disease can have a huge impact on an individual's daily activities and overall lifestyle. Learning coping strategies, preventing falls, getting proper nutrition, participating in regular movement and exercise, getting proper amounts of sleep, and ensuring adequate hydration can help those suffering from Parkinson's disease maintain a high quality of life.
Coping With Parkinson's Disease
Maintain a positive attitude in both occupational and social situations.
Keep friends and co-workers informed of your status, and to help maintain your independence, accept help only when needed.
Perform tasks on a priority basis to achieve a sense of accomplishment and purpose.
Join local Parkinson's disease organizations and support groups.

Fall Prevention

Avoid carrying objects in both hands while walking, which can disrupt balance.
Avoid standing for long periods with your feet too close together, which can increase your risk of falls.
Lift your feet when walking. Falls may result when you shuffle your feet, and falls can occur as a result of foot drag, which is common among people with Parkinson's disease.
Swing your arms when walking. This helps maintain balance and decreases fatigue.
If your feet feel "frozen to the floor" when you start to walk or move, you can (1) attempt to step over an actual or imaginary obstacle in your path or (2) rock from side to side.

If balancing is difficult, you can learn to use a single-point cane with a large, rubber tip. It takes practice to use a cane comfortably, but once mastered, this skill can make it much easier for you to maintain your balance.

Do not wear rubber-soled shoes because they grip the floor and may cause you to trip.
If rising from a seated position is difficult, place your feet directly under your knees and stand up firmly to overcome the pull of gravity. Rather than using your hands and arms when attempting to stand up, use your thigh muscles. This exercise also helps strengthen the large muscles of the legs, maintaining strength and promoting continued ambulation.
If you tend to feel lightheaded, move slowly when changing positions. When getting out of bed, sit up slowly, remain seated on the side of the bed for 15 to 30 seconds, and then stand in one place for 15 to 30 seconds before walking. This technique can prevent falls.
Do not use throw rugs or wax the floors of your home. Ensure that rooms are well lit, and consider using night-lights in hallways and bathrooms. Keep your home free of clutter to prevent tripping.

In the bathroom, you may need to use grab bars to get into and out of the bathtub. A raised toilet seat with arm rails may also be a necessity.
In the kitchen, you may need to use a long-handled sponge or mop to wipe up spills. Keep supplies that you use often in an easy-to-reach cabinet.

Nutritional Guidelines
Eat small, frequent meals rather than three large meals daily. This helps your body use food properly and makes it easier for you to maintain a healthy weight. Parkinson's disease can slow digestion and affect swallowing. If you have difficulty consuming solid foods, liquid supplements such as Ensure can help provide proper nutrition.

If you have no trouble digesting or swallowing food, eat foods that are high in fiber (vegetables, whole-grain bread, and cereals) and drink plenty of fluids to help prevent constipation and dehydration.
Sleep disturbances are common in individuals with Parkinson's disease. Proper sleep hygiene such as going to bed at the same time every night can be helpful.

Especially for the Caregiver
It is important to set goals that are realistic, and then strive toward them.
Realize that you can't do everything, and recognize when you need help. Available support services may include counseling, a registered nurse, a speech therapist, and a physical therapist.
Be assertive when discussing your concerns with the individual you're caring for or with the healthcare team.

Take time for yourself, including time for rest, relaxation, hobbies, and friends.

Take part in support groups. Talking with others in similar situations may help you realize that you're not alone. Information on support groups can be obtained through the American Parkinson's Disease Association (800.223.2732) and National Parkinson Foundation (800.327.4545).
What is on the horizon?
Molecular science techniques, including gene therapy, stem cell technology, and stimulation of nerve growth factors, are the newest research areas being explored in the treatment of Parkinson's disease.
The National Institute of Neurological Disorders and Stroke is looking to establish effective therapies to slow the progression of Parkinson's disease. Research was conducted to see if Mirapex and Requip slow the progression of Parkinson's disease. The results showed that Requip minimally slowed down the progression of Parkinson's disease when it was compared to levodopa. Patients initially treated with Mirapex also demonstrated a reduction in dopamine neuron degeneration, compared with those initially treated with levodopa, during a 46-month period. More investigations however are needed for a definite conclusion.

Recent studies have also shown that Coenzyme Q10 may be effective in slowing the progression of the Parkinson's disease. This discovery has opened doors for researchers to further investigate the effectiveness of Coenzyme Q10.
References
American Parkinson's Disease association Home Page. http://www.apdaparkinson.org/user/AboutParkinson.asp. Accessed: March 2006.
The National Parkinson Foundation, Inc. Web site. Available at: http://www.parkinson.org/. Accessed: March 2006.
National Institute of Neurological Disorders and Stroke Web site. http://www.ninds.nih.gov/health_and_medical/disorders/parkinsons_disease.htm Accessed: March 2006.
Parkinson's Disease Foundation Web site. Available at: http://www.pdf.org/. Accessed: March 2006.
American Academy of Family Physicians Home Page. Parkinson's Disease. http://www.aafp.org/afp/990415ap/2155.html. Accessed: March 2006.
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Michael J. Fox Foundation Web site. Available at: http://www.michaeljfox.org/ Accessed: March 2006.
Young R. Update on Parkinson's Disease. American Family Physician Web site. Available at: http://www.aafp.org/afp. Accessed: March 2006.
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Olanow CW, Watts RL, Koller WC. Treatment guidelines: an algorithm for the management of Parkinson's disease.Neurology 2001; 56(Suppl 5):S1-S88.
Standaert DG, Young AB. Treatment of Parkinson’s Disease. Goodman and Gilman’s -The Pharmacological Basis of Therapeutics -11th ed. McGraw & Hill; 2006: pages 533-538.
Chen JJ, Shimomura SK. Parkinsonism. Textbook of Therapeutics-Drug and Disease Management-7th ed. Lippincott Williams & Wilkins; 2000: pages 1139-1152.
Ernst ME, Gottwald MD, et al. Parkinson’s Disease. Applied Therapeutics: The Clinical Use of Drugs-8th ed. Lippincott Williams & Wilkins; 2005: pages 53-1 to 53-28.
Parkinson’s Action Network. Available at: http://www.parkinsonaction.org/ Accessed: March 2006.
Parkinson's Disease Health Condition Last Updated: March 2006

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.
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