Parkinson's disease occurs when some of the nerve centers in the brain lose the ability to control muscle movements. As a result, you may have rigid muscles, tremors, and trouble walking and swallowing.
Parkinson's disease is one of the most common diseases affecting movement in people over age 55.
Parkinson's disease results when nerve cells in a certain part of the brain die or stop working properly. These nerve cells are in a small area called the substantia nigra, deep inside the lower part of the brain. They send nerve fibers upwards and outwards (fanning out like a large tree) to parts of the brain that control how you move, especially your voluntary movements--the ones you plan, like walking or reaching for things.
When you have Parkinson’s disease, the nerve cells in the substantia nigra stop making an important brain chemical called dopamine. Dopamine normally passes signals to the other parts of the brain that affect controlled muscle movement. Most dopamine signals slow down and smooth out the signals of other nerve cells. Losing dopamine in nerves is the root cause of the tremor at rest and the rigidity or frozenness of regular movements, like walking and turning around on your feet. The brain science is pretty complicated. For example, without enough dopamine, brain cells in a part of the brain called the globus pallidus fire out of control and you lose normal control of your movements. The increase in nerve signals from the globus pallidus goes to the part of the brain called the thalamus, and the increased signals turn down the nerves in the thalamus. The nerves in the thalamus normally help your brain plan and control movements. When the thalamus is turned down, you have trouble with voluntary movements and feel rigid or frozen.
No one knows why the nerve cells die or become impaired. Theories include:
The 4 main symptoms of Parkinson’s disease are:
A tremor is a rhythmic shaking that you cannot control. You may have tremors of the hands and sometimes the head as well as a constant rubbing together of thumb and forefinger (called a pill-rolling tremor). Tremors from Parkinson’s disease are more obvious when your arm and hand are resting, so they are called resting tremors. The tremors stop when you deliberately do something, such as move or change position. Other types of tremors not caused by Parkinson’s happen when you try to move your hand or arm, which is just the opposite of tremors from Parkinson’s disease.
In the earliest stages of the disease, symptoms may not be noticed or may be very slight. Someone close to you might notice a slight limp, stooped posture, or a mild hand tremor. Over time, you may stop making some movements that are normally automatic, such as the natural swinging of your arms when you walk. It may become harder to:
Other symptoms may include drooling and abdominal cramps. You may have trouble swallowing. In later stages, it often gets harder to think and remember.
Your healthcare provider will ask about your medical history and examine you. He or she will look for the physical signs of tremor, rigid muscles, and slow movements that suggest Parkinson's disease.
There are no tests that can confirm the diagnosis. However, tests may be done to rule out other diseases. Some other brain diseases also cause a break-down (degeneration) of parts of the brain. Severe depression can sometimes cause symptoms similar to Parkinson’s. In most cases you will have at least 1 brain imaging test, usually an MRI, to help rule out strokes or the general shrinkage of the brain that comes on with Alzheimer’s disease or a lifetime of alcoholism. However, if you have the typical symptoms of Parkinson’s disease–rigidity and tremor–without symptoms of other brain diseases, brain imaging may not be needed.
You may see a specialist called a neurologist to help with the diagnosis and treatment.
There is no cure yet for Parkinson's disease. However, medicines can help relieve a lot of the symptoms. The medicines help restore the balance of chemicals in your brain. Treatment may also include speech therapy and physical therapy. In severe cases not helped by medicine, surgery may help prevent the tremors.
In mild cases of Parkinson's disease, your healthcare provider may not prescribe medicine because the medicines used to treat Parkinson's disease cause side effects. Your provider will want to see you regularly to keep track of your symptoms and determine when it might be time to start taking medicine. The goal of treatment will be to keep your movements as normal as possible with the smallest amount of medicine. It may not be possible to get rid of all of your symptoms.
Several different drugs are used to treat Parkinson's disease. Levodopa is the main medicine used to treat the disease. The brain can make dopamine from levodopa. In pill form, levodopa is combined with carbidopa. Carbidopa protects levodopa from destruction in the gut while it is being absorbed. Possible side effects of levodopa are:
Ask your healthcare provider if you should eat less protein to help the levodopa work better.
Some of the other medicines your provider may prescribe are:
Almost everyone with Parkinson’s disease will take levodopa as the main drug for their symptoms. However, many other drugs also work, sometimes only on specific symptoms. You will need regular visits with a specialist or primary care doctor who has experience managing the symptoms of Parkinson’s disease.
Exercise and physical or occupational therapy
A program of daily exercise will help you have better use and control of your muscles. Exercise can help prevent problems that happen if you are not using your muscles. It will increase your muscle strength and improve coordination. You will have less muscle rigidity. Physical therapists can teach you how to walk and move in a way that will reduce your risk of falling. Occupational therapists help you learn to adapt to your symptoms. You can learn the right way to use a walker or tools to help fasten buttons and belts.
Two types of brain surgery can be helpful for people who have advanced Parkinson’s disease. One procedure destroys precise, small areas of the brain. The other implants an electrical probe or stimulator into other parts of the brain. Both surgeries require a surgeon to have strong skill and expertise in this type of surgery. There is a risk of brain damage or infection, so they are done only in hospitals with specially trained and experienced neurosurgeons.
Deep brain stimulation is more commonly done in the US than the other surgeries. The results are somewhat better, but DPS is more complicated to manage, more costly, and has a bit more risk of infection than the other surgeries. DBS is reversible—you can have an operation to remove the probe. Pallidotomy or thalamotomy are permanent surgeries. They cannot be reversed or undone.
You will have Parkinson’s disease for the rest of your life. With treatment many people with Parkinson’s disease stay in fairly good health for years. However, the disease does get worse even with treatment and can become disabling over time.
To cope with Parkinson's disease and to help relieve your symptoms
Parkinson's Disease Foundation
Web site: http://www.pdf.org
National Parkinson Foundation, Inc.
Web site: http://www.parkinson.org
Your healthcare provider will want to check on how well your treatment is working. Keep your follow-up appointments on the schedule your provider recommends. Discuss any questions and concerns you have at these visits.
Call your healthcare provider if:
There is no known way to prevent Parkinson’s disease. Many drugs and supplements have been studied, but no treatment has shown consistent helpful effects.