(PD, is also
known as idiopathic or primary parkinsonism,
hypokinetic rigid syndrome
/HRS, or paralysis agitans) is a brain disorder and a
progressive disease that leads to persistent movement disorder and worsens over
time. It is caused by the loss of dopamine brain cells (neurons). The patient
usually experiences uncontrollable shaking and tremors, slow movement, problems
in standing up, difficulty in balancing and stiffness in the limbs. It mostly
affects the middle-aged and elderly. Idiopathic Parkinsonís disease is the most
common type and causes tremors, rigidity and slowness of movement. Although
there is no permanent cure, medication and surgery are both available to manage
its symptoms. Dr Richard Wade-Martins, University of Oxford is conducting a
research on ĎTRAPing Parkinsonís Ė why do some cells die?í and he aims to find
out why some cells die while others live.
Causes of Parkinsonís Disease
is a slowly progressive disease caused by the loss of dopamine brain cells
(neurons). Dopamine, are brain cells produced in the substantia nigra of the
brain. It is a neurotransmitter and a chemical messenger. Messages are
transmitted between the substantia nigra and other parts of the body by
dopamine. Dopamine brain cell death causes lesser dopamine. This causes
impairment of movement in body parts.
Symptoms and Signs of Parkinsonís disease
The symptoms of
Parkinsonís disease begins when about 50 to 80 percent of dopamine neurons have
died and it is hard for doctors to detect PD at its early stages. However,
about 70 per cent of people with the disease experience slight tremors in the
hand and the foot over one side of the body. The symptoms are branched out to ĎPrimary
and ĎSecondary Motor Symptomsí
Motor Symptoms are as described here:
Here is a
list of Secondary Motor Symptoms:
- ďResting tremorĒ is usually experienced and
happens when a personís muscles are completely relaxed. Typically, tremors
on one finger are prominent.
- ďSlow movementĒ also known as bradykinesia or movement disorder is another
symptom that results in abnormal stiffness and decreases facial
expression. A personís repetitive movements and routine functions are also
often affected. This condition of slow movement may often lead to reduced
- ďRigidityĒ is yet another condition resulting in stiffness
and the muscles do not relax like in a normal person. The person
experiences rigidity in the neck, shoulder and legs.
- ďPostural instabilityĒ is the most important sign of a PD patient.
The person with this condition loses some reflexes essential for
maintaining an upright posture. Patients with balance problem may have
difficulty when turning around or pivoting or during quick movements.
- Freezing causes fear to put the foot forward. The person
feels that their feet are stuck to the ground. However it is a temporary
- Micrographia is the result of a Parkinsonís patient whose
handwriting shrinks. Mask-like Expression happens due to decreased and
unconscious facial movements. A PD patient exhibits flexed posture
resulting from rigidity and bradykinesia.
accelerations occur in PD patients and cause trouble in speech and movement. People who experience festination face
greater risks to falls.
Parkinsonís DiseaseStage I:
This is the mildest stage of PD which least interferes with routine tasks.
Tremors and other symptoms are restricted to one side of the body.
It is a moderate stage in PD where stiffness, tremors and trembling can be
noted and facial expressions may change. The symptoms are sensed on both sides
of the body.
This is the mid-stage in PD, which symbolizes a major change point in PD
progression. In addition to loss of balance and decreased flexes, the symptoms
mentioned in stage II also occur. Occupational therapy combined with medication
may help in decreasing the symptoms.
this progressive stage, it becomes difficult for the patient to move without a
walker or other assistive device. However, the person can stand without
is the most advanced and debilitating stage of PD. Stiffness in legs may cause
freezing when standing. Patients are frequently unable to stand without
falling. They may experience hallucinations and occasional delusions.
In order to
diagnose Parkinsonís disease, the physician takes a neurological history and
executes an examination. Clinical information provided by the PD person and
findings from neurological examination plays a key role in the diagnosis, as there
are no standard diagnostic tests available. The observations carried out
- The doctor examines the PD patientís expression
- The patientís arms are observed for any tremors that
may occur at rest or when extended
- Stiffness in limbs or neck are observed
- It is checked if the patient can rise from a chair
- The patientís pattern of walking is observed; the
patient may be walking in short steps.
- It is examined if the patientís arms swing
- Also, the patientís quickness in regaining balance is
Over the years,
it has been concluded that most PD patients respond to medications. However,
the duration of drug efficiency varies from one person to another. Movement disorder
and also non-motor symptoms vary from person to
person. These affect PD patients at all stages of the disease. For some PD
patients, fatigue or depression may be more complicated to deal with than
In order to
manage the symptoms of PD, it is common for PD patients to take an assortment
of medications at different times and in different doses. A proper medication
schedule provides great benefits to the patient. Certain classes of medication
are available to treat PD. However, the exact condition of the patient and
symptoms are diagnosed before prescribing the right combinations of medication
Some of the Medications
are mentioned below:
- Carbidopa/ Levodopa Therapy
- Dopamine Agonists
- MAO-B Inhibitors
- COMT Inhibitors
- Rivastigmine tartrate