Parkinson’s Disease Treatment

What is Parkinson’s Disease?

Parkinson’s disease is a degenerative neurologic condition that typically causes progressive tremor, slowed movement, muscle stiffness, and trouble walking. Eventually, individuals may develop behavioral changes.  Most people develop symptoms during middle age (around age 56).

The condition usually starts with shaking or tremor in one arm.  Over time, patients may become physically disabled without the ability to perform daily activities.  In fact, Parkinson’s disease is a relatively common cause of falls in the elderly.

Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Parkinson’s Disease?

Parkinson’s disease is caused by the degeneration of nerve cells in a specific region of the brainstem called the substantia nigra.  This part of the brain is responsible for the generation of dopamine, which is an important molecule when it comes to the smooth pursuit of movement.

The most common form of Parkinson’s disease is called sporadic Parkinson’s disease – this accounts for about 90% of cases.  Sporadic Parkinson’s disease is related to certain genetic abnormalities. Family members of people with Parkinson’s disease have a higher likelihood of developing the disease.

In some cases, people may develop features of Parkinson’s disease such as tremor, slow movement, and muscle stiffness due to another condition such as:

  • Stroke
  • Traumatic brain injury
  • Medication use – Antipsychotics

The most commonly prescribed drugs associated with Parkinson’s features include the long-term use of Haldol – haloperidol, Risperdal - risperidone), or certain nausea medications (Reglan - metoclopramide).  These medications are less likely to cause symptoms if used at low doses and for a short period of time.

How common is Parkinson’s Disease?

Parkinson’s disease affects approximately 0.1-0.5% of Americans.  About 1 million people in the United States have this condition.  It typically affects people around age 56, and is rare before age 30.  This condition frequently requires referral to a Neurology specialist.

What are the symptoms and signs of Parkinson’s Disease?

The most common features of Parkinson’s disease include:

  • Tremor
  • Slow movement (bradykinesia)
  • Muscle stiffness (rigidity)
  • Instability

These symptoms slowly progress over time.  Patients may have difficulty performing tasks such as brushing, feeding, bathing, and clothing.  They may eventually not be able to take care of their daily activities as a result of reduced mobility and function.  Over time, patients can develop personality changes and memory loss.  The most common cause of death in patients with Parkinson’s disease is pneumonia, a type of bacterial lung infection.

Your doctor will often evaluate for certain findings on your physical examination such as how quick you can move.  They will also usually test for muscle rigidity, muscle strength, sensation, and reflexes.  They may have you stand with your eyes closed to check your balance.

A very common feature is shaking of the hand or upper limb at rest.  This shaking or tremor usually improves with purposeful movements such as grabbing objects.  It can involve other parts of the body such as the head and even voice.

Your doctor may also test your memory by asking your name, date, where you are, and who the current president is.  Sometimes they will perform a detailed memory test where you are asked to remember certain words and repeat them, as well as copy various figures using a pen or pencil.  They may even ask you to draw a clock.

How is Parkinson’s Disease diagnosed?

Parkinson’s disease is diagnosed based on symptoms, family history, and physical examination findings.  Your doctor will usually obtain an MRI of your brain to evaluate for other conditions that could be responsible for your symptoms such as brain tumor or stroke.  There are newer imaging techniques being performed such as the DaTSCAN, which specifically evaluates for the amount of dopamine in the substantia nigra – the abnormal brain region in Parkinson’s disease. The only way doctors know you have Parkinson’s disease for certain is if they perform brain autopsy after death.

Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), vitamin B12 level, and thyroid hormones.  They will also usually check your cholesterol levels and screen for diabetes.

How is Parkinson’s Disease treated?

If features of Parkinson’s disease occur as a result of medication use such as antipsychotics (e.g. Haldol, Risperdal, Reglan), these medications are typically discontinued if possible.

The goals of Parkinson’s disease therapy are to increase the patient’s ability to move and socially function – this includes reducing the risk for falls.  The most commonly prescribed drugs used to treat sporadic Parkinson’s disease include:

  • Sinemet (levodopa/carbidopa)
  • Parlodel (bromocriptine)
  • Prascend (pergolide)
  • Mirapex (pramipexole)
  • Requip (ropinirol)
  • Comtan (entacopone)
  • Tasmar (tolcapone)

These drugs generally work by increasing dopamine levels or activating dopamine receptors in the brain – remember the loss of dopamine in the brain is the cause of Parkinson’s disease.

Parkinson's Disease Patient Summary:

  • Parkinson’s disease is a progressive neurologic disease characterized by tremor, slow movement, stiff muscles, and instability.
  • This disease is a relatively common cause of falls in the elderly.
  • It typically affects individuals around age 50 and often starts with a tremor in the upper limb at rest – the tremor usually improves with purposeful hand movements.
  • As the disease progresses, patients can lose the ability to move and perform daily activities – most patients die of pneumonia.
  • Risk factors for Parkinson’s disease include genetics (family history), stroke, head injury, and long-term use of certain medications such as antipsychotics (Haldol) or anti-nausea drugs (Reglan).
  • The diagnosis is usually made by obtaining detailed family history information and assessing for certain symptoms and physical examination findings.
  • Lab tests and brain MRI are typically used to exclude other diseases – your doctor may recommend ordering a test called the DaTSCAN.
  • Treatment of Parkinson’s disease typically consists of one or more medications that increase the amount of dopamine in the brain or activating dopamine receptors in the brain.
  • These medications frequently include Sinemet (levodopa/carbidopa), Parlodel (bromocriptine), Prascend (pergolide), Mirapex (pramepexole), Requip (ropinirol), Comtan (entacopone), and Tasmar (tolcapone).

References:

  1. Gazewood JD, Richards DR, Clebak K. Parkinson’s disease: an update. Am Fam Physician. 2013 Feb 15;87(4):267-73.
  2. Beitz JM. Parkinson’s's disease: a review. Front Biosci (Schol Ed). 2014 Jan 1;6:65-74.

 

 

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.