Parkinson's disease is a degenerative disease of a
part of the brain called the substantia nigra. In patients
with Parkinson's disease, this part of the brain (that
normally helps control motion) slowly stops working.
Parkinson's disease generally affects people who are elderly,
but on occasion Parkinson's disease occurs in people in their
40s. Importantly, Parkinson's disease is not inherited.
What are the symptoms of Parkinson's
disease?
Parkinson's disease has several
classic symptoms including tremor, stiffness of the limbs,
mask-like face, gait disturbance (difficulty walking), and
dementia.
A resting tremor: especially of the hands and
fingers. This is described as a "pill rolling" tremor. The
name is derived from the similarity of the tremor's movement
to that required to "roll a pill" in early pharmacies. In the
early stages of the disease, the tremor stops when the person
does something active, such as opening a door.
Stiffness of the limbs and difficulty initiating (starting) movements: In the early stages of the disease,
this may show up as trouble running, etc. As the disease
worsens, the patient may have a difficult time initiating
activities such as walking or dressing.
Mask-like face: Along with a limited capacity in
moving the extremities, a patient with Parkinson's disease
also experiences a decreased ability in moving the muscles of
the face. The facial expression tends to be unchanging as a
result, and, therefore, "mask like."
Gait disturbance: Another manifestation of
Parkinson's disease is difficulty stopping an action once it
has been initiated. For instance, patients may have trouble
stopping once they do start walking. This is medically
referred to as a "festinating" gait. Affected individuals may
go faster and faster until they fall or hit some object in
their path.
Dementia (memory loss) and depression: One in five
individuals with Parkinson's disease develops memory loss and
up to 50% of patients are affected by depression.
Additionally, some people with Parkinson's disease may have
hallucinations (seeing and hearing things that are not real).
Other symptoms which can occur with Parkinson's
disease are decreased blinking, stooped posture, and increased
saliva production.
How fast does Parkinson's disease
worsen?
The course of Parkinson's disease
varies from patient to patient. It varies from slowly
progressive over many years to rapidly progressive within many months.
What other conditions can be similar
to Parkinson's disease?
A number of
medications including those used for nausea (especially
metoclopramide (Reglan) and for psychiatric problems, such as
schizophrenia (for example Haldol and Mellaril), can cause
Parkinson's-like symptoms. Carbon monoxide, cyanide, and
manganese poisoning, as well as other neurologic illnesses
(brain diseases) can also result in a Parkinson's-like
condition.
Finally, some families have an inherited tremor that can be
mistaken for Parkinson's disease. However, this "benign
essential tremor" may respond to alcohol (in small amounts!)
and is not present at rest. This is the opposite of
Parkinson's disease where the tremor is present at rest.
Is there any treatment for Parkinson's
disease?
Yes. There are a number of
medications that can be used to help control the symptoms of
Parkinson's disease such as the tremor and stiffness. However,
no medications have yet been developed that stop the
progression of Parkinson's disease.
Medications used to help control the symptoms of
Parkinson's disease include selegiline, artane, cogentin,
amantadine, and carbidopa/levodopa. Selegiline (Eldepryl) is
thought to protect the area of the brain that stops working in
Parkinson's disease and thus slow the course of the illness.
However, there is no benefit after 4 years of therapy and
there are multiple side effects. In fact, even though it may
help Parkinson's disease, selegiline may actually increase the
death rate in those patient's treated with it. Artane and
cogentin are examples of anticholinergic medications which are
similar to diphenhydramine (Benadryl). These drugs can be used
to treat the tremor. However, they may cause constipation,
blurred vision, and confusion, however. Amantadine can be used
to control tremor and trouble initiating activities.
Carbidopa/Levodopa (Sinemet), a combination of two drugs, is
currently the mainstay of therapy for Parkinson's disease.
This combination can help control tremor and slowing and is
effective long term. Side effects including hallucinations and
confusion.
Non-medical treatments, such as structuring the environment
to minimize confusion and injuries, family support groups,
etc. are also very important in helping patients with
Parkinson's disease function.
Surgical treatments for Parkinson's disease include
operations to repair the affected areas of the brain or
transplant tissues to the brain that send hormones to these
areas. These procedures have been tried with some success.
However, none has been shown to be routinely effective.
Parkinson's Disease At A Glance
- Parkinson's disease is degenerative (progressive) disease of the part of the brain that controls movement.
- Parkinson's disease is found mostly in elderly people, but may occur in people as young as 40 years of age.
- The signs of Parkinson's disease include tremor (shakiness), stiffness, stooped posture, and trouble starting movements.
- While there are no medications that can stop Parkinson's disease from progressing, many good medical therapies are available for its symptoms.
© 1996-2001 MedicineNet, Inc.
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