Parkinson's disease
In Nagpur, Parkinson’s disease is a progressive nervous system disorder that gradually affects various body functions. It begins very mildly in one limb, often a slight tremor of the hand. However, stiffness and slow movement are much more common than tremors.
Early stages include limited facial expression, less arm swing during walking, and softer or slurred speech. Symptoms progress with the progression of the disease. Since Parkinson’s disease has no cure, the symptoms are manageable through medication. Surgery is sometimes considered for specific regions of the brain to alleviate some symptoms.
Parkinson's symptoms
- Tremor: This rhythmic shaking often begins in a limb, such as your hand or fingers, and can occasionally resemble a pill-rolling motion. The tremor may be induced by resting your hand and may ease during activity.
- Slowed movement (bradykinesia): Movements may slow down as Parkinson’s progresses, and tasks become increasingly difficult. Examples include walking with shorter steps, it may be difficult to get up from a chair, and walking may become shuffling or dragging.
- Stiffness: This can occur in any part of the body, and the patient may complain of stiffness leading to pain as well as restriction of movements.
- Poor posturing and balance: Posturings and balance problems can occur, thereby increasing the risk of falling.
- Loss of automatic movements: Automatic movements such as blinking of eyelids, smiling, swinging arms while walking become less.
- Change in speech: speech is softer, faster, slurred, and hesitant, often with a monotonous tone.
- Tremor: This repetitive movement often starts in a limb, such as your hand or fingers, sometimes described as pill-rolling in nature. Resting in your hand may provoke the tremor, which may improve with activity.
- Slowed movement (bradykinesia): The longer Parkinson’s disease is present, the slower movements become and the more difficult tasks are to accomplish. Walking may become more of a shuffle or drag, rising from a chair difficult, or standing up from a lying position.
- Muscle stiffness: It develops, even in various parts of the body, with aching and restrictive movement.
- Posture and balance disturbances: A stooping posture and poor balance make falls likely.
- Reduced automatic movements: Blinking, smiling, and swinging arms while walking are reduced suddenly in an uncontrolled manner.
- Speech disturbance: Speech is softer, faster, slurred, and hesitant and often monotonous.
- Handwriting changes: The writing may also get progressively difficult, with much smaller and hardly readable handwriting.
- Writing Changes: becomes inconvenient, with little and hard-to-read handwriting.
Treatments
The disease is irreversible, but the symptoms can be well managed with medications. More advanced stages require surgical intervention. Lifestyle modification in the form of regular aerobic exercise is also encouraged.
Physical therapy would involve exercises for balance improvement and stretching, besides which speech therapy can also be taken. Medications in Parkinson’s are mainly used to enhance the gait and mobility while keeping the tremors under control. This is achieved by maintaining dopamine levels within the brain. The most commonly prescribed drugs include:
Carbidopa-levodopa: Converts to dopamine within the brain, usually an effective drug for control of symptoms. May cause nausea and light-headedness.
Dopamine agonists: Mimic dopamine effects but may cause hallucinations and compulsions.
MAO B inhibitors: Prevents dopamine breakdown in the brain. Usually used along with levodopa because they greatly reduce the fluctuation of symptoms.
COMT inhibitors: Extend the effect of levodopa by preventing dopamine breakdown. May cause diarrhea or dyskinesias.
Anticholinergics: Tremor control is possible, but memory may be impaired, and the mouth may become dry.
Amantadine: May temporarily improve Parkinson’s in the early stages of the disease or can be used to treat involuntary movements in advanced stages.
Other medications such as adenosine receptor antagonists and Nuplazid may be prescribed for specific symptoms like hallucinations.
Talk with your health care provider about medication management and other possible side effects.
Causes and Risk Factors:
The exact cause of a Parkinson’s disease is not fully understood, but the several factors may contribute to its development:
- Genetic Factors: A small percentage of cases are linked to genetic mutations, particularly in younger individuals with early-onset Parkinson’s.
- Environmental Factors: Exposure to certain toxins (like pesticides) or chemicals may increase risk.
- Age: The risk of developing Parkinson’s increases with age, with most cases occurring in people over 60.
- Family History: Having a close relative with the Parkinson’s increases the risk.
Diagnosis of Parkinson’s Disease:
Diagnosing Parkinson’s disease primarily involves clinical evaluation, as there is no definitive test for a condition. The diagnosis typically includes:
- Medical History: Reviewing symptoms, family history, and any relevant medical history.
- Physical Examination: Assessing motor symptoms, rigidity, bradykinesia, and balance.
- Neurological Examination: Evaluating reflexes, muscle strength, or a coordination.
- Response to Medication: Improvement of symptoms with dopaminergic medications (like levodopa) may support the diagnosis.
Treatment Options:
While there is no cure for Parkinson’s disease, various treatments can help manage symptoms or improve quality of life:
- Medications:
Levodopa/Carbidopa: The most effective treatment, levodopa is converted to dopamine in the brain. Carbidopa helps prevent its conversion before reaching the brain.
Dopamine Agonists: Medications like pramipexole and ropinirole mimic dopamine’s effects and can be used alone or in combination with levodopa.
MAO-B Inhibitors: These medications (e.g., selegiline, rasagiline) help inhibit the breakdown of dopamine.
COMT Inhibitors: Medications like entacapone are used to prolong the effect of levodopa. - Surgical Options:
Deep Brain Stimulation (DBS): A surgical procedure involving the implantation of electrodes in specific brain areas to help manage symptoms, particularly tremors and rigidity. - Physical and Occupational Therapy:
Physical Therapy: Helps improve mobility, flexibility, and balance through targeted exercises.
Occupational Therapy: Focuses on a adapting daily activities or environments to enhance independence. - Speech Therapy:
Addresses speech and swallowing difficulties that may arise due to muscle rigidity and coordination issues. - Lifestyle Modifications:
Regular exercise, a balanced diet, and social engagement can improve overall well-being.
Prevention
Since the cause of Parkinson’s is yet to be known, there is no proven way to prevent the disease. Some studies may however suggest reducing one’s risk for developing Parkinson’s through a few means:
Aerobic exercise may reduce the incidence of Parkinson’s:.
Some research indicates that persons who consume beverages with caffeine, such as coffee, tea, and cola, might have a reduced risk of developing Parkinson’s disease, compared with those not consuming these beverages. The drinking of green tea has also been observed to be associated with a reduced risk for Parkinson’s. It is not known whether caffeine itself provides some protection against Parkinson’s or if the relationship is based on another mechanism. There is currently insufficient evidence from human studies to conclude that consumption of beverages with caffeine reduces the risk for Parkinson’s.
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