Parkinson's Disease and Other Movement Disorders

What is Parkinson’s disease?

Parkinson’s disease is a common, slowly progressive, neurodegenerative disease. It results from the degeneration of neurons in the substantia nigra, a region of the brain that controls movement. This degeneration results in a shortage of a neurotransmitter called dopamine, therefore, causing impaired movement.

What are the Symptoms of Parkinson's Disease?

Common Early Symptoms of Parkinson's disease 

1. Tiredness

2. Difficulty standing from a sitting position

3. The shakiness of hands initially at resting state (asymmetric to start)

4. Changes in speech

5. Handwriting that looks cramped or "spidery"

6. Losing track of words or thoughts

7. Irritability and depression

8. Lack of facial expression and animation

9. Slow movements of limbs and slowness of gait

10. Inability to move

11. Rigid limbs

12. Shuffling gait

13. Stooped posture

Major symptoms

There are four symptoms that the majority of Parkinson’s disease patients experience.

1. Rigidity: stiffness when an arm, leg, or neck is moved. The muscles remain constantly tensed and contracted, so the person feels stiff and/or weak.

2. Resting tremor: a tremor that occurs when the person is at rest. 

3. Bradykinesia: slowness in initiating movement.

4. Loss of postural reflexes or postural instability: resulting in poor balance and coordination. Patients sometimes develop a forward or backward lean and fall easily.

What Causes of Parkinson's disease?

Parkinson’s disease is associated with a gradual loss of cells in the substantia nigra, which produces dopamine.

The exact cause for the loss of cells is unknown. Possible causes currently being researched are:

1. Free radicals are unstable molecules produced during normal chemical reactions in the body. 

2. Environmental toxins: This has been seen in people who took an illegal drug contaminated with a chemical called, MPTP. 

3. Accelerated aging: As a person ages, there is a normal wearing away of dopamine producing neurons, which leads to the premature loss of dopamine.

4. Genetics-15-20% of Parkinson’s disease patients have a close relative who has also experienced parkinsonian symptoms. This leads us to believe that there may be a genetic component involved in Parkinson's disease. Studies with Parkinson’s disease twins and families have shown a multifactorial pattern of inheritance. 

How is Parkinson's Disease Diagnosed?

A neurologist usually diagnoses Parkinson’s disease. Anti-Parkinson’s drugs are prescribed to confirm the diagnosis. If the patient responds to these drugs, a diagnosis of Parkinson’s can be made. 

How is Parkinson's Disease Treated?

The treatment is symptoms specific. A comprehensive approach, including early diagnosis, exercise, good nutrition, and medications, is thought to work best in relieving symptoms. Also, some may opt for surgical intervention. 

Medications

Medications are used to relieve the symptoms of Parkinson’s disease. The type and dosage of each medication are tailored to each person’s individual needs.

1. Levodopa (L-dopa). 
2. Bromocriptine, pergolide, pramipexole, and ropinirole. 
3. Selegiline (deprenyl). 
4. Anticholinergic. 
5. Amantadine.

Diet and Exercise

If a person is taking L-dopa, their doctor may recommend adjusting the amount of protein in their diet, since protein may interfere with the absorption of the drug. Swimming, walking, physical therapy, and muscle strength exercises help to maintain muscle tone and strength and improve mobility. Full range of motion exercises improve balance, walking, and strength.

Surgery

Surgery is performed only in cases where drugs lead to abnormal movements known as dyskinesia or are not effective in controlling seizures. The surgery performed are:

1. Cryothalamotomy, Pallidotomy: 
2. Deep brain stimulation (DBS)

What is DBS?

DBS uses advanced computer technology to pinpoint areas of the patient’s brain where faulty electrical signals are triggering symptoms. Guided by this information, a neurosurgeon and neurologists make a small opening in the skull and implants electrodes in targeted areas of the brain like STN. In properly selected cases DBS is very effective in improving the quality of life of a patient, improvement of rigidity, tremors, and bradikinesia as well as reducing the dosage of medications.

Other movement disorders

Any patient experiencing a lack of movement or too much movement most likely has some form of movement disorder. Other disorders include:

DYSTONIA

1. Involuntary, irregular static, very slow, torsion or twisting movements involving the neck, trunk, or proximal muscles of the extremities

2. Restless legs syndrome is perhaps the most common movement disorder, experienced by up to 10 percent of the general population. Symptoms include cramping or other sensory discomforts in the legs at night. The condition is relieved by walking but returns when the patient goes back to bed.

3. Huntington’s disease is a progressive, hereditary neurological disorder characterized by various degrees of chorea (involuntary twitches, clumsiness, jerking, twisting, or dance-like movements) and other involuntary movements. Patients also can experience behavioral and mental problems.
4. Tourette syndrome is an involuntary disorder often seen in younger patients, with symptoms that include an increasing urge to yell, twitch or move repeatedly, commonly accompanied by obsessive-compulsive behaviors. 

MAX HOSPITAL SAKET, NEW DELHI -  We have the best facilities available for managing these cases. We have regular “MOVEMENT DISORDER CLINIC” for comprehensive care for these patients.  

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