A B C D E F G H I J K L M N O P R S T U V W

PARKINSON'S DISEASE

What is Parkinson's Disease ?

Parkinson’s disease is one of the most common neurodegenerative diseases affecting up to 2% of the elderly population. Patients or their relatives become gradually aware of stiffness and difficulty moving, often with a shaking movement (tremor) at rest. The disease often starts on one side, usually affecting the use of the hand, with tremor and difficulty with everyday activities. A stooping or shuffling walk may also be noticed. Activities such as shaving or dressing seem to take much longer. There may be loss of expression in the face, softness of the voice which may seem monotonous, and progressive shrinkage of the handwriting. People seem to sit very still. Other complaints include drooling of saliva, depression and constipation. Some other degenerative diseases have some features in common with Parkinson's disease. They can be grouped together as Parkinsonism or Parkinsonian disorders.

How does Parkinson's Disease occur ?

It results from gradual loss of specialised cells in a tiny area of the brain. These cells produce a chemical message (dopamine), which is needed for smooth and flexible movements to be made. In the common form of Parkinson's disease, no cause is found. Rarely, it occurs as a hereditary condition and some cases follow a brain infection. A similar disorder can be caused by certain drugs, (usually given for psychological illness).

Why does Parkinson's Disease occur ?

Apart from the causes mentioned above, it is not known why Parkinson's disease develops. In a few cases there may be a family history of the disease. It is rare in smokers.

Treatment Involved for Parkinson's Disease

The condition is usually diagnosed on the basis of the symptoms and an examination. Tests are not often helpful. There is unfortunately no treatment that has been shown to prevent the progression of the disease. Therefore treatment does not have to be started at an early stage. When the symptoms are mild the doctor will usually just explain what is wrong and encourage the patient to remain active in the knowledge that treatment can be started when activities become restricted. Physiotherapy can be useful. Drug treatments work by replacing the dopamine which the patient lacks. Other drugs interfere with the processes which destroy dopamine in the body. Some other drugs help with the tremor or treat symptoms such as constipation and depression. Levodopa, (L-Dopa) is combined with an antidote to its unwanted effects as co-careldopa (Sinemet) or co-beneldopa (Madopar). These have to be taken several times a day. After some years, the benefit may be marred by fluctuations of the effect and by side effects. As an alternative, dopamine agonists can be used alongside L-Dopa. Inhibitors of the breakdown of dopamine are taken with each dose, (Entacapone) or once daily (Selegeline). In severe cases, surgery to destroy a tiny area of the brain or to implant an electronic stimulator in the brain has been moderately successful. Physiotherapists, occupational therapists speech and language therapists and social workers can all help over the course of the illness. A proportion of patients develop memory problems and confusion, often heralded by hallucinations.

During Treatment for Parkinson's Disease

Side effects of drugs are common but can often be dealt with by altering the dose or type of drug: treatment can usually continue. Most dopamine replacement treatments can produce nausea, involuntary movements and confusion.

After Treatment for Parkinson's Disease

Once treatment is started it is usually maintained indefinitely but modifications may be needed to cope with side effects or as new treatments become available. The illness often seems to be stabilised during the first few years of treatment but the benefits may then not be sustained throughout the day and patients complain of unpredictable "on" and "off" periods. When they are "on" they can move easily perhaps with some involuntary fidgeting movements, but when they are "off" they are often stuck in a chair or stay rooted to the spot.

If Parkinson's Disease is Left Untreated

Before treatment became available patients would very slowly deteriorate, finding it increasingly difficult to move until they would eventually become bedridden. Life expectancy used to be reduced but with modern treatment it is near normal.

Effects on Family of Parkinson's Disease

It is important for family and friends to realise that in most cases memory function and personality should not be significantly impaired. The patient needs a little more time to join in with conversation and may respond well to physical activities and social events. As the patient gets older and the illness progresses more help at home may be required and the principal carer may need periods of respite.