Parkinson’s Disease – 1
Dr. Ravindra Patil
on
April 11, 2022
Parkinson’s Disease – 1
Overview
Parkinson’s is a progressive nervous system disease that affects movement, expression, speed and so on. Symptoms start gradually and slowly increase.
Although Parkinson’s disease can’t be cured, medications greatly help improve symptoms. Rarely, surgery may help reduce symptoms.
Parkinson’s disease is named after the English physician James Parkinson, who in 1817 published a comprehensive description of a disease called the Shaking Palsy or Paralysis Agitans.
Table of Contents
Symptoms
- Tremor or shaking begins in a limb, hand or fingers, even at rest. You may rub your thumb and forefinger back and forth, known as a pill-rolling tremor.
- Movements are slowed. This makes simple tasks difficult. Steps may become shorter while walking. Difficult in getting out of a chair. Patient’s feet may drag.
- Rigid muscles, they can be painful. Range of motion is limited.
- Impaired posture and balance. Posture may be stooped, may have balance problems.
- Loss of automatic movements like blinking, smiling or swinging arms while walking.
- Patients speak softly, monotonously, quickly, slur or hesitate before talking.
- It becomes hard to write.
Stages of Parkinson’s Disease
- Symptoms are mild, do not interfere with life.
- Daily activities are difficult and take more time.
- The patient loses balance, moves slowly, and falls often. Daily activities like dressing, eating, and brushing teeth are impaired.
- The patient needs assistance while walking and for daily activities.
- The patient is unable to walk and needs full-time assistance for living.
When to see a doctor
If you are above 60, see your doctor if you have any of the above symptoms, see a doctor.
Causes of Parkinson’s Disease
Certain neurons [nerve cells] in the brain break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to impaired movement and other symptoms of Parkinson’s disease.
The cause of Parkinson’s disease is unknown, but several factors play a role.
- Specific genetic mutations can cause Parkinson’s disease.
- Exposure to certain toxins may increase the risk of Parkinson’s disease.
- The presence of Lewy bodies holds an important clue to the cause of Parkinson’s disease.
Risk factors
- Risk increases with age. Most people are affected at 60 years or older.
- A close relative with Parkinson’s disease increases the chances that you’ll develop the disease.
- Sex: Men are more likely to develop Parkinson’s disease than women.
- Exposure to toxins.
- When compared to Parkinson’s disease(PD)-free individuals with no seizure-provoking conditions, those with concomitant neurological illnesses had the highest risk of epileptic seizures.
Complications
There are many complications, but they may be treatable:
- Thinking difficulties, dementia
- Depression and emotional changes.
- Emotional changes: fear, anxiety, or loss of motivation.
- Chewing and eating problems, choking, and poor nutrition.
- Swallowing problems, drooling.
- Sleep problems, falling asleep during the day.
- Inability to control urine, difficulty in urinating.
- Constipation, is due to a slower digestive tract.
- Orthostatic hypotension: feeling dizzy or lightheaded when patients stand up due to a sudden drop in blood pressure.
- Problems with your sense of smell.
- Fatigue, especially later in the day.
- Pain in anywhere.
- Decrease in sexual desire or performance.
Prevention
As the cause of Parkinson’s is unknown, ways to prevent the disease also remain a mystery.
Regular aerobic exercise might reduce the risk of Parkinson’s disease.
People who consume caffeine in coffee, tea, green tea, and cola have a reduced risk of Parkinson’s disease.
Diagnosis
No specific test exists to diagnose Parkinson’s disease. Brain specialists [neurologists, neurosurgeons] diagnose Parkinson’s disease based on the patient’s medical history, a review of signs and symptoms, and a neurological and physical examination.
Lab tests are done to rule out other conditions that have similar symptoms to Parkinson’s.
Special scans like SPECT or a dopamine transporter scan [DaTscan] tests can help. Other scans such as MRI, ultrasound of the brain, and PET scans may be used to help rule out other disorders. However, imaging tests aren’t particularly helpful for diagnosing Parkinson’s disease.
In addition to testing, Parkinson’s disease medications are given in a sufficient dose and if the patient benefits, the diagnosis of Parkinson’s can be confirmed.
Sometimes it takes time to diagnose Parkinson’s disease. Doctors may recommend regular follow-up appointments with neurologists to evaluate the patient’s condition and symptoms over time and diagnose Parkinson’s disease.
Treatment
Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some more advanced cases, surgery may be advised.
The doctor may also recommend lifestyle changes, especially aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is also useful and important. Speech and language therapists may help improve speech problems.
Medications
Medications may help you manage problems with walking, movement, and tremor. These medications increase or are a substitute for dopamine.
People with Parkinson’s disease have low brain dopamine concentrations. However, dopamine can’t be given directly as a medicine, as it can’t enter the brain. Hence medicines that enter the brain and increase dopamine or are dopamine replacements are given.
Significant improvements in symptoms occur after beginning Parkinson’s disease treatment. However, over time, the benefits of drugs gradually diminish or become less consistent. Yet usually symptoms are controlled fairly well.
Some of the Parkinson’s Medicines
Carbidopa-levodopa. Levodopa, the most effective Parkinson’s disease medication, is a natural https://popcake.com.ua chemical that passes into your brain and is converted to dopamine.
Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside your brain. This prevents or lessens side effects such as nausea.
Side effects may include nausea or light-headedness (orthostatic hypotension).
After many years, as the disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane.
Involuntary movements (dyskinesia) may occur after taking higher doses of levodopa. Hence doctors lessen the dose of medicines to control these side effects.
Inhaled carbidopa-levodopa is also used. It may be helpful in managing symptoms that arise when oral medications suddenly stop working during the day.
Carbidopa-levodopa infusion is made up of carbidopa and levodopa. However, it’s administered through a feeding tube that delivers the medication in a gel form directly to the small intestine. It is for patients with advanced Parkinson’s who still respond to carbidopa-levodopa, but who have a lot of fluctuations in their response. As this combination is infused slowly and continually infused, blood levels of the two drugs are fairly steady.
The tubes delivering the drugs are placed via a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.
Instead of Dopamine, drugs very similar to Dopamine, called Dopamine agonists are used. Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in the human brain. They aren’t as effective as levodopa in treating symptoms. However, they last longer and may be used with levodopa to smooth the sometimes “ups and downs” effect of levodopa.
Dopamine agonists include pramipexole, ropinirole and rotigotine patch. Apomorphine is a short-acting injectable dopamine agonist used for quick relief.
Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa. They can include hallucinations, sleepiness and compulsive behaviours such as hypersexuality, gambling and eating. So patients on these medications must be observed if they are behaving out of character for you, and the treating doctor must be informed.
MAO B inhibitors like include selegiline, rasagiline, and safinamide are useful. They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Selegiline given along with levodopa may help prevent wearing-off of levodopa.
Side effects of MAO B inhibitors may include headaches, nausea or insomnia. When added to carbidopa-levodopa, these medications increase the risk of hallucinations.
Catechol O-methyltransferase (COMT) inhibitors. Examples are Entacapone and Opicapone. They mildly prolong the effect of levodopa therapy. Side effects are an increased risk of involuntary movements (dyskinesia), diarrhoea, nausea or vomiting.
Anticholinergics medications were used for many years to help control the tremor associated with Parkinson’s disease. Examples are benztropine and trihexyphenidyl.
Amantadine is used for short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements (dyskinesia).
We will discuss surgical treatment for Parkinson’s disease and how to cope with Parkinson’s disease as a patient and as a family member or friend.
Never Ignore a Head Injury
Dr. Ravindra Patil
on
May 21, 2021
A head injury is any injury to the brain, skull, or scalp. It may be a mild bump, bruise or a skull fracture involving brain injury. A lump on head because of an injury is called a concussion, cut scalp injuries are called scalp wounds. Broken skull bones are called skull fractures.

