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Parkinson?s Disease by Dr. Rehan Rahim M.D.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by chronic and progressive muscle control loss. It is commonly known to occur in individuals aged above 50 years although early onset is possible.

The progression of PD and degree of impairment varies from individual to individual. Once diagnosed, some are able to adapt and have productive lives in contrast to others that may quickly lose ability. Premature death (relative to PD) may be due to complications such as fall-related injury or pneumonia.

Pathology: Degeneration of neurons in the region of substantia nigra of the brain. These brain cells produce dopamine which controls movement and coordination.

Causes: Unknown. Possibly genetic, hereditary or due to aging, environmental factors & toxins

Symptoms: Progression is unique to every individual. Primary symptoms may include:

  • Tremor of the hands, arms, legs, jaw and face (usually resting tremor)
  • Bradykinesia i.e. slowness of movement ? Rigidity of the limbs & trunk
  • Postural instability or impaired balance & coordination
  • Loss of automatic movements i.e. loss of facial expression, no arm swing, gestures, etc
  • Speech problems
  • Writing changes i.e. writing may appear small & difficult
  • Depression, dementia, anxiety, sleep problems, emotional & behavioral changes
  • Bladder, bowel problems & sexual dysfunction

Diagnosis is usually based on history, clinical signs & symptoms in addition to neurological examination. Tests are sometimes performed to rule out other movement disorders.

Treatment - Presently non-curative. Treatment options include medication and surgery whose benefits help to manage symptoms & delay progression.

Rehabilitation - Comprehensive multi-disciplinary program that involves the patient, family and health professionals.

  • Specialists involved may include: neurologist, geriatrician, psychiatrist, physiatrists.
  • Typically includes health professionals specialized in: nursing, physiotherapy, occupational therapy, speech therapy, psychology, nutrition and social work.
  • Community or home nursing care complements rehabilitation to maintain patients at home.

Medications are given to increase or substitute for dopamine neurotransmitters

For example: Carbidopa-levodopa (sinemet), Dopamine agonists (pramipexole, ropinirole, apomorphine); MAO B inhibitors (selegiline, rasagiline), COMT inhibitors, Entacapone, Tolcapone, Anticholinergics (benztropine,trihexyphenidyl), Amantadine.

Surgery - Brain Stimulator Implantation

Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms, commonly used for the debilitating symptoms of Parkinson’s disease (PD). (Credit NINDS)

Palliative Care is required during the final stages

Parkinson's disease (PD) is a chronic, progressive illness with profound implications that may be frustrating for the patient as walking, talking and eating become increasingly difficult and time-consuming to manage.

Every aspect of the patient’s life is affected. Moreover, it presents enormous challenges for the patient in addition to the family. Although there is presently no definite cure, it is important to support, maintain and improve caregiver / patient quality of life.