Overview Of Parkinson’s disease

Parkinson’s disease is a progressive disorder of the central nervous system that can have devastating effects upon both the patient and their family members. The main features of Parkinson’s disease are slowness of movements, difficulty maintaining balance, muscle rigidity, and tremor. The disease is thought to be caused by low levels of a chemical called dopamine, which activates cells in our brains that let us move. While there is currently no cure for Parkinson’s disease, there are a variety of treatments available that can help to improve symptoms. 

Symptoms of Parkinson’s disease

There are primary and secondary symptoms of Parkinson’s disease. Not everyone with the disease experiences all of the symptoms and the progression of the disease is different from person to person. Most people who get Parkinson’s are over 60, but recently there have been more identified cases in younger men and women.
Most of the symptoms of the disease involve disruption of motor functions (muscle and movement). However, lack of energy, mood and memory changes, and pain can also occur as part of the disease.


Primary symptoms of Parkinson’s disease

Slow movement (Bradykinesia) – slowness in voluntary movement such as standing up, walking, and sitting down. This happens because of delayed transmission signals from the brain to the muscles. This may lead to difficulty initiating walking, but in more severe cases can cause “freezing episodes” once walking has begun.
Tremors – often occur in the hands, fingers, forearms, foot, mouth, or chin. Typically, tremors take place when the limbs are at rest as opposed to when there is movement.
Rigidity – otherwise known as stiff muscles, often produces muscle pain that is increased during movement.
Poor balance –happens because of the loss of reflexes that help posture. This causes unsteady balance, which can often lead to falls.

Diagnosing Parkinson’s disease

There are no lab tests that can definitively diagnose Parkinson’s disease. A systematic neurological exam will include testing your reflexes and observing things like muscle strength throughout your body, coordination, balance, and other details of movement. These tests are also necessary to rule out other conditions, such as nerve dysfunction, narrowing of the spinal canal, or other types of tremor. Your doctor may also order tests, such as blood or urine tests or CT or MRI scans, to exclude the possibility of these other disorders. 

Treatment of Parkinson’s disease

There is no cure for Parkinson’s disease; however, there are several medications and other types of treatment available to address the symptoms of the disease.

Commonly used medications for Parkinson’s disease

Levodopa/Carbidopa (Sinemet) - This is a combination of Levodopa (the chemical that patients with Parkinson’s disease lack) and Carbidopa (a chemical that helps the levodopa reach the brain). It works very well for controlling symptoms for most patients but can cause some side effects, especially after several years. Its effectiveness tends to decrease after several years. 
Entacapone (Comtan) - This is a medication that helps Sinemet work better when it starts to lose its effectiveness. It is also available together with levodopa and carbidopa in a combined product called Stalevo. 
Dopamine agonists - These include ropinorole (Requip) and pramipaxole (Mirapex), medications designed to enhance your body’s natural production of dopamine by stimulating your brain to produce more. They do not have as much risk of long-term side effects as levodopa, and they have less chance of losing effectiveness over time. However, they can cause dizziness and hallucinations, especially in the elderly or in patients with dementia. These factors make the agonists more suitable medications for younger patients. There is some theoretical evidence that the agonists may slow the progression of Parkinson’s disease, but scientists have not proven this definitively. 
Monoamine oxidase inhibitors - These include selegiline (Eldepryl and Zelapar) and rasagaline (Azilect). These are less commonly used types of medication that increase the amount of dopamine available in the brain. They can be very helpful in a small number of patients with Parkinson’s disease. These medications often have fewer side-effects than the dopamine agonists but can be harmful when used together with certain other medications, especially some types of antidepressants. Patients can also develop critically elevated blood pressure when combining these medications with certain types of foods. 

Surgical treatment for Parkinson’s disease

There are some surgical options for patients with Parkinson’s disease, the most common of which is known as Deep Brain Stimulation (DBS). This form of surgery is sometimes used to help reduce the severity of muscle rigidity and slowness of movements. DBS involves placing a wire into the brain connected to a pacemaker-type device implanted just below the skin in the chest. 

Other helpful treatments for Parkinson’s disease

If you have been diagnosed with Parkinson’s disease, you can help keep yourself as healthy and safe as possible by taking certain precautions.
Physical therapy is often recommended and almost always beneficial.
Group wellness programs and other support groups for patients with Parkinson’s disease unite you with other people facing the same challenges. This can greatly help with feelings of isolation and depression that affect many Parkinson’s patients. 

Exercise can also ease symptoms. Research shows that patients with Parkinson’s disease who exercise regularly do better than those who don’t. Any type of physical activity that raises your heart rate can be beneficial. 

Exercise tips for people with Parkinson’s disease:

1. Before starting an exercise regime, you should always check with your doctor.
2. Pursue physical and occupational therapy.
3. Exercise your face and jaw whenever possible.
4. Practice bending, stretching, and breathing exercises.
5. Try exercising in bed; it may be easier than on the floor.
6. Build your walking skills, even if that means having to hold onto something.
7. Try exercising in the water; it is easier on the joints.

Tips for diet and eating:

Cut foods into smaller portions to avoid choking and to encourage digestion.
Remain upright for 30 minutes after eating.
For upset stomachs linked to medication, try eating a small amount of non-protein based food before taking medication.
Protein may block your body’s ability to absorb levodopa (Sinemet), so you may need to avoid taking this medication within 30 minutes before to 1 hour after eating meat or other high-protein foods.



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