Parkinsonism

What is a Parkinsonism?

Parkinson's disease is a progressive nervous system disorder that affects movement. In Parkinson's disease, certain nerve cells (neurons) in the brain gradually 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 symptoms of Parkinson's disease.

Symptoms

Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Parkinson's signs and symptoms may include:

Other symptoms that may or may not occur:

Causes

The cause of Parkinson's is largely unknown. Scientists are currently investigating the role that genetics, environmental factors, and the natural process of aging have on cell death and PD.

How to diagnose parkinsonism?

No specific test exists to diagnose Parkinson's disease. Neurologist will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

Blood tests to rule out other conditions that may be causing your symptoms.
Imaging tests such as MRI, and PET scans may also be used to help rule out other disorders. Imaging tests aren't particularly helpful for diagnosing Parkinson's disease.

How to treat parkinsonism?

Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically.

  • Medications
    Almost all patients with Parkinson’s disease eventually need to take medication to help with their motor symptoms. Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. It also may be used in combination with other classes of medications including Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents. Treatment is highly individualized and adjusted over time based on symptoms and side effects. A new method to take medication is through a drug pump that delivers a carbidopa/levodopa gel (Duopa) directly into the intestines. Surgery is required to place a small hole (stoma) in the stomach through which a tube is connected to a portable pump worn on your belt. It is designed to deliver the medicine continuously, a little at a time, to improve absorption and reduce off-times. Duopa is similar to insulin pumps used by diabetics.
  • Deep Brain Stimulation
    Some patients with Parkinson’s disease may benefit from deep brain stimulation (DBS), a surgical therapy that has been FDA approved for over a decade. DBS involves implanting an electrode into a targeted area of the brain, The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest. Patients that are considered good candidates for this procedure are those with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance. The procedure can help patients with medication-resistant tremors. It can also help patients who have significant motor fluctuations in which medication response varies during the day and dyskinesias or extra movements may occur as a side effect of medication.