Symptoms and Treatment of Parkinson's Disease

Symptoms

Symptoms may be present on one or both sides of the body. The person's intellectual ability is unchanged until the advanced stages of the illness, when it deteriorates slowly. The following are a list of symptoms to be aware of:

  • Tremors

  • Bradykinesia

  • Rigidity

  • Facial Expressions

  • Voice Pitch

  • Swallowing

  • Depression

  • Tremors

A common early symptom is a tremor in one finger that eventually spreads to involve the whole arm. Tremors are most noticeable when the person is at rest, and may involve a distinctive movement in which the thumb and the index finger rub together rhythmically (four or five times a second) in what is described as the 'pill-rolling' tremor. Tremors can also occur in the head, lips, tongue, and feet.  Some patients report experiencing internal tremors, which may occur several times a week, but are of short duration (under half an hour). Tremors do not occur during sleep.

Bradykinesia

Bradykinesia, one of the most common symptoms, refers to the slowness of movement, the difficulty in initiating movement and the decrease in automatic movement that is seen in people with Parkinson's. It takes them longer to react and move than people without the disease.

Rigidity

Rigidity in the person with Parkinson's is caused by an increase in muscle tone caused by overactivity of certain cells in the spinal cord. The PD patient walks with short, increasingly rapid shuffling steps. The arms, instead of swinging, remain pressed to the person's sides. There are problems with balance.

Facial Expressions

The facial expressions of people with Parkinson's are adversely affected by the disease, resulting in a 'mask-like' face that may cause others to believe the person is inattentive or unemotional.

Voice Pitch

The voice of the individual may become flat and atonal and may rise in pitch.

Swallowing

The person with PD will have difficulty in swallowing saliva, and that may lead to drooling. This is not caused by excessive production of saliva, but simply the inability to swallow the saliva normally produced.

Depression

Depression is common in people with Parkinson's. That's to be expected in people experiencing such a disabling illness, but studies have shown that patients with PD experience depression more than patients with other similarly disabling illnesses. In some patients the depression can be more disabling than the disease. In a few patients, the depression may become so severe that psychiatric treatment for it may become more important than the treatment of the illness. Improvement in the patient's outlook often leads to an improvement in Parkinsonian symptoms.

Treatment

Parkinson's is currently considered incurable, but symptoms can be relieved or controlled. There are a variety of different types of treatments for Parkinson's Disease, ranging from medication, to surgery.   The following is a list of known treatments presently available. Please note that medical research and studies are progrssing rapidly in the treatment of Parkinson's Disease. These tretaments are provided as examples rather than a definitive list. You should consult with a specialized healthcare provider for the most up-to-date treatments available.

L-Dopa

L-Dopa, which is obtained from broad beans or produced synthetically, has been prescribed for the treatment of Parkinson's disease for more than 20 years. A major difficulty with L-Dopa treatment is that its effectiveness is limited and varies from person to person. As well, its effectiveness lessens over time, so greater doses must be given, and that eventually produces unwelcome side effects. Two recent advances in the treatment of Parkinson's include the development of continuous-release preparations of L-Dopa, and the use of an inhibitor to slow the breakdown of L-Dopa in the body before it reaches the brain so more of it gets there. (L-Dopa, incidentally, may turn urine black or brown.)

Activa

A device called the Activa has had success. Doctors drill through the skull and implant an electrode into the thalamus, the message relay center in the brain. A wire is run just under the scalp down to the collarbone area, where a small "pulse generator" is implanted. It sends electrical waves, customized for each patient, to the electrode. By emitting regular, small electrical impulses the Activa blocks the tremors.

Pallidotomy

A procedure called a pallidotomy - which was fairly common in the treatment of Parkinson's until the advent of L-Dopa - has returned, thanks to a Swedish doctor named Laitenen who began performing the operation in 1992. In pallidotomy a tiny hole is drilled into the skull and then, using the data taken from the computer, a microelectrode is directed to a part of the brain called the globus pallidus. (Overactive cells there are responsible for the patient's tremors.) Once the globus pallidus is reached, a special electric current generator is used to burn a few small lesions in it, destroying the overactive cells. Local anesthetic is used, so the patient is awake during the procedure. There is no pain or discomfort.

Laitenen worked initially on 38 patients with 'medically refractory' (unresponsive to treatment) Parkinson's, and had remarkable success. Some patients described the results as 'miraculous'. They were able to walk again, and much or all of their tremors disappeared. Results were not so dramatic in a few of the patients, but virtually all reported improvement. Other surgeons have since followed Laitenen's lead.

Thalamatomy

A surgical procedure called thalamatomy has also generated renewed interest, and is effective for certain PD patients in whom tremor is the predominant complaint. A small region of the thalamus is destroyed.

Physical Therapy

As for day-to-day care, physical therapy is, of course, recommended and so are generous helpings of encouragement, reassurance and treatment of associated conditions.

Occupational and Speech Therapy

Health professionals may recommend occupational and speech therapy for PD patients, as they have both proven helpful as the condition progresses.

Deep Brain Stimulation

A recent and very promising technique to control the tremors associated with Parkinson's is described as 'deep brain stimulation'. This involves placing a permanent electrode in the region of the brain that produces the tremors.  The electrode implanted deep in the brain is connected to a power source placed under the skin on the patient's chest, and the power can be adjusted as symptoms dictate. Said one 61-year-old woman on whom the procedure was performed, "I was unable to feed myself, unable to walk - to do anything, basically. I'm at least 80 per cent better. Friends can't stop asking me - 'What did they do to you?' It's fantastic." Talk to your health professional about this and other techniques.

 

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