By Dr. Gerard Muraida
Parkinson’s disease was first described by the English neurologist James Parkinson. In 1817, he published a paper describing the classic physical findings we still use today and referred to the disease as the “shaking palsy.”
Parkinson’s disease is a neurologic disorder where the basal ganglia nerve cells in our brain (responsible for producing the neurotransmitter dopamine) deteriorate and eventually die. These neurotransmitters allow chemical messages to travel throughout our nervous system. In addition to dopamine, the neurochemical acetylcholine can also become depleted.
Although no blood test is available to diagnose Parkinson’s disease, some blood tests can rule out other conditions that may mimic Parkinson’s disease. There are several recognized risk factors for Parkinson’s disease, such as exposure to pesticides, but for now, the only confirmed causes of Parkinson’s disease are genetic. Still, inherited or familial Parkinson’s accounts for only 10% of all cases.
When Parkinson’s disease isn’t genetic, experts classify it as “idiopathic.” (This term is of Greek origin and means “a disease of its own”). This means that it’s cause is unknown.
It is now believed that the body’s inability to properly handle a protein called α-synuclein (alpha sy-nu-clee-in) is associated with Parkinson’s. When mishandled, this brain protein folds up and the body can’t use it or eliminate it. With nowhere to go, the proteins may build up in certain cells, forming tangles or clumps referred to as Lewy bodies. The buildup of these Lewy bodies causes toxic effects and cell damage.
Protein misfolding is common in many other disorders, such as Alzheimer’s disease and Huntington’s disease.
A common early sign of Parkinsons is a slight shaking or tremor in a finger, thumb, hand or the chin. This tremor, often at rest, usually begins on one side of the body but can change sides or involve both sides. A change in handwriting can also appear early on. This is called micrographia, where the letters become smaller or crowded together. Difficulty walking, a feeling that one’s feet are stuck to the floor, decreased arm swing, and body stiffness are also early complaints of Parkinson’s patients. Lack of facial expression, referred to as masked facies, a decreased sense of smell, and a low, tremulous voice can also be seen with Parkinson’s disease.
While there is no cure, there are several treatments. The main therapy for Parkinson’s is carbidopa-levodopa. This is a combination drug where the carbidopa prevents levodopa from being broken down before entering the brain via the bloodstream. Levodopa is the precursor to dopamine, the neurotransmitter that promotes fluid movements. Carbidopa also helps reduce nausea and vomiting, which can be side effects of levodopa, by preventing the conversion of levodopa to dopamine in the gut.
Other medications to treat Parkinson’s symptoms include those that stimulate production of dopamine in the brain and medications that slow down the enzymes that break down of dopamine in the brain. To reduce involuntary movements and reduce tremors and muscle rigidity, amantadine and anticholinergic meds may be prescribed as well.
For some drug-resistant Parkinson’s patients, deep brain stimulation (DBS) may be an option. DBS is a procedure where electrodes deliver small electrical currents into areas of the brain that may stop Parkinson’s-related tremor, slowness of movement, and rigidity.
Non-medication interventions can also help control Parkinson’s symptoms. Physical, occupational, and speech therapies may help with gait and voice disorders, tremors and rigidity, and decline in mental functions. Yoga, tai chi and exercises to strengthen muscles and improve balance, flexibility, and coordination can also be helpful.
Parkinson’s disease can be managed, and progression may be slowed by the above interventions. If you feel you may be developing Parkinsonian symptoms, ask your provider to consider the diagnosis and possible neurological evaluation.
