Parkinson's  Disease 
What is Parkinson's disease?
Parkinson's disease (PD) is a chronic neurodegenerative disordered of brain. It is named after the doctor who first described it. It mainly affects the way the brain co-ordinates the movements of the muscles in various parts of the body.

Who gets Parkinson's disease?
PD mainly develops in people over the age of 50. It becomes more common with increasing age. About 5 in 1,000 people in their 60s, and about 4 in 100 people in their 80s have PD. It affects both men and women but is a little more common in men. Rarely, it develops in people under the age of 50.
PD is not usually inherited, and it can affect anyone. However, genetic (hereditary) factors may be important in the small number of people who develop PD before the age of 50.

What causes Parkinson's disease?
A small part of the brain called the substantia nigra is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Messages are passed between brain cells, nerves and muscles by chemicals called neurotransmitters. Dopamine is the main neurotransmitter that is made by the brain cells in the substantia nigra.

If you have PD, a number of cells in the substantia nigra become damaged and die. The exact cause of this is not known. Over time, more and more cells become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain causes nerve messages to the muscles to become slowed and abnormal.

 
Parkinson's disease symptoms
The brain cells and nerves affected in PD normally help to produce smooth, co-ordinated movements of muscles. Therefore, three common Parkinson's symptoms that gradually develop are:

 
  • Slowness of movement (bradykinesia). For example, it may become more of an effort to walk or to get up out of a chair. When this first develops you may mistake it as just 'getting on in years'. The diagnosis of PD may not become apparent unless other symptoms occur. In time, a typical walking pattern often develops. This is a 'shuffling' walk with some difficulty in starting, stopping, and turning easily.
  • Stiffness of muscles (rigidity), and muscles may feel more tense. Also, your arms do not tend to swing as much when you walk.
  • Shaking (tremor) is common, but does not always occur. It typically affects the fingers, thumbs, hands, and arms, but can affect other parts of the body. It is most noticeable when you are resting. It may become worse when you are anxious or emotional. It tends to become less when you use your hand to do something such as picking up an object.
 At first, one side of your body may be more affected than the other.

Some other symptoms may develop due to problems with the way affected brain cells and nerves control the muscles. These include:

Fewer facial expressions such as smiling or frowning. Reduced blinking.
 
  • Difficulty with fine movements such as tying shoe laces or buttoning shirts.
  • Difficulty with writing (handwriting tends to become smaller).
  • Difficulty with balance and posture and an increased tendency to fall.
  • Speech may become slow and monotonous.
  • Swallowing may become troublesome, and saliva may pool in the mouth.
  • Tiredness, and aches and pains.
  • Constipation.
  • Alterations in your sense of smell.
  • Difficulties with sleeping.
How is Parkinson's disease diagnosed?
To diagnose Parkinson’s, the physician takes a careful neurological history and performs an examination. There are no standard diagnostic tests for Parkinson’s, so the diagnosis rests on the clinical information provided by the person with Parkinson’s and the findings of the neurological exam.

What are the Medical treatments for Parkinson's disease?  
Treatment is by giving dopamine and dopamine agonist  in the form tablets as disease is due to the deficiency of dopamine.

What are the Surgical treatments for Parkinson's disease?
Surgery for Parkinson's disease has come a long way since it was first developed more than 50 years ago. The newest version of this surgery, deep brain stimulation (DBS), was developed in the 1990s and is now a standard treatment. Worldwide, about 30,000 people have had deep brain stimulation.

What is DBS?
During deep brain stimulation surgery, electrodes are inserted into the targeted brain region using MRI and neurophysiological mapping to ensure that they are implanted in the right place. A device called an impulse generator or IPG (similar to a pacemaker) is implanted under the collarbone to provide an electrical impulse to a part of the brain involved in motor function. Those who undergo the surgery are given a controller, which allows them to check the battery and to turn the device on or off. An IPG battery lasts for about three to five years and is relatively easy to replace under local anesthesia.
Other treatments for Parkinson's disease
 
  • A physiotherapist can advise on posture, walking and exercises.
  • An occupational therapist can advise on such things as home adaptations which may ease many tasks.
  • If difficulties with speech, swallowing or saliva occur, a speech and language therapist can help.
  • The advice of a dietician and other therapists may be needed for some people.
  • A psychologist may be able to help if you have problems with depression.
   

 

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