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Parkinson’s Disease

It is a neurological disorder that mainly occurs in old age due to the degeneration of the neurons in the brain, especially the ones that produce dopamine. The neuron damage mainly affects the movement making the muscles stiff and weak.

 

With time, the disease may progress further, leading to worsening of the symptoms. Medications can help someone with Parkinson’s, and surgery may also be recommended in a few cases where certain areas of the brain need to be repaired.

 

What can be the probable causes of Parkinson’s disease?

The exact cause of Parkinson is still unknown; however, certain risk factors can be identified:

 

  • Age: The risk increased with age and has been observed seldom in young individuals. Usually, the symptoms appear after the age of 60.

  • Hereditary: If someone close to your family has a history of Parkinson’s disease, then you might be at risk. The more relatives with history, the greater the risk. Specific gene mutations might occur in the family over several generations that might lead to Parkinson’s disease.

  • Gender: Males have been observed to be affected more than females.

  • Environment: Exposure to certain pesticides or insecticides may increase the risk.

 

What may be the complications of Parkinson’s disease?

 

  • Cognitive difficulties

  • Pain

  • Urinary problems like involuntary passage or difficulty in passing urine

  • Constipation

  • Dementia 

  • Depression

  • Difficulty in chewing, eating or swallowing

  • Fatigue

 

What are the symptoms of Parkinson’s disease?

The disease progresses very gradually in the body. You may see the actual symptoms like tremors or dementia much later. 

 

In the very early stages, some symptoms may be visible:

  • Forgetfulness

  • Lack of concentration

  • Sleep issues

  • Constipation

  • Depression

  • Low blood pressure, especially while standing

 

Not every patient may present with these symptoms, and your doctor shall observe your symptoms and overall health over a period of time to reach a diagnosis.

 

The following symptoms may also appear as the disease shall progress:

 

  1. Muscle stiffness may affect a part or various parts of the body, making the movements painful and limited.

  2. Posture and balance may be affected such that you may lose balance while walking, and you might stoop while sitting or standing and may require support.

  3. There may be a generalized slowness in the movements; you will start walking slower with shorter steps. There may also be difficulty in sitting up from the chair.

  4. There are various unconscious movements such as swinging of the arm while walking, smiling, blinking that may affect Parkinson’s disease.

  5. Tremors may be present in the hands or fingers, sometimes even at rest.

  6. The speech may be affected as you may not be able to speak quickly or loudly as before. 

  7. The writing ability will also be compromised to an extent due to muscle weakness & stiffness.

 

Diagnosis of Parkinson’s Disease

If the signs and symptoms indicate a neurological disease, the doctor shall conduct a thorough physical examination with more emphasis on neurological functions. The examination findings shall be correlated with the history of the illness, medical history and investigation reports. The following tests may be advised:

 

  • Blood tests: to evaluate your overall health and rule out other conditions that may be causing your symptoms.

  • Dopamine Transporter scan (DaTscan): This is a single-photon emission computerized tomography that measures the amount of dopamine present in your brain. This test may help the medical team to reach the diagnosis. This test may not be performed in several instances as the diagnosis cannot be made solely based on this test.

  • PET Scan: This scan is done by injecting a radioactive substance into the body that helps make visible then abnormal activity in the brain and other organs in the PET scanner. This scan is also used to diagnose other conditions such as heart ailment and various types of cancer. 

  • Ultrasound of brain

  • MRI

  • CT Scan

 

Parkinson’s disease may not get diagnosed by running a series of tests in one go. Sometimes, several physical examinations and tests conducted over a period of time may help reach a diagnosis of Parkinson’s disease.

 

How can Parkinson’s disease be treated?

Parkinson’s cannot be cured, but it can be managed well with medications, lifestyle modifications, alternative therapies, and in severe cases, with surgical procedures. As speech and writing skills are also compromised in this disease, a speech-language therapist and physical therapist may also help improve your symptoms.

 

The medications that may be prescribed are:

 

  1. Carbidopa-levodopa: Levodopa is a natural chemical that is converted into dopamine in your brain. It is one of the most effective medications for Parkinson’s. Carbidopa is combined with levodopa that protects levodopa and prevents its conversion into dopamine outside the brain. It also helps in relieving the side effects of levodopa, such as nausea and lightheadedness. 

 

            Though an effective medicine, it may not be helpful in the long term. Its effectiveness tends to decrease over time, and it needs to be tapered off gradually. If you experience extreme side effects such as involuntary movements, the doctors adjust your dosage. This combination may also be prescribed in an inhaled or infused form. 

 

  1. Dopamine agonists: These are the medications that have a similar effect as that of dopamine. These may be prescribed along with or on and off with carbidopa-levodopa. These medications include pramipexole (Mirapex), ropinirole (Requip), and rotigotine. The side effects of dopamine agonists may include hallucinations, nausea, and sleepiness.

 

  1. MAO B inhibitors: Monoamine oxidase B is an enzyme that breaks down dopamine. These inhibitors include selegiline (Zelapar) and rasagiline (Azilect). The side effects such as headache, nausea, and insomnia may occur.

  2. Catechol O- methyltransferase (COMT) inhibitors: These medications, such as Entacapone (Comtan) and opicapone (Ongentys), may help in augmenting the effect of levodopa.

  3. Anticholinergics: Benztropine or trihexyphenidyl may help manage the tremors.

  4. Amantadine: Usually prescribed in early stages to manage the mild symptoms.

 

Surgical procedures

Deep brain stimulation: Electrical impulses generator is implanted near the collarbone in your chest so that the signals can be transmitted to the electrodes implanted in specific areas of your brain. These electrical signals help in managing the symptoms of Parkinson’s disease to a great extent.

 

In cases where there is no response to medications any more or the severity of the symptoms such as tremors, rigidity, slowness of movements has increased to a great extent. Deep brain stimulation may lead to complications such as stroke, bleeding or infection. 

 

Pallidotomy: A part of the brain called globus pallidus causes the symptoms of tremors, stiffness in muscles, loss of balance, and restricted movements. In this surgery, this part is removed, easing the symptoms.

 

Thalamotomy: Thalamus is an integral part of our brain which imparts balance to the body and sensations in extremities. When the tremors are incredibly severe, hindering the daily functioning, surgical removal of a part of the thalamus may be considered. 

 

Pallidotomy and thalamotomy are very rarely performed in patients with Parkinson’s disease owing to the wide range of side effects.

 

Gamma Knife: This is a minimally invasive method of treating a brain dysfunction identified with the help of an MRI or CT scan and then targeted with radiation to alleviate the symptoms. This treatment is considered when no response to medications and deep brain stimulation cannot be performed.

 

Self Care:

Along with treatment, specific lifestyle changes and therapies are essential for someone with Parkinson’s disease.

 

Healthy eating:  It is essential to focus on your diet by including adequate fruits, vegetables, whole grains, salads so that you get a good amount of fibre and nutrients such as omega 3 fatty acids. Along with this, drink plenty of water so that you are not constipated. 

 

Exercise: While you may feel discouraged to exercise due to muscular issues, do not let your symptoms come in your way. Being physically active will help you regain your mental as well as physical strength. A physical therapist shall assist you in various movements and guide you about the appropriate exercises for you.

 

Mental Health: It is very common to feel anxious, depressed, and angry at times when dealing with a chronic illness. If you feel that you cannot cope, seek support from your family and friends, and consult a doctor for the same. 

 

Symptoms of Parkinson’s disease

The symptoms of Parkinson can be caught on early before the motor problems occur. The earliest symptoms are:

  • Decreased ability to smell (anosmia)
  • Constipation
  • Small, cramped handwriting
  • Voice changes
  • Stooped posture
  • Major Motor Problem’s symptoms are:
  • Tremor (shaking that occurs at rest)
  • Slow movements
  • Stiffness of arms, legs, and trunk
  • Problems with balance and tendency to fall

Secondary symptoms include:

  • blank facial expression
  • a tendency to get stuck when walking
  • muffled, low-volume speech
  • decreased blinking and swallowing
  • the tendency to fall backward
  • reduced arm swinging when walking

Other, more severe, symptoms may include:

  • Seborrheic Dermatitis, which results in flaky white or yellow scales on oily parts of the skin
  • Increased risk of melanoma, a serious type of skin cancer
  • Sleep disturbances such as talking, vivid dreams, and movement during sleep
  • Depression
  • Anxiety
  • Hallucinations
  • Psychosis
  • Problems with attention and memory
  • Difficulty with visual-spatial relationships

Usually, early signs of Parkinson’s disease go unrecognized. Recognize the warning signs and symptoms and visit the doctor at the earliest.
 

Causes of Parkinson’s disease

The researchers have not been able to determine the exact cause of Parkinson’s disease but there are several aspects that play a significant part.
Your genes: There are specific genetic mutations that can cause Parkinson’s disease. Certain gene variation appears to increase the risk of Parkinson’s disease but there is a small risk of Parkinson’s disease for each of these genetic markers.
Environmental triggers: If you are exposed to specific toxins or certain environmental factors, there is an increased risk of later Parkinson’s disease, but the risk is relatively small.
The presence of Lewy bodies: Researchers believe that abnormal proteins called Lewy bodies, which are present in brain cells also hold an important clue to the cause of Parkinson’s disease.
 

Diagnosing Parkinson’s disease

To diagnose Parkinson’s disease, there is no specific test. Diagnosis is presented based on the patient’s health history, a physical and neurological exam, as well as a review of signs and symptoms.
Also, the Doctor uses imaging tests such as CAT scan or MRI to rule out other conditions. A dopamine transporter (DAT) scan may also be used by Doctor. While these tests won’t confirm Parkinson’s, they help the doctor to rule out other conditions and support the doctor’s diagnosis.
 

Treatment for Parkinson’s disease

The treatment for Parkinson’s involves a combination of medications, lifestyle changes, and therapies. The doctor will recommend adequate rest, exercise, and a balanced diet.
Therapies such as Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self-care.
In most cases, medication will be prescribed by the doctor to help control the various physical and mental health symptoms associated with the disease.
 

Surgical Treatment of Parkinson’s

Deep Brain Stimulation: Surgeons implant electrodes into a specific part of your brain. Electrical Pulses are sent to your brain using an electrode connected to a generator that is implanted in your chest near your collarbone. This surgery is usually recommended for people with advanced Parkinson's disease who have unstable medication (levodopa) responses. This surgery will reduce or halt involuntary movements (dyskinesia), medication fluctuations, reduce rigidity, reduce tremors, and improve the slowing of movement.

Recovery after Treatment

After surgery, you will have to closely work with your doctor to get the greatest relief from symptoms with the fewest side effects. Also, you will have to change your lifestyle by:
Healthy eating: Eat Foods high in Fiber and drink an adequate amount of fluids can help prevent constipation that is common in Parkinson's disease. Follow a balanced diet that provides nutrients.
Exercise: Exercise daily to increase your muscle strength, flexibility, and balance.
 

Parkinson’s Prevention

Many kinds of research have been conducted on Parkinson’s. However, doctors and researchers don’t understand what causes Parkinson’s. They are also baffled to their different progression on each person. Though it is unclear how you can prevent the disease, you can certainly adopt good lifestyle practices to prevent it.
If you have a family history of Parkinson’s, go for genetic testing. It doesn’t necessarily mean that you will develop this disease if you have a certain gene mutation. You should talk to your doctor about the risks and benefits of genetic testing.
In this battle against Parkinson’s disease, become a warrior as fierce, brave, courageous, and strong. Make a commitment to a life of compassion to promote your well-being.
 

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