Parkinson’s Disease

What is Parkinson’s disease?

It is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia).

What are the types of parkinson’s disease?

  • It is also called "primary parkinsonism" where the symptoms may result from toxicity, drugs, genetic mutation, head trauma, or other medical disorders.
  • Idiopathic - where cause is not known .

What are the signs and symptoms of parkinson’s disease?

(A) Motor symptoms

  • Tremor- when the limb is at rest, and decreased with voluntary movement. It is typically unilateral at onset.
  • Rigidity- stiffness; increased muscle tone. In combination with a resting tremor, this produces a "cogwheel" rigidity when the limb is passively moved.
  • Bradykinesia/akinesia- slowness or absence of movement. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude. Also "dysdiadochokinesia", which is the loss of ability to perform rapid alternating movements
  • Postural instability- failure of postural reflexes, which leads to impaired balance and falls.
  • Other motor symptoms include:

  • Gait and posture disturbances:
    • Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to trip the patient
    • Decreased arm swing
    • Rather than the usual twisting of the neck and trunk and pivoting on the toes, patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
    • Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk
    • Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
    • Gait freezing: inability to move the feet, especially in tight, cluttered spaces or when initiating gait.
    • Dystonia : abnormal, sustained, painful twisting muscle contractions, usually affecting the foot and ankle.
  • Speech and swallowing disturbances in form of soft, excessively rapid speech, drooling and impaired ability to swallow which can lead to aspiration, pneumonia.
  • Fatigue ,a mask-like face with infrequent blinking, difficulty in rolling in bed or rising from a seated position, small, cramped handwriting, impaired fine and gross motor coordination;
(B) Non-motor symptoms

Mood disturbances, depression,cognitive disturbances,dementia, hallucinations, delusions, short term memory loss, sleep disturbances(excessive daytime sleep),sensation disturbances and autonomic disturbances like urinary incontinence,constipation and weight loss.

What is the treatment for parkinson’s disease?

Parkinson's disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy,speech therapy, exercise, and nutrition. At present, there is no cure , but medications like Levodopa , dopamine-agonists like bromocriptine and MAO-B inhibitors like Selegiline and rasagiline or in extreme cases surgery can provide relief from the symptoms.