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-- Programs and Services -- Contact Information What is Parkinson’s disease?
By Laurie E. Knepper, M.D.
Parkinson’s disease is most common after age 70. It affects an average of 100,000 people in the United States. The exact cause is unknown. Toxins such as rotenone, manganese, and carbon monoxide can cause a Parkinson’s like disease. Medications such as reglan and antipsychotic medications can induce Parkinson’s symptoms. Other brain disorders including stroke, hydrocephalus, and tumors can mimic Parkinson’s disease.
Parkinson’s disease is a degenerative disease of the brain. There is a loss of brain cells and the neurotransmitter dopamine in the gray matter of the brainstem, called the substantia nigra, and other areas deep in the brain.
What are the symptoms of Parkinson’s disease?
There are four cardinal features of Parkinson’s disease: a resting tremor (usually more prominent in one hand), a slowing of movements, stiffness of the joints (especially wrist, elbow, spine), and an unsteady gait.
What is the treatment of Parkinson’s disease?
Parkinson’s disease cannot be prevented and treatment does not stop the progression of the disease. There are a variety of medications that effectively manage the symptoms of the disease and promote the return to a near-normal lifestyle. Many new medications are being developed. The choice of treatment depends on the severity of symptoms and to what degree they are interfering with daily activities. Treatment is tailored to control the specific symptoms, such as reducing a severe tremor, decreasing stiffness, and improving mobility. The most commonly used medication is Sinemet, a dopamine derivative, which essentially replaces the missing brain chemical. Long-term use can be associated with abnormal movements, unpredictable fluctuations, and a need for increasing doses. Usually it is well tolerated and remains the mainstay of treatment. Most people with Parkinson’s disease will be on Sinemet at some point. A medicine called Comtan can be added to augment its effect.
Medications that mimic dopamine at dopamine sites in the brain, are also a common treatment and include Requip and Mirapex. These medications have the benefit of lasting longer than Sinemet, but must be started at small doses and slowly increased. In older people they can cause dizziness, sleepiness, and occasionally hallucinations. In severe Parkinson’s disease, stereotactic microneurosurgery can lesion or implant stimulator devices in deep areas of the brain to control tremor and abnormal movements. These procedures are not without risk and are reserved for cases when the disease cannot be controlled.
When someone is diagnosed, what can he or she expect?
Symptomatic treatment can be quite effective and provide considerable return of function and mobility. Because of the potential side effects of the medications, low doses are started and slowly increased. Improvement may not occur until an adequate dose is reached. Parkinson’s disease progresses at different rates in each person, and its course is difficult to predict. Many people can be maintained on low doses of medication for quite some time. Eventually medications may need to be added and doses adjusted to improve mobility, control a tremor, and maintain independent living for as long as possible.
How can family members help?
A supportive family is a blessing for anyone with a progressive disease. Family members can record day-to-day fluctuations, and thus help physicians adjust medication. They can provide input about the need for walking aides such as a cane or a walker and can do a safety assessment of the home. Since the patient may be unaware that memory impairment and difficult driving can occur, a family member can document and monitor the severity and progression of symptoms, ensuring appropriate intervention occurs. Although Parkinson’s disease cannot be prevented, it can be treated. The treatment is effective, relatively well-tolerated and can result in a return to previous activity levels and promote independent living.
Dr. Laurie Knepper is a board certified Neurologist who practices general Neurology in Lenox at Neurology In The Berkshires.