Parkinson's Disease
Parkinson’s Disease (PD) is a chronic,
progressive neurological disorder, which impairs
one’s ability to move easily. In PD, cells
that produce a chemical called dopamine begin
to die. When 70-80% of dopamine is lost, one
begins to experience the symptoms of PD. The
most common symptoms are:
- Resting tremor (shaking of a hand or leg)
- Slowness of movement (bradykinesia)
- Stiffness in arms and legs (rigidity)
Parkinson’s Disease usually starts on
one side of the body. Tremor can be present when
the hand or leg is at rest, as opposed to the
tremor found in “essential tremor,” a
disorder commonly confused with PD. Often people
with Parkinson’s will note a change in
their handwriting; it gets smaller, a result
of rigidity in the arm. There is no diagnostic
test for PD. The diagnosis is made after a clinical
exam by a specialist who notes if two of the
three signs listed above are present. In addition,
secondary symptoms can be present in PD:
- Lack of arm swing
- Difficulty with gait (foot dragging or smaller
steps taken)
- Decreased facial expression (lack of smiling)
- Softer voice
- Stooped posture
- Balance problems
PD affects about 1.5 million individuals in
the United States. Typically it strikes middle
to older aged people but can affect younger men
and women. Michael J. Fox, Pope John Paul II
and Muhammad Ali are some famous people with
PD.
Treatment
Although there is no cure for PD, specialists at the Penn Neurological Institute
can manage symptoms and provide treatment options not typically available
at other hospitals. Several drugs are available to help patients combat their
symptoms. Levadopa (Sinemet), the most common one, is actually manufactured
dopamine. Other drugs called agonists (Permax, Mirapex and Requip) mimic
dopamine and trick the brain into believing it is receiving dopamine. COMT
inhibitors (Comtan) sustain the life of Levadopa and help it to be more efficient.
Physical, speech and occupational therapies are all disciplines that can
help PD patients. Some people use alternative therapies such as tai chi and
yoga for relief of muscle rigidity and balance improvement.
Surgical Intervention
Deep brain stimulation is an innovative and proven treatment for PD sufferers.
Under MRI guidance, a neurosurgeon maps out the brain and looks for the affected
area. An electrode is placed in the brain connected via a wire to a pacemaker-like
device implanted under the collarbone. The lead receives electric impulses
from the pacemaker, which can suppress Parkinson’s symptoms. The device
can be adjusted or turned off and on. A PD patient must be Levadopa responsive
in order to be a candidate and not have significant cognitive impairment.
Usually surgery is considered after medication options are exhausted.
Research
Clinical trials, currently taking place, are looking at new medications to
alleviate symptoms. Neuroprotective compounds are being studied which would
slow the progression of the disease by protecting existing dopamine cells.
Resources
There is a network of 30 support groups in the Delaware Valley. Specific groups
for young onset, men, women and care partners exist. There are also exercise
groups available. These groups are a valuable way to gain information and
share common experiences.
Many different PD organizations exist. The largest
is the National
Parkinson Foundation (NPF), which supports
patient programs and research and designates
certain physician practices as Centers of Excellence. The
Parkinson’s Disease Foundation, Michael
J. Fox Foundation and Parkinson's
Action Network are some of the others. The
Parkinson Council is the chapter of the National
Parkinson Foundation serving the greater Delaware
Valley.
For more information, visit the Penn
Neurological Institute's Parkinson’s
Disease and Movement Disorders Center at Pennsylvania
Hospital, an NPF Center of Excellence.
To order a copy of the Penn Vital Signs episode
on Parkinson's Disease, visit the Penn
Vital Signs web site. You may also watch
the show online.
Reviewed by Amy
Colcher, MD
April 2004
|
