The average age at which symptoms begin in the USA. is 58-60.
The nerve cells in the part of the brain which control movements are
mainly affected. The nerve cells (neurons) which make the chemical
called dopamine either dont work sufficiently or are completely
destroyed. The real cause behind this had never been identified. Though,
many risk factors have been enumerated in literature.
Persons suffering from Parkinsons disease need not
present with every common symptom. The number of symptoms
and their intensities are known to vary with every
individual. Most common signs & symptoms of Parkinsons
Tremors felt in the fingers, hands, arms, legs, jaw
and face. Initially these tremors are mild and
only while resting. Eventually they become visible even
during routine movements.
Rigidity is another symptom. Persons suffering often
feel stiffness or inflexibility in their muscles. Muscles
normally stretch when they move, and then relax when they
are at rest. In rigidity, the muscle tone of an affected
limb is always stiff and does not relax, sometimes resulting
in a decreased range of motion.
Muscular movements like walking, running, dancing, sitting,
grasping objects with fingers all seem very stiff. Rigidity
can cause pain and cramping. The sense of fluidity in these
movements is lost. In advanced conditions, even the facial
muscles become very rigid, thus giving an appearance of an
expressionless face, something akin to wearing a mask.
Bradykinesia or slowness of movements usually
accompanies the sensation of stiffness and rigidity. A
person with bradykinesia will probably also have incomplete
movements, difficulty initiating movements and sudden
stopping of ongoing movement.
There is increasing inability to perform tasks which require
rapid alternating movements.
Loss of balance and in coordination of movements results in
frequent falls when beginning to walk or run.
Gait: There is a shuffling gait characterized by
short steps, with feet barely leaving the ground, producing
an audible shuffling noise. Small obstacles tend to trip the
Decreased arm swing.Turning en-bloc, rather than the
usual twisting of the neck and trunk and pivoting on the
toes, PD patients keep their neck and upper body rigid,
requiring multiple small steps to accomplish a turn.
Stooped, forward-flexed posture both when sitting and
standing. 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.
Dystonia: abnormal, sustained, painful twisting
muscle contractions, usually affecting the foot and ankle,
interfering with gait. However, dystonia can be quite
generalized, involving a majority of skeletal muscles; such
episodes are very painful and completely disabling.
They may go through periods of "freezing", which is when a
person feels stuck to the ground and finds it difficult to
start walking. The slowness and incompleteness of movement
can also affect speaking and swallowing.
Speech: the voice becomes very soft. Later, the
sound turns hoarse and monotonous. Occasionaly, the
speech becomes excessively rapid, soft, and
Gradual progress in the disorder causes an inability to
understand the meaning & essence of speech. Also, there
is difficulty in deciphering the facial expressions seen
on others when conversing.
Drooling: Weak swallowing and stooped posture causes
drooling of saliva.
More symptoms which are seen in PD are:
Small, cramped handwriting
Dementia and confusion
Fear or anxiety
Slow thinking & memory problems
Fatigue and body aches
Loss of energy
Sleep disturbances: excessive daytime sleepiness; insomnia;
vivid, disturbing dreams.
These symptoms certainly vary in intensities in different
persons. They are seen as the disease progresses and
everyone do not suffer from all of them.
We now know that many of the signs and symptoms of
Parkinson's disease develop when certain nerve cells
(neurons) in an area of the brain called the substantia
nigra are damaged or destroyed. Normally, these nerve cells
release dopamine a chemical that transmits signals between
the substantia nigra and another part of the brain, the
corpus striatum. These signals cause your muscles to make
smooth, controlled movements.
As a normal part of aging everyone loses some
People with Parkinson's disease lose half or more of neurons
in the substantia nigra. Although other brain cells also
degenerate, the dopamine-containing cells are critical for
movement and so their damage takes center stage.
Causes of Parkinson's disease:
Why Parkinson's Disease occurs, no one knows. These are some
factors that scientists believe predisposes individuals to
Genetic factors: About 15 to 25 percent of people
with Parkinson's report having a relative with the disease.
This means that if your parent has Parkinson's, your chances
of developing the disease are slightly higher than the risk
in the general population.
Studies have revealed that there may be more of a genetic
basis to young-onset PD (that is, the 10 percent or so of
people with Parkinson's for whom onset occurs at or before
age 50) than to later-onset PD.
The vast majority of Parkinson's cases are not directly
inherited, but researchers have discovered several genes
that can cause the disease in a small number of families.
Genetic diseases occur when important genes contain
mutations, which result in abnormal proteins that in turn
Environmental factors: Scientists have suggested that
Parkinson's disease may result from exposure to an
environmental toxin or injury. Research has identified
several factors that may be linked to PD, including rural
living, well water, herbicide use and exposure to
pesticides. Pesticides are thought to adversely affect the
brain by inhibiting energy production resulting in brain
Studies have also shown that smoking and caffeine use appear
to protect against the development of PD. However, it is
universally agreed that the health risks associated with
smoking are worse than any incidental benefits that might be
gained by this habit.
Also, a synthetic narcotic agent called MPTP can cause
immediate and permanent Parkinsonism if injected.
Head trauma: Past episodes of head trauma are
reported more frequently by sufferers than by others in the
Drug induced: Antipsychotics, which are used to treat
schizophrenia and psychosis, can induce the symptoms of
Parkinson's disease (or parkinsonism) by lowering
Currently no blood or laboratory tests that have been proven
to help in diagnosing PD. It is difficult to diagnose PD
accurately. Thus, medical history and a neurological
examination alone guide the physician in diagnosing.
The Unified Parkinson's Disease Rating Scale (UPDRS) is a
rating scale used to follow the longitudinal course of
There is no permanent cure for PD. Though many patients show
dramatic response to medications initially, with gradual
progress, the benefits of drugs diminish.
Treatment usually comprises of: -
Medications: medications help control the problems
faced in walking, movements and tremor. However, they need
to be taken in various combinations which need to be changed
after every little while. The medicines used are:
Levodopa and Carbidopa: Levodopa had been the gold
standard for treating PD since its introduction in 1960.
levodopa is a naturally occuring substance in nature. It is
a precursor of the chemical dopamine which gets converted to
dopamine by the nerve cells in the brain. There is a fine
meshwork-like structure in the brain which acts like a
filter that allows only selective substances to cross
through and enter the brain. This structure is called the
blood-brain barrier. Dopamine itslef cannot cross this
barrier, but levodopa can. Hence, dopamine itself is never
prescribed in PD.
Unfortunately, though the side-effects of these
drugs(nausea; postural reduction in blood pressures) are not
major, their doses need to be frequently regulated. The
quantity of each dose as well as its frequency of repetition
keeps increasing lifelong.
These medicines nevertheless allow persons suffering to
extend the period for which they can lead a normal life.
Dopamine agonists: though not levodopa, these drugs
mimic the action of levodopa and cause neurons to behave as
though they are receiving dopamine.
This class of drugs includes:
Pramipexole (Mirapex) and
Selegiline: This drug helps prevent the breakdown of
Catechol-O-methyltransferase: These drugs prolong the
actions of levodopa and carbidopa by preventing an enzyme
from breaking down dopamine.
Anticholinergics: These are used to control the tremors.
But, often the side effects (loss of memory, hallucinations,
confusions, dry mouth, nausea, urine retention, severe
constipation) make their use undesirable.
Amantadine: Provides short-term relief from early, mild
Parkinsons disease. Side-effects (swollen ankles, purple
mottling of skin) are not very severe.
Co-enzyme Q10: The majority of the energy utilized by the
cell is produced within the mitochondria. This is a
substance present within the mitochondria of the cells.
Co-enzyme Q10 is responsible for electron transport by which
the cell derives energy from Oxygen during respiration.
Thalotomy: destroys a few tissues within the thalamus
(a major centre in the brain handling the relay of messages
and transmitting sensations. This procedure reduces tremors
in some people. Though, it can cause slurring of speech and
lack of coordination in movements.
Pallidotomy: this procedure consists of removing tissues
within the pallidus (a part of the brain responsible for
causing PD). Tremors, rigidity and slowness of movements are
all controlled by this procedure. Though the procedure
provides relief, the effects are not long-lasting and the
condition usually recurs. Slurred speech, vision problems,
severe weaknesses are some of the side-effects.
Deep brain stimulation: A small device that transmits
electrical impulses is planted deep within the brain from
where it stimulates the sub-thalamic nucleus which controls
many motor functions. This procedure however runs the risk
of developing a bleed (hemorrhage) like a stroke. There are
high incidences of developing an infection as well. Hence,
this procedure is a last option.
Certain changes in diet and life style can go a long way in
improving a persons coping skills with PD.
Eat more of fruits, vegetables and whole grains.
These foods are high in fiber, which is important for
helping prevent constipation. Also, drink plenty of water
and increase fibre intake through supplements.
Regular exercise is extremely important if you have
Parkinson's disease. It helps improve mobility, balance,
range of motion and even emotional well-being. Your doctor
or physical therapist may recommend a formal exercise
program, but any physical activity, including walking,
swimming or gardening, is beneficial. Weight-bearing
exercises, such as walking, jogging and dancing, may be
Keep in mind that your energy level may go up and down, and
you'll sometimes need to pace yourself. If you're tired, try
doing one part of your routine at one time of day and adding
another segment later. Choose a time to exercise when your
medicines are working well and you feel strong.
Be sure to stretch before and after you exercise. Stretching
warms up your muscles, helps prevent stiffness, and improves
your flexibility and balance.
Walking with care
Parkinson's disease can disturb your sense of balance,
making it difficult to walk with a normal gait. These
suggestions may help:
If you notice yourself shuffling, slow down and check your
posture. It's best to stand up straight with your head over
your hips and your feet eight to 10 inches apart.
Buy a good pair of walking shoes. Avoid running shoes.
Practice taking long steps and exaggerate lifting your legs
and swinging your arms.
If you become stuck in place known as freezing rock gently
from side to side or pretend you're stepping over an object
on the floor.
In the later stages of the disease, you may fall more
easily. That's because Parkinson's disease affects the
balance and coordination centers in the brain. In fact, you
may be thrown off balance by just a small push or bump. The
following suggestions may help:
Ask your doctor or physical therapist about exercises that
improve balance, especially Tai chi. originally developed in
China more than 1,000 years ago, tai chi uses slow, graceful
movements to relax and strengthen muscles and joints.
Wear rubber-soled shoes. They're less likely to slip than
are shoes with leather soles.
Remove all area rugs from your home and make sure carpeting
is secured firmly to the floor.
Install handrails, especially along stairways.
Keep electrical and telephone cords out of the way.
Install grab bars around your tub and beside the toilet.
Make sure you can reach the telephone from your bed and
carry a cordless phone with you during the day.
Dressing can be the most frustrating of all activities for
someone with Parkinson's disease. The loss of fine motor
control makes it hard to button and zip clothes, and even to
step into a pair of pants. A physical therapist can point
out techniques that make daily activities easier. These
suggestions also may help:
Allow plenty of time so you don't feel rushed.
Lay clothes nearby.
Choose clothes that you can slip on easily, such as sweat
pants, simple dresses or pants with elastic waistbands.
Look for clothes and shoes with fabric fasteners, such as
Velcro, or replace buttons on clothes you have with fabric
Even in the early stages of Parkinson's disease, your voice
may become very soft or hoarse. To communicate more easily:
Face the person you're talking to, and deliberately speak
louder than you think is necessary.
Practice reading or reciting out loud, focusing on your
breathing and on having a strong voice.
Speak for yourself don't let others speak for you.
Consult a speech-language pathologist who is trained to
treat people with Parkinson's disease.
May help people with Parkinson's improve motor skills and
balance, and help them walk better.
Music therapy: A recent study showed symptoms
improved with music and dance therapy compared to physical
Alexander Technique: emphasizes posture and balance. May
help improve mobility and gait
Feldenkrais Method: aims to re-educate the body about
movements that are difficult. May improve gait
Nutritional supplements: Many supplements may
interact with medications you take for Parkinson's, or may
only be effective at particular doses, do not take any
supplements, even vitamins, without your doctor's guidance.
Homoeopathic Treatment for Parkinsons disease:
Our experience based on about 10 cases of Parkinsons disease
(as on April, 2008), is suggestive of encouraging results.
At this point, we recommend homoeopathy in the early cases
and also those cases where the conventional treatment has
either not helped at all or has helped partially.