What is Parkinson’s Disease?
Parkinson’s disease is a slowly-progressing degenerative disease of the brain caused by deposition of lewy bodies(protein alpha-synuclein) in a certain region of the brain, called the substantia nigra of basal ganglia, leading to loss of dopaminergic neurons which produces a substance called dopamine. Dopamine helps in the controlling body movements; deficiency of this leads to irregular and uncoordinated signals leading to motor symptoms. This condition is called as Parkinsonism or Parkinson’s Disease, as it is commonly known.
What causes Parkinson’s Disease?
The exact cause of Parkinson’s Disease is unknown but it’s a multi factorial illness with some environmental and genetic determinants.
Role of many genetic factors are increasingly recognised; particularly, if onset is below 50 years of age.
Environmental factors include:
- MPTP( previously identified in IV drug abusers)
- Certain pesticides (paraquat, rotenone)
- Other metal poisoning
- Organic toxins
- Prior head injuries
The risk of Parkinson’s Disease is lower with high dietary intake of antioxidant rich food, caffeine and cigarette smoking.
What are the symptoms of Parkinson’s Disease?
Age of onset of Parkinson’s Disease is above 50 years. onset and progression are gradual. disease before 30 years is rare and often suggests hereditary form of Parkinson’s Disease. Symptoms can be divided into two categories: Motor and Non-Motor.
Motor symptoms are the most recognizable ones, which includes:
- Tremors( shaking): Tremor in resting position is the most common symptom of Parkinson’s Disease. It typically starts in one hand (unilateral) and then spreads to the opposite side as the disease progresses. It’s a slow and pill rolling type tremor.
- Bradykinesia (slowness of movement): It is seen in all patients with Parkinson’s Disease. It includes difficulty in initiation and execution of movements, taking longer time for the completion of skilled acts, soft speech (hypophonia), change in writing (micrographia)sudden arrest in movement (freezing episodes) and gait imbalance.
- Rigidity: Another common symptom which is visible among patients with Parkinson’s disease is rigid movement. Fidgety behaviour with other rigid movement of hands or even legs is a sign of Parkinson’s.
Non-motor symptoms include:
- Urinary frequency & urgency
- Disordered sweating
- Memory loss
- Behavioural inconsistency
- Sleep disturbances
- Anxiety, depression and other mood disorders
Can Parkinson’s Disease be treated?
The most important step in treating Parkinson’s Disease is diagnosis. Diagnosis mostly depends on clinical findings and rarely needs any imaging like CT scan, MRI or DAT SCAN. But on occasions, to rule out secondary Parkinsonism, PET-CT may be required. Medical and surgical treatment options are available, but there is no standard treatment or cure for the disease. The treatment varies depending on the symptomatic profile of the patients.
Medicine: Symptoms can be controlled with medications which improves dopamine availability in the basal ganglia. Various medications like levodopa (dopamine analogue), MAO inhibitors, dopamine agonists, Amantadine and Anticholinergic agents are available. usually the initial treatment is Levodopa. However, the treatment is going to be for the person’s lifetime.
Surgeries: A surgical option is available in the form of DBS (deep brain stimulation).
Physiotherapy: Physiotherapy is a potential form of treatment.
Deep Brain Stimulation Surgery
Deep Brain Stimulation Surgery is one of the most commonly performed surgeries. But not every patient will be a good candidate for the surgery. Patients who show betterment in motor response after taking levodopa and patients suffering for more than 5 years with motor fluctuations & troublesome dyskinesias due to long term medications can be considered for surgery.
Deep Brain Stimulation Surgery helps reducing symptoms like stiffness, tremor and slowness and lessens the medication requirement in appropriately selected cases. This procedure involves stimulation of subthalamic nucleus/ globus pallidus interna (parts of basal ganglia) with the help of microelectrode wires inserted by making small holes in the skull one or both sides of the brain.
Interestingly, more often than not, the patient stays awake during the surgery to guide the electrode placement while assessing the clinical signs. The electrodes are connected to the external pacemaker which is implanted in the subcutaneous pocket in the chest (similar to cardiac pacemaker). The current in the pacemaker is adjusted according to the patients symptoms with the help of hand held programmer which can be operated by the patients by themselves.
Curing Parkinson’s disease entirely is probably not yet possible. But the best hope comes from Deep Brain Stimulation Surgery. A surgery might sound scary but it’s worth a try if it gives you back the control of your own body, don’t you think? Talk to your doctor about your concerns. She will help you clear your doubts and calm your mind before the surgery!
About the Doctor:
After completing her MBBS in 1999 and getting a gold medal from SVS Medical College in Mahboobnagar, Dr. Anitha Kotha went on to becoming the Diplomate in National Board for General Medicine at the prestigious Nizam’s Institute of Medical Sciences for 3 years. After that, she went on to serve as the Doctor of Medicine for Neurology in NIMS. Dr. Anitha is one of the most experienced neurosurgeons and is a life member of the prestigious Indian Academy of Neurology and also the Medical Association of India.