CLINICAL
NEUROLOGY
PARKINSON’S: AN OVERVIEW
There is no cure yet for Parkinson’s disease, but there are numerous therapies that help the symptoms.
SYMPTOMS
The four basic, so called 'cardinal signs' include tremor, slowness of movement, stiffness of movement
Parkinson's disease (PD) is a
chronic and progressive movement
disorder, meaning that symptoms
continue and worsen over time.
Nearly one million people in the US are
living with Parkinson's disease. The
cause is unknown, and although there is
presently no cure, there are treatment
options such as medication and surgery
to manage its symptoms.
Parkinson’s disease was first
described 200 years ago in 1817 by
Dr James Parkinson, a London-based
physician. However, the cause of this
neurological disease remains elusive.
Parkinson's disease may produce
a great variety of symptoms, but
the four basic, so called 'cardinal
signs' include tremor, slowness of
movement, stiffness of movement,
and impairment of balance. There is no
test for Parkinson's disease. Diagnosis
is established by listening to the
symptoms and physical examination by
an experienced clinician.
Parkinson’s involves the malfunction
and death of neurons. Parkinson's
primarily affects neurons in the
substantia nigra. Some of these dying
neurons produce dopamine, which
sends messages to the part of the
brain that controls movement and
coordination. As PD progresses, the
amount of dopamine produced in the
brain decreases, leaving a person
unable to control movement normally.
The specific group of symptoms that
an individual experiences varies from
person to person. Primary motor signs
of PD include the following.
• Tremour of the hands, arms, legs,
jaw and face
• Bradykinesia or slowness of
movement
• Rigidity or stiffness of the limbs
and trunk
• Postural instability or impaired
balance and coordination.
Scientists are also exploring
the idea that loss of cells in other
areas of the brain and body contribute
to Parkinson’s. For example,
researchers have discovered that the
hallmark sign of Parkinson’s disease
- clumps of a protein alpha-synuclein,
which are also called Lewy Bodies -
are found not only in the mid-brain but
also in the brain stem and the
olfactory bulb.
These areas of the brain correlate
to nonmotor functions such as sense
of smell and sleep regulation. The
presence of Lewy bodies in these
areas could explain the nonmotor
symptoms experienced by some
people with PD before any motor sign of
the disease appears.
The intestines also have dopamine
cells that degenerate in Parkinson’s,
and this may be important in the
gastrointestinal symptoms that are
part of the disease.
The four primary symptoms of
Parkinson’s are tremour or trembling in
hands, arms, legs, jaw, and face; rigidity
or stiffness of the limbs and trunk;
bradykinesia, or slowness of movement
and postural instability or impaired
balance and coordination.
Patients may also have difficulty
walking, talking, or completing other
simple tasks. The disease is both
chronic and progressive. Parkinson’s is
not usually inherited. Early symptoms
are subtle and occur gradually.
Dyskinesia is usually lifelong and
progressive; therefore, physicians
generally see the disorder in elderly
patients. Medical treatment must be
carefully selected on the basis of the
cause of the dyskinesia. Parki nsonian
dyskinesia is well controlled by drug
therapy. However, patients can become
less responsive to a drug after years
of use and may experience unwelcome
side effects. Cerebellar tremor is
extremely disabling because it worsens
with activity, but no satisfactory
therapy is available. Senile, essential,
and familial tremours are also
intensified by action, but they can often
be suppressed with a mild tranquiliser
or a beta blocker. Drug treatment of
blepharospasm and spastic dysphonia
has been disappointing: Facial or
laryngeal surgery is sometimes
required. Tardive dyskinesia is caused
by neuroleptic drugs, so the only
therapy for the disorder is withdrawal of
the offending drug.
TREATMENT
A variety of medications provide
dramatic relief from the symptoms,
but no drug can stop the progression
of the disease. In some cases, surgery
is an appropriate treatment. Some
doctors recommend physical therapy or
muscle-strengthening exercises.
References available on request.
S4
Biperiden Hydrochloride
(Each Tablet Contains 2mg Biperidin Hydrochloride)
Recommended dosage for the treatment of Parkinson's Disease
B1042 (Act 101/1965)
Reference: 1. MCC approved package insert. 2. Carr J. Guideline for the treatment of Parkinson’s disease SAMJ 2009.
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MEDICAL CHRONICLE | MAY 2017 29