Parkinsonism

Parkinsonism refers to a group of chronic, progressive disorders that severely impair an individual’s motor control, or ability to activate and coordinate the muscles and limbs used in movement. Impacted motor skills include gross motor skills, which involve the large muscle groups that affect walking, running, balancing, and climbing stairs. They also refer to fine motor skills, which involve small muscle groups such as those that enable grasping, holding, and manipulating small objects.

Because these conditions are chronic and progressive, they gradually worsen over time. They are not considered fatal conditions because they do not directly lead to death. However, they have severe complications that may shorten the life span and result in quality of life challenges.

Classifications

Parkinsonism disorders are classified as primary parkinsonism or secondary parkinsonism. Primary parkinsonism refers to disease that develops due to a genetic problem. Abnormalities with at least ten genes are tied to primary parkinsonism.

Secondary parkinsonism refers to conditions that are brought on by certain medicines (including street drugs), a nervous system disorder, or some other illness or injury. These conditions mimic the problems of primary parkinsonism but are not caused by genetics. Some experts suspect that secondary parkinsonism can also be caused by a combination of genes and environmental factors, such as exposure to pesticides or other toxins.

Parkinson's disease is the primary and most common form of parkinsonism.

Parkinson's Disease

Symptoms of Parkinson's disease (PD) usually begin slowly and often only affect one side of the body at first. Symptoms include characteristic shaking or trembling of the hands, arms, legs, jaws, and face; muscle stiffness and a corresponding slowness of movement; and poor balance, which often leads to falls and broken bones, especially in older persons.

As symptoms worsen, patients have trouble with simple tasks such as walking, talking, swallowing, picking up objects, and eating. They may also experience mental issues, such as dementia and memory loss, and may feel anxious and depressed.

Diagnosis

Doctors cannot diagnose PD easily because there is currently no lab test available. Instead, diagnosis is dependent on a complete history, neurological exam, and the presence of one or more of four primary motor symptoms.

Primary Motor Symptoms

The following primary motor symptoms were originally described by James Parkinson in 1817 and expanded and refined by Jean-Marie Charcot in 1872.

• Resting tremors. One of the most characteristic signs of PD is tremors while at rest. More than 70 percent of patients display this symptom. Tremors may initially be limited to slight shaking of a single hand, foot, finger, or one side of the body. The tremor is noticeable when at rest and tends to subside with action. As the disease progresses, the tremor becomes more obvious in other body parts or along the other side of the body.
• Bradykinesia. This slowness of movement appears as abnormal stiffness, a lack of facial expressivity, and a limited range of motion. Bradykinesia causes difficulties with everyday functions because it interferes with the spontaneity of movement.
• Rigidity. People with PD experience an inflexibility of the muscles, which appear constantly contracted. The most common points of rigidity include the neck, shoulders, and legs. This symptom can be painful and uncomfortable.
• Postural instability. A key sign of PD is the tendency to be unstable when standing in an upright position. This occurs due to a loss of the reflexes and balance needed to maintain an upright posture.

Secondary and Non-Motor Symptoms

A doctor’s diagnosis will also consider any secondary motor symptoms experienced by the patient as well as non-motor symptoms, or those symptoms that do not involve movement, coordination, or mobility.

Secondary symptoms may vary in degree or presentation and include the following:

• Gait freezing, or problems with motion
• Unwanted acceleration, or a tendency to move too rapidly
• Stooped posture, or a tendency to lean forward
• Decreased ability to swing the arms
• Speech problems, including soft tones and/or slurring
• Difficulty swallowing
• Drooling
• Cramping
• Sexual dysfunction

Non-motor symptoms considered in diagnosis include the following:

• Loss of sense of smell
• Chronic constipation
• Sleep disorders
• Mood disorders
• Low blood pressure when standing
• Weight loss or gain
• Vision problems
• Dental problems
• Fatigue and loss of energy

Treatment Options

Parkinson's disease and related disorders are incurable. However, treatment options can help to alleviate symptoms and improve quality of life. These options include medication, surgery for qualified patients, and lifestyle changes.

Although a variety of classes of prescription medications are available to treat the disease, the most effective is a formulation called carbidopa/levodopa. It works by increasing the amount of dopamine in the brain. However, it also has side effects that many patients find unpleasant, including nausea, low blood pressure, confusion, and dry mouth. Fortunately, many formulations are available at different dosages so that patients and their health care providers can find the prescription that works best. Health care providers may also prescribe other prescription medications as well.

Deep brain stimulation (DBS) is the most common surgical treatment option. During this procedure, electrodes are inserted at particular regions in the brain and a device called an impulse generator is implanted under the collarbone. The device sends electrical impulses to the part of the brain that controls movement. DBS helps to reduce stiffness, slowness, tremors, and other obvious characteristics of Parkinson's disease. Patients are given a controller to administer impulses as needed. DBS is not a cure but can help alleviate symptoms for a period of several years.

Recommended lifestyle changes include eating a healthy diet; avoiding smoking, alcohol, and caffeine; and staying as active as possible. Health care experts recommend that patients with parkinsonism seek adjunct therapeutic treatments such as physical and occupational therapy in order to maintain the highest quality of life; additionally, support groups can help patients feel less alone as they deal with this condition.

Bibliography

"Parkinson Disease." MedlinePlus. National Institutes of Health, U.S. National Library of Medicine. Web. 18 Feb. 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000755.htm

"Parkinsonism." Genetics Home Reference. Lister Hill National Center for Biomedical Communications, U.S. National Library of Medicine. 15 Feb. 2016. Web. 18 Feb. 2016. http://ghr.nlm.nih.gov/glossary=parkinsonism

"Secondary Parkinsonism." MedlinePlus. National Institutes of Health, U.S. National Library of Medicine. Web. 18 Feb. 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000759.htm

"Understanding Parkinson’s." The Michael J. Fox Foundation for Parkinson’s Research. The Michael J. Fox Foundation for Parkinson’s Research. Web. 18 Feb. 2016. https://www.michaeljfox.org/understanding-parkinsons/index.html

"What Is Parkinson’s Disease?" Parkinson’s Disease Foundation. Parkinson’s Disease Foundation, Inc. Web. 18 Feb. 2016. http://www.pdf.org/en/about‗pd