Managing Parkinson’s Disease
Parkinson’s Disease is diagnosed clinically, treated with dopamine replacement and patients can lead a good life with appropriate management. Parkinsons Disease (PD) is a neurodegenerative illness primarily caused due to loss of cells secreting Dopamine, which is an important neurotransmitter (chemical signal) dealing with smooth and balanced muscle movement.
• In most cases the cause of PD is not known. Environmental factors such as pesticide exposure and heavy metals have been postulated. In practice we are finding a significant increase in PD. This may be related to increased exposure of people to pesticide content in food including vegetables and fruits.
• The incidence of PD increases with ageing. Prevalence and incidence of PD are expected to increase by more than 30% by 2030.
Does it run in families?
One of the common question many people ask is do they have Parkinson's as my parent is suffering from same. There are many new genetic mutations now described in Parkinson’s. However familial Parkinson’s is rare and constitute less than 15%. Some of the early onset Parkinson's (less than 40 years) may be familial.
The classical symptoms described are Bradykinesia (Slowness), Rigidity (Stiffness) and Tremors (shaking). Later it affects the walking (Gait) as well as balance.
• In addition there are other non-motor symptoms including Depression, anxiety, disturbed sleep, constipation. In later stages patients may have memory and other behavior issues.
Are all tremors Parkinson's?
• No. Most common cause of tremor is Essential tremor (ET), which may run in families. In ET the tremor interferes with action including writing. In contrast Parkinson tremor usually absent with activities and mainly seen when the patient is at rest or walking.
• The other causes of tremor include Hyperthyroidism and some medications.
• The diagnosis is mainly clinical, based on the history and neurological examination.
• There are no specific tests or markers for diagnosis. Sometimes a brain imaging is done to rule other causes.
• Newly available scans including SPECT scan and Dopamine transporter scan (DaT scan) may support the diagnosis of Parkinson's, but these are usually not required.
• Dopamine replacement is the primary mode of treatment. This includes Levodopa which is the gold standard, and Dopa agonists.
• There are other drugs which are used to support the replacement therapy.
• Drugs to improve non motor symptoms like depression, sleep disorders, constipation and urinary symptoms may be needed in selected patients.
What is Deep Brain Stimulation (DBS)?
• DBS is a surgical procedure that involves implanting electrodes in the brain, which deliver electrical impulses through a pacemaker that modify the abnormal brain activity resulting in symptoms of Parkinson’s disease.
• It’s useful for selected patients who develop uncontrolled abnormal movements (dyskinesias) while on Levodopa therapy and patients with uncontrolled tremors.
• It's not useful for patients who have poor response to levodopa (Atypical Parkinson's).
• Surgery is usually not recommended if patient has adequate symptom relief with medications.
• In rightly selected patients it leads to significant improvement in quality of life.
Advances in Parkinson's disease
• Since James Parkinson first described the disease 200 years back (1817), considerable advances has happened in understanding the genetics and pathology of illness.
• Active research is ongoing for novel therapeutic strategies (Eg. Neurotrophic factors) which can prevent progression of disease as well as newer drug delivery system.
• Currently there is no cure available. However most patients can a lead a good life with appropriate management.
• Patient should have a regular follow up with a neurologist who is proficient in managing the same. Patient and relatives should be able to identify his problems, both motor and non-motor, and discuss with the treating doctor and take appropriate correction.
• Regular exercise including aerobic, walking and resistance training improve fitness, balance, motor coordination and overall well-being. Research had shown patients who exercise regularly for at least 2.5 hours weekly, reduces the progression of the disease.
• Hobbies like gardening, learning new skills like music, dancing etc., improve the quality of life in PD patients.
• A good family and social support have an equally important role.