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What is Parkinson's disease?

Parkinson's disease (PD) is a chronic neurological condition named after Dr. James Parkinson, a London physician who was the first to describe the syndrome in 1817. PD is a slowly progressive disease that affects a small area of cells in the mid brain known as the substantia nigra. Gradual degeneration of these cells causes a reduction in a vital chemical known as "dopamine". This decrease in dopamine can produce one or more of the classic signs of Parkinson's disease:
   resting tremor on one side of the body
   generalized slowness of movement (bradykinesia)
   stiffness of limbs (rigidity)
   gait or balance problems (postural dysfunction)

What are some other signs of Parkinson's disease??

Other symptoms observed in some persons with Parkinson's disease can include:
   Small cramped handwriting (micrographia)
   Lack of arm swing on the affected side
   Decreased facial expression (hypomimia)
   Lowered voice volume (dysarthria)
   Feelings of depression or anxiety
   Episodes of feeling "stuck in place" when initiating step...called "freezing"
   Slight foot drag on the affected side
   Increase in dandruff or oily skin
   Less frequent blinking and swallowing

Few patients experience all of these symptoms and some may experience other signs.

Is this a rare disease?

It is estimated that up to 1.5 million Americans are affected, more persons than those suffering from Multiple Sclerosis and Muscular Dystrophy combined. Although 15% of patients are diagnosed before age 50, PD is generally considered a disease which targets older adults.

Parkinson's disease affects one of every 100 persons over the age of 60. Thanks to public health strides and healthier lifestyle choices, many people now live well into their eighties, adding to the impression that the incidence of Parkinson's disease is increasing.

While there is, as yet no cure for this condition, progressive treatments allow many patients to maintain a high level of function throughout their lifetimes. It is crucial to note that Parkinson's disease is not a fatal illness.

What do we know about the cause of Parkinson's disease?

The cause of Parkinson's disease remains a mystery. Most people who develop symptoms of primary Parkinson's disease have "Idiopathic Parkinson's Disease"..(idiopathic meaning the etiology or exact cause is unknown).

Patients may attempt to link the onset of Parkinson symptoms with some acute trauma...an accident, surgery, or extreme emotional distress. Most neurologists discount any direct link; a traumatic event might trigger symptoms before they would otherwise manifest, but this should not be confused with actual causation of the Parkinsonism. After all, most people who experience these traumatic events do not develop a movement disorder such as PD.

There are also secondary forms of Parkinsonism. Some drugs interfere with the brain's metabolism of dopamine, and prolonged use can produce Parkinson features. These medications include:
    Haloperidol and other medications used to treat hallucinations and confusion in the elderly
   Some anti-hypertensive drugs which contain reserpine
   A commonly prescribed anti-nausea drug, metoclopramide (Reglan).

The worldwide epidemic of encephalitis in the early 1900's induced Parkinson-like symptoms, as portrayed in the popular film, The Awakening. This epidemic of an atypical inquiry led to extensive scientific inquiry into the possibility of a virus as the cause of Parkinson's disease. However, there is no substantive evidence for this theory. Parkinson's disease is certainly not contagious, passed from one person to another, as one might suspect with a viral agent.

While there are isolated instances of a high incidence of Parkinson disease in certain families. there is at present no definitive research that identifies an actual gene linked to Idiopathic Parkinson's Disease (the most common form of PD). Early studies of PD in identical twins sponsored by the National Institute of Health denied the existence of any hereditary etiology; that data is currently under review and other studies are investigating the possibility of some familial predisposition to this neurological condition.

Is there a cure for Parkinson's disease?

To date, there is no known prevention or cure for Parkinson's Disease. It would be a mistake for newly diagnosed patients to drift from doctor to doctor looking for a "magic bullet" or miracle drug to completely eliminate all symptoms of PD.

Since there is no definitive lab test or brain scan to verify the clinical diagnosis of Parkinson's disease, it is strongly recommended that patients seek clinical verification of the diagnoses from a board-certified neurologist who specializes in movement disorders.

The good news is that physicians now have a much clearer profile of this condition, and many effective medications are now available to treat the symptoms. Good medical management helps restore lost functions in an untreated patient, and protects against secondary symptoms that could otherwise develop.

What is the pattern of progression in Parkinson's disease?

Parkinson's disease often begins with an episodic tremor of the hand on one side of the body. Tremors may be distressing because of their visibility to others, but fortunately, this symptom rarely lead to serious disability (approximately 25%, of PD patients do not even have tremors).

Resting tremors may be accompanied over time with slowness and stiffness on the affected side. As symptoms progress, patients may notice impairment on the other side of the body, almost always less severe than the primary side. Due to fine motor deficits, finger and hand movements requiring skilled coordination--such as brushing teeth, shaving, and buttoning clothes may become slow and difficult. Some patients notice a slight foot drag on the affected side, or a feeling of walking with great effort ("as if through quicksand") at times. Steps become shorter, or freezing (described earlier) may occur when initiating movement. The voice can become softer in volume and take on a raspy quality.

Many Parkinson patients do at some point experience gait and balance problems. Difficulty navigating doorways and narrow passages, stutter-steps, and precarious balance on turning are common examples of Parkinsonian gait disturbance. Preventing falls and subsequent injuries becomes a major priority.

It is critical to stress again that both the nature and severity of symptoms vary tremendously from one patient to another. A patient should not assume he or she will experience all symptoms described, since this rarely is the case.

If Parkinson symptoms do interfere with a patient's ability to manage his or her independent activities of daily living, the physician can recommend referral to physical, occupational, or speech therapists who can evaluate and provide therapy to address the problems.

Pharmacotherapy is certainly not the only effective tool in treating Parkinson's disease.

Where can I find further information on Parkinson's disease?

The Parkinson Foundation of the National Capital Area is available to answer any questions you may have. For more information on our programs and services, please call 703-287-8729.