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Parkinsonís disease (PD)
Parkinsonís disease, also called paralysis agitans or shaking palsy is a movement disorder. Cases of PD are reported at all ages, though it is uncommon in people younger than 40.
This disease is more common among men and usually occurs after 60 years.
The average age at which symptoms begin in the USA. is 58-60.
The nerve cells in the part of the brain which control movements are mainly affected. The nerve cells (neurons) which make the chemical called dopamine either donít work sufficiently or are completely destroyed. The real cause behind this had never been identified. Though, many risk factors have been enumerated in literature.
Persons suffering from Parkinsonís disease need not present with every common symptom. The number of symptoms and their intensities are known to vary with every individual. Most common signs & symptoms of Parkinsonís include:
Tremors felt in the fingers, hands, arms, legs, jaw and face. Initially these tremors are mild and visible only while resting. Eventually they become visible even during routine movements.
Rigidity is another symptom. Persons suffering often feel stiffness or inflexibility in their muscles. Muscles normally stretch when they move, and then relax when they are at rest. In rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes resulting in a decreased range of motion.
Muscular movements like walking, running, dancing, sitting, grasping objects with fingers all seem very stiff. Rigidity can cause pain and cramping. The sense of fluidity in these movements is lost. In advanced conditions, even the facial muscles become very rigid, thus giving an appearance of an expressionless face, something akin to wearing a mask.
Bradykinesia or slowness of movements usually accompanies the sensation of stiffness and rigidity. A person with bradykinesia will probably also have incomplete movements, difficulty initiating movements and sudden stopping of ongoing movement.
There is increasing inability to perform tasks which require rapid alternating movements.
Loss of balance and in coordination of movements results in frequent falls when beginning to walk or run.
Gait: There is a Ďshufflingí gait characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to trip the patient.
Decreased arm swing.Turning Ďen-blocí, rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and upper body rigid, requiring multiple small steps to accomplish a turn. Stooped, forward-flexed posture both when sitting and standing. Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
Dystonia: abnormal, sustained, painful twisting muscle contractions, usually affecting the foot and ankle, interfering with gait. However, dystonia can be quite generalized, involving a majority of skeletal muscles; such episodes are very painful and completely disabling.
They may go through periods of "freezing", which is when a person feels stuck to the ground and finds it difficult to start walking. The slowness and incompleteness of movement can also affect speaking and swallowing.
Speech: the voice becomes very soft. Later, the sound turns hoarse and monotonous. Occasionaly, the speech becomes excessively rapid, soft, and poorly-intelligible.
Gradual progress in the disorder causes an inability to understand the meaning & essence of speech. Also, there is difficulty in deciphering the facial expressions seen on others when conversing.
Drooling: Weak swallowing and stooped posture causes drooling of saliva.
These symptoms certainly vary in intensities in different persons. They are seen as the disease progresses and everyone do not suffer from all of them.
We now know that many of the signs and symptoms of Parkinson's disease develop when certain nerve cells (neurons) in an area of the brain called the substantia nigra are damaged or destroyed. Normally, these nerve cells release dopamine ó a chemical that transmits signals between the substantia nigra and another part of the brain, the corpus striatum. These signals cause your muscles to make smooth, controlled movements.
As a normal part of aging everyone loses some dopamine-producing neurons.
People with Parkinson's disease lose half or more of neurons in the substantia nigra. Although other brain cells also degenerate, the dopamine-containing cells are critical for movement and so their damage takes center stage.
Causes of Parkinson's disease:
Why Parkinson's Disease occurs, no one knows. These are some factors that scientists believe predisposes individuals to PD.
Genetic factors: About 15 to 25 percent of people with Parkinson's report having a relative with the disease. This means that if your parent has Parkinson's, your chances of developing the disease are slightly higher than the risk in the general population.
Studies have revealed that there may be more of a genetic basis to young-onset PD (that is, the 10 percent or so of people with Parkinson's for whom onset occurs at or before age 50) than to later-onset PD.
The vast majority of Parkinson's cases are not directly inherited, but researchers have discovered several genes that can cause the disease in a small number of families. Genetic diseases occur when important genes contain mutations, which result in abnormal proteins that in turn cause disease.
Environmental factors: Scientists have suggested that Parkinson's disease may result from exposure to an environmental toxin or injury. Research has identified several factors that may be linked to PD, including rural living, well water, herbicide use and exposure to pesticides. Pesticides are thought to adversely affect the brain by inhibiting energy production resulting in brain cell death.
Studies have also shown that smoking and caffeine use appear to protect against the development of PD. However, it is universally agreed that the health risks associated with smoking are worse than any incidental benefits that might be gained by this habit.
Also, a synthetic narcotic agent called MPTP can cause immediate and permanent Parkinsonism if injected.
Head trauma: Past episodes of head trauma are reported more frequently by sufferers than by others in the population.
Drug induced:Antipsychotics, which are used to treat schizophrenia and psychosis, can induce the symptoms of Parkinson's disease (or parkinsonism) by lowering dopaminergic activity.
Currently no blood or laboratory tests that have been proven to help in diagnosing PD. It is difficult to diagnose PD accurately. Thus, medical history and a neurological examination alone guide the physician in diagnosing.
There are a number of disorders that mimic Parkinsonís disease in some of their symptoms. On close examination though, they are distinguisale from the idiopathic PD. These conditions fortunately have additional symptoms which do not occur in PD.Such disorders need to be ruled out before establishing a diagnosis of PD.
These Parkinson-plus syndromes are usually more rapidly progressive and less likely to respond to anti-parkinsonian medication than Parkinson's disease. However, the additional features of the diseases may respond to medications not used in Parkinson's disease.
There is no permanent cure for PD. Though many patients show dramatic response to medications initially, with gradual progress, the benefits of drugs diminish.
Treatment usually comprises of: -
Medications: medications help control the problems faced in walking, movements and tremor. However, they need to be taken in various combinations which need to be changed after every little while. The medicines used are:
Levodopa and Carbidopa: Levodopa had been the Ďgold standardí for treating PD since its introduction in 1960. levodopa is a naturally occuring substance in nature. It is a precursor of the chemical dopamine which gets converted to dopamine by the nerve cells in the brain. There is a fine meshwork-like structure in the brain which acts like a filter that allows only selective substances to cross through and enter the brain. This structure is called the blood-brain barrier. Dopamine itslef cannot cross this barrier, but levodopa can. Hence, dopamine itself is never prescribed in PD.
Unfortunately, though the side-effects of these drugs(nausea; postural reduction in blood pressures) are not major, their doses need to be frequently regulated. The quantity of each dose as well as its frequency of repetition keeps increasing lifelong.
These medicines nevertheless allow persons suffering to extend the period for which they can lead a normal life.
Dopamine agonists: though not levodopa, these drugs mimic the action of levodopa and cause neurons to behave as though they are receiving dopamine.
This class of drugs includes:
Pramipexole (Mirapex) and
Selegiline: This drug helps prevent the breakdown of dopamine.
Catechol-O-methyltransferase: These drugs prolong the actions of levodopa and carbidopa by preventing an enzyme from breaking down dopamine.
Anticholinergics: These are used to control the tremors. But, often the side effects (loss of memory, hallucinations, confusions, dry mouth, nausea, urine retention, severe constipation) make their use undesirable.
Amantadine: Provides short-term relief from early, mild Parkinsonís disease. Side-effects (swollen ankles, purple mottling of skin) are not very severe.
Co-enzyme Q10: The majority of the energy utilized by the cell is produced within the mitochondria. This is a substance present within the mitochondria of the cells. Co-enzyme Q10 is responsible for electron transport by which the cell derives energy from Oxygen during respiration.
Thalotomy: destroys a few tissues within the thalamus (a major centre in the brain handling the relay of messages and transmitting sensations. This procedure reduces tremors in some people. Though, it can cause slurring of speech and lack of coordination in movements.
Pallidotomy: this procedure consists of removing tissues within the pallidus (a part of the brain responsible for causing PD). Tremors, rigidity and slowness of movements are all controlled by this procedure. Though the procedure provides relief, the effects are not long-lasting and the condition usually recurs.
Slurred speech, vision problems, severe weaknesses are some of the side-effects.
Deep brain stimulation: A small device that transmits electrical impulses is planted deep within the brain from where it stimulates the sub-thalamic nucleus which controls many motor functions. This procedure however runs the risk of developing a bleed (hemorrhage) like a stroke. There are high incidences of developing an infection as well. Hence, this procedure is a last option.
Certain changes in diet and life style can go a long way in improving a persons coping skills with PD.
Eat more of fruits, vegetables and whole grains.
These foods are high in fiber, which is important for helping prevent constipation. Also, drink plenty of water and increase fibre intake through supplements.
Regular exercise is extremely important if you have Parkinson's disease. It helps improve mobility, balance, range of motion and even emotional well-being. Your doctor or physical therapist may recommend a formal exercise program, but any physical activity, including walking, swimming or gardening, is beneficial. Weight-bearing exercises, such as walking, jogging and dancing, may be helpful.
Keep in mind that your energy level may go up and down, and you'll sometimes need to pace yourself. If you're tired, try doing one part of your routine at one time of day and adding another segment later. Choose a time to exercise when your medicines are working well and you feel strong.
Be sure to stretch before and after you exercise. Stretching warms up your muscles, helps prevent stiffness, and improves your flexibility and balance.
Walking with care
Parkinson's disease can disturb your sense of balance, making it difficult to walk with a normal gait. These suggestions may help:
If you notice yourself shuffling, slow down and check your posture. It's best to stand up straight with your head over your hips and your feet eight to 10 inches apart.
Buy a good pair of walking shoes. Avoid running shoes.
Practice taking long steps and exaggerate lifting your legs and swinging your arms.
If you become stuck in place ó known as freezing ĺ rock gently from side to side or pretend you're stepping over an object on the floor.
In the later stages of the disease, you may fall more easily. That's because Parkinson's disease affects the balance and coordination centers in the brain. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:
Ask your doctor or physical therapist about exercises that improve balance, especially Tai chi. originally developed in China more than 1,000 years ago, tai chi uses slow, graceful movements to relax and strengthen muscles and joints.
Wear rubber-soled shoes. They're less likely to slip than are shoes with leather soles.
Remove all area rugs from your home and make sure carpeting is secured firmly to the floor.
Install handrails, especially along stairways.
Keep electrical and telephone cords out of the way.
Install grab bars around your tub and beside the toilet.
Make sure you can reach the telephone from your bed and carry a cordless phone with you during the day.
Dressing can be the most frustrating of all activities for someone with Parkinson's disease. The loss of fine motor control makes it hard to button and zip clothes, and even to step into a pair of pants. A physical therapist can point out techniques that make daily activities easier. These suggestions also may help:
Allow plenty of time so you don't feel rushed.
Lay clothes nearby.
Choose clothes that you can slip on easily, such as sweat pants, simple dresses or pants with elastic waistbands.
Look for clothes and shoes with fabric fasteners, such as Velcro, or replace buttons on clothes you have with fabric fasteners.
Even in the early stages of Parkinson's disease, your voice may become very soft or hoarse. To communicate more easily:
Face the person you're talking to, and deliberately speak louder than you think is necessary.
Practice reading or reciting out loud, focusing on your breathing and on having a strong voice.
Speak for yourself ó don't let others speak for you.
Consult a speech-language pathologist who is trained to treat people with Parkinson's disease.
May help people with Parkinson's improve motor skills and balance, and help them walk better.
Music therapy: A recent study showed symptoms improved with music and dance therapy compared to physical therapy
Alexander Technique: emphasizes posture and balance. May help improve mobility and gait
Feldenkrais Method: aims to re-educate the body about movements that are difficult. May improve gait
Many supplements may interact with medications you take for Parkinson's, or may only be effective at particular doses, do not take any supplements, even vitamins, without your doctor's guidance.
Homeopathic Treatment for Parkinsonís disease:
Our experience based on about 10 cases of Parkinsonís disease (as on April, 2008), is suggestive of encouraging results. At this point, we recommend homeopathy in the early cases and also those cases where the conventional treatment has either not helped at all or has helped partially.
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