At its simplest, it is a progressive* neurological disorder, which so far cannot be cured. It is variable in its progression, i.e. some people progress more slowly than others, and the symptoms can be effectively controlled with medication for many years. Parkinson’s results from a shortage of dopamine, a chemical that helps instructions from the brain to cross from one nerve cell to the next, in a part of the brain called the substantia nigra, which has to do with controlling movement. We all lose some of this chemical as we get older, and the loss starts at birth! However, it is only when we have lost about 80% of our dopamine we start to have symptoms. So people with Parkinson’s have lost this chemical at a slightly faster rate than others.
So how can you help yourself?
Parkinson’s does not react well to stressful situations, so avoid stress as much as possible. Eat well balanced diets and exercise often to keep joints and muscles agile and flexed. Continue to live well and do not avoid social interactions. Drug management is critical to living well and it is important to take any drugs prescribed to you in the way that they have been prescribed.
*progressive = getting worse over time Substantia Nigra
The most common signs of Parkinson’s are tremors (involuntary shaking), usually seen in one hand or foot, a slowness in movement and a increase in rigidity (stiffness).
There are two classifications of symptoms – motor and non-motor. Motor symptoms relate to movement, such as tremor, and non-motor relate to problems such as depression and constipation.
Tremor seen in people with Parkinson’s is present when the hand or leg is at rest, or not in use, and we call this a resting tremor. For example, if you have a resting tremor in your hand, when you are sitting and relaxed, your hand begins to tremble, but when you reach your hand out to pick up something, the movement stops.
Anxiety can cause the tremor to become worse, so people with Parkinson’s will often notice that in times of high stress, the tremor can be very noticeable. Not all people with Parkinson’s will have a tremor, although according to the UK Parkinson’s Society website, it is estimated that up to 70% of people with Parkinson’s will develop a tremor.
Slowness of Movement (Bradykinesia)
Slowness of movement is often described as a difficulty in completing daily tasks at the usual speed and ease, for example getting dressed.
This slowness in movement can also affect the way in which you walk, as it may cause short, shuffling steps.
The stiffness caused by Parkinson’s can be a result of the muscles being unable to stretch or relax. Light exercises or physiotherapy can help loosen up tight muscles, and improve mobility.
Feel free to contact your local Parkinson association for some helpful tips and tricks and request a copy of our exercise wall chart devised by a physiotherapist specifically for Parkinson’s.
Constipation in Parkinson’s is a very common problem. It is very important to manage this, as constipation can cause a delay in the uptake of medication, and result in little or no benefit from the drugs. Simple tips to avoid constipation include drinking plenty of fluids, especially water, try to include fresh fruit and vegetable in your diet, as they are a great source of fibre, and try to stay as active as possible, as lack of exercise can contribute to constipation.
If you do suffer from constipation, and you find that these tips don’t help, it’s important to talk to your doctor and it may be necessary to start taking a laxative to help.
Depression is a very common symptom in Parkinson’s. It is diagnosed after a prolonged period (2 weeks or longer) of low mood. Depression can be a very debilitating element of Parkinson’s, causing feelings of low self-esteem and hopelessness. It is very important that you tell your doctor if you are having issues with your mood, as depression can be managed very well with the right help.
Anxiety is often seen in people with Parkinson’s, and can be associated with wearing off (i.e. the wearing off of the medication).
So how can you help yourself? You can avoid or deal with stress, eat well, exercise, and that all helps. Some people are prescribed antioxidants by their neurologists on the basis that they might help slow down the progression.
The first and most important aspect to treatment is to have a proper diagnosis. Following diagnosis a treatment regime will be planned for you and this may include:
- occupational therapy
- speech and language therapy
- community nurse
- nurse specialist
- social worker
Drugs will inevitably form a part of the treatment at some stage but your physician may not opt for this type of treatment in the early stages of the condition.
The main families of drugs useful for treating motor symptoms are Levodopa, dopamine agonists and MAO-B inhibitors. The most commonly used treatment approach varies depending on the condition stage. Two phases are usually distinguished: an initial phase in which the individual with Parkinson’s has already developed some disability for which s/he needs pharmacological treatment, and a second stage in which the patient develops motor complications related to Levodopa usage. Treatment in the initial state aims to attain an optimal trade off between good management of symptoms and side-effects resulting from enhancement of dopaminergic function.
The start of L-DOPA treatment may be delayed by using other medications such as MAO-B inhibitors and dopamine agonists, in the hope of causing the onset of dyskinesia to be reduced. Dyskinesia consist of effects including diminished voluntary movements and the presence of involuntary movements. In the second stage the aim is to reduce symptoms while controlling fluctuations of the response to medication. Sudden withdrawal from medication is unsafe, and overuse by some patients can be detrimental, so have to be controlled.
Deep Brain Stimulation (DBS)
When medications are not enough to control symptoms or where a person with Parkinson’s reacts badly to Parkinson’s medication, surgery and deep brain stimulation can be of use. Not everyone is a suitable candidate for DBS and there is a rigorous process for candidate selection. Unfortunately DBS is not available in Ireland and patients must travel to the UK for treatment under the Health Service Executive (HSE).Deep brain stimulation is a surgical treatment involving the implantation of a medical device into the brain, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement disorders such as Parkinson’s, tremor and dystonia. DBS directly changes brain activity in a controlled manner and remarkable results can be seen at an early stage.
Parkinsonism is an umbrella term, which means that the person has symptoms similar to Parkinson’s (like tremor, rigidity, slowness of movements and balance problems), although a doctor is not sure whether those symptoms are due to the loss of dopamine. A number of patients with Parkinsonism do not have PD. Only 85% of all Parkinsonism are due to idiopathic Parkinson’s. Certain medications, vascular problems, and other neurodegenerative conditions can cause the symptoms similar to Parkinson’s. In fact, early in the condition process it may be difficult to know whether a patient has typical Parkinson’s or a syndrome that mimics it. The development of additional symptoms and the subsequent course of the condition generally points to the correct diagnosis.
Neurodegenerative conditions causing Parkinsonism are commonly grouped together under the category of Atypical Parkinsonism or Parkinson – plus syndromes. The plus part means, that in addition to expected symptoms of PD, patients have some atypical symptoms as well. Atypical Parkinsonism should be considered particularly in patients with:
- Poor response to dopamine
- Early loss of balance
- Prominent intellectual changes (dementia)
- Rapid onset or progression
- Conspicuous postural hypotension, urinary and bowel incontinence
- Little or no tremor.
Multiple system atrophy (MSA)
Both multiple system atrophy and Parkinson’s cause stiffness and slowness in the early stages. But the additional problems, such as difficulty with swallowing and dizziness that develop in multiple system atrophy, are unusual in early Parkinson’s. The condition used to be known as striatonigral degeneration, Shy Drager syndrome, or olivopontocerebellar atrophy.
Progressive supranuclear palsy (PSP)
Progressive supranuclear palsy is sometimes called Steele-Richardson-Olszewski syndrome. It affects eye movement, balance, mobility, speech and swallowing.
Vascular or arteriosclerotic Parkinsonism
Sometimes, people who have had a stroke, often one so mild that they didn’t notice it, may experience this form of parkinsonism.
Some drugs can cause a form of parkinsonism, which is usually reversible.
Response to Parkinson’s drugs
If your specialist thinks you have Parkinson’s, they will expect you to have a good response to Parkinson’s drugs, such as levodopa (Madopar, Sinemet, or Stalevo). A good response means that your symptoms will improve, as long as a large enough dose is given that lasts for a long enough time. Sometimes, it will only be clear that you’ve responded to medication when the drug is reduced or stopped, and your symptoms become more obvious again. If you don’t have any response to Parkinson’s medication, it may cast doubt on your diagnosis.
Most people with forms of parkinsonism other than Parkinson’s usually don’t respond, or don’t respond as well, to Parkinson’s drugs. But to confuse matters, some people with forms of parkinsonism other than Parkinson’s will show a good response.
Please remember, if you have both unusual symptoms and no response to Parkinson’s drugs, this doesn’t automatically mean you have another form of parkinsonism. But it may make your specialist want to investigate further.