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Parkinson disease is a degenerative disorder of the brain that affects movement. The disease gradually progresses over time and can become debilitating. Most people associate Parkinson disease with a tremor, but there are multiple other movement problems that patient can experience, including:
- Tremors – Involuntary movements that can occur in the face, arms, fingers, legs, and toes. Tremors usually occur at rest, but in severe cases, tremors can also occur with movement.
- Rigidity – Muscle stiffness that hinders movement
- Bradykinesia – Slowing of movement
- Hypomimia – Decreased facial expressions as well as decreased blinking
- Abnormal Gait – Difficulty walking, including freezing of gait
- Abnormal Posture – Bent standing posture
While it is called a movement disorder, Parkinson disease affects more than just movement. Other symptoms of Parkinson disease include:
- Depression – can occur in up to 80% of patients with Parkinson disease
- Constipation – Infrequent and difficult bowel movements
- Anosmia – Decreased smell
- Sleep disorder – Vivid dreams, acting out in sleep, and difficulty sleeping
- Impaired decision making and multitasking
- Dementia – Often later in disease. When it occurs early, it may indicate a different diagnosis should be considered
- Chronic pain
Parkinson disease is caused by the gradual death of neurons (nerve cells) in the brain. These neurons produce dopamine, a neurotransmitter that is responsible for transmitting signals between neurons in the brain. When dopamine levels decrease due to the neuron death it can cause abnormal brain activity to occur and can lead to the development of Parkinson disease.
While the exact cause of Parkinson’s disease is not fully understood, there are identifiable factors that have been shown to play a role in the development of Parkinson’s disease. These factors include your genes and environmental triggers such as exposure to toxins known to cause Parkinson’s disease. Age is also an important factor since Parkinson’s rarely occur in younger individuals and is much more prevalent in patients around 60 years old. Men are also at a higher risk of developing Parkinson’s disease.
Treatment for Parkinson disease is driven by symptoms. In general, treatment is not initiated until symptoms are bothersome. Treatment always begins with medications that aim to increase the amount of dopamine in the brain. The gold standard therapy is Sinemet, or carbidopa-levadopa, with directly provides dopamine to the brain. There are other medications as well, including dopamine agonists (which act like dopamine in the brain) and medications that help dopamine last longer in the brain (MAO and COMT inhibitors). Managing medications for Parkinson disease can be very complex and requires balancing many medications, and often requires taking medications 5-6 x per day.
When medications cause side effects and when the movement symptoms of Parkinson disease are the most bothersome symptoms, one can consider Deep Brain Stimulation. Deep brain stimulation is like a pacemaker for the brain. Deep brain stimulation works with medicines to make medications work more effectively and reduce the side effects of medication. The most important predictor of the potential benefit of deep brain stimulation is how effective medications are when medications are working perfectly. Deep brain stimulation is not considered a “last ditch” effort for someone with severe disease and it is also not used when medications are still working effectively. Rather, it is a treatment that specifically works for people who benefit from medications but have side effects with medicaitons, like wearing off, fluctuations, dystonias, and dyskinesias. Deep brain stimulation requires comprehensive evaluation by a team of neurologists, neurosurgeons, and psychologists.