There is no cure for Parkinson's disease. Treatment centers on the administration of medication to relieve symptoms. The Food and Drug Administration (FDA) also has approved a surgically-implanted device that lessens tremors. In some severe cases, a surgical procedure may offer the greatest benefit.

Primary Symptoms of Parkinson's

Bradykinesia is slowness in voluntary movement. It produces difficulty initiating movement, as well as difficulty completing movement once it is in progress. The delayed transmission of signals from the brain to the skeletal muscles, due to diminished dopamine, produces bradykinesia. Bradykinesia and rigidity that affects the facial muscles can result in an expressionless, "mask-like" appearance.

Tremors in the hands, fingers, forearm, or foot tend to occur when the limb is at rest, but not when the patient is performing tasks. Tremor may occur in the mouth and chin as well.

Rigidity, or stiff muscles, may produce muscle pain and facial masking. Rigidity tends to increase during movement.

Poor balance is due to the impairment or loss of the reflexes that adjust posture in order to maintain balance. Falls are common in people with Parkinson's disease.

Parkinsonian gait is the distinctive unsteady walk associated with Parkinson's disease. There is a tendency to lean unnaturally backward or forward, and to develop a stooped, head-down, shoulders-drooped stance. Arm swing is diminished or absent and people with Parkinson's tend to take small shuffling steps (called festination). Patient's with Parkinson's may have trouble starting to walk, may appear to be falling forward as they walk, may freeze in mid-stride, and may have difficulty making a turn.

Causes of Parkinson's:

Dopamine agonists are drugs that bind to and activate dopamine receptors

Dopamine agonists are drugs that bind to and activate dopamine receptors.

The substantia nigra is a very small area located deep within the brain. The symptoms of Parkinson's disease do not become noticeable until about 80 percent of the cells of the substantia nigra have died.

Under the microscope we can see substantially fewer cells in this substantia nigra than in that of healthy brains, and the remaining cells often show signs of abnormality.

Once a specific neurotransmitter is produced that causes the substantia nigra to degenerate and die, dopamine is lost and dopamine-relayed messages to other motor centers cannot go through. This is this primary cause of the motor symptoms in Parkinson's disease.

Although we have some understanding that neurochemical disturbance causes the symptoms of Parkinson's, we still do not know what causes the neurodegeneration.

Treatment for Parkinson's:

As Parkinson's disease progresses, drug dosages may have to be modified and medication regimens changed. Sometimes a combination of drugs is given.

Levodopa and carbidopa combined (Sinemet®) is the mainstay of Parkinson's therapy. Levodopa is rapidly converted into dopamine by the enzyme dopa decarboxylase (DDC), which is present in the central and peripheral nervous systems. Much of levodopa is metabolized before it reaches the brain.

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Carbidopa blocks the metabolism of levodopa in the liver, decreasing nausea and increasing the amount of levodopa that reaches the brain. Levodopa is most effective in treating bradykinesia and rigidity, less effective in reducing tremor, and often ineffective in relieving problems with balance.

Side effects include nausea, especially early in treatment, low blood pressure (hypotension), and abnormal movements (dyskinesias). Slow dosage adjustment and taking medication with food can reduce these effects and using the lowest effective dose may prevent or delay the appearance of motor dysfunction. Levodopa can become ineffective over time.

Depression, confusion, and visual hallucinations also may occur with these medications, especially in the elderly.


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