Understanding Parkinson’s Disease (PD)

What Is Parkinson’s Disease?

Parkinson’s disease (PD) occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a “movement disorder.” But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinson’s. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.

• Tremors – shaking begins In a limb, pin rolling
• Bradykinesia – simple tasks difficult and time consuming most handicapping
• Rigidity- increased muscle tone
• Impaired posture, balance
• Loss of automated movement – blinking, smile,swinging of arms
• Speech impairment
• Microgrophia (progression to progressively smaller handwriting)

• Smell dysfunction
• Depression
• Constipation
• Insomnia, day-time drowsiness
• Sweating
• Urinary/sexual dysfunction
• Fatigue
• Pain
• Orthostatic hypotension (a condition in which your blood pressure falls significantly when you stand up quickly)
• Impulse control disorders
• Punding – repetitive, aimless stereotyped behaviors
• Hallucinations delusions

Stage 1 – Mild, unilateral

Stage 2 – Bilateral

Stage 3 – Balance, slowness

Stage 4 – Severely disabling

Stage 5 – Most advanced inability to rise from chair or bed

• Medical:
  • Carbidopa/ Levodopa- dyskinesia
  • Dopamine agonist-pramipexole, ropinrole, rotigotine
  • MAO inhibitors-selegiline, rasagaline,
  • Amantidine
  • COMT INHIBITORS
• Surgery – Deep Brain Stimulation (DBS), focused ultrasound
• Lifestyle management- diet, exercise, massage, meditation, pet therapy

What is DBS

DBS is the most commonly performed surgical treatment for PD. A surgeon places thin metal wires in the brain; these wires send electrical pulses to the brain to help control some motor symptoms.

What DBS helps and does not help with:

• DBS typically helps reduce motor symptoms of stiffness, slowness and tremor
• It doesn’t work as well for imbalance, freezing of gait (sudden inability to move when walking) or non-motor symptoms.
• As DBS may worsen thinking or memory problems, it’s not recommended for people with dementia.

Who are best suited for DBS surgery:

DBS is not recommended for all PD patients. Typical candidates considered for DBS are:

• Those who have had Parkinson’s disease for at least four years
• Those who get a benefit from medication but have motor complications, such as significant “off” time (periods when symptoms return because medication isn’t working well) and/or dyskinesia (uncontrolled, involuntary movements).

How DBS works:

• Diet and nutrition
• Exercise->150minutes a week improve mobility and flexibility
• Massage – ease stiffness
• Sleep
• Planning and activity
• Speech therapy