Parkinson's Disease

Disease Process

Parkinson's Disease is a degenerative neurological disease which primarily affects the specific part of the brain (substantia nigra) which produces the neurotransmitter, dopamine.

In Parkinson's disease, for reasons that are not fully understood, nerve cells in the part of the brain that produces dopamine, the substantia nigra, begin to decrease in number. The result of this imbalance is a lack of coordination of your movement that often appears as tremor, stiff muscles and joints, and/or difficulty moving.

Causes

The cause of Parkinson's Disease is not known. Some researchers believe it may result from toxins, head traumas or strokes. Parkinson's Disease may also have a genetic link.

Why an individual develops Parkinson's disease remains undetermined. The causes likely include both genetic and environmental factors. It is thought that a combination of factors leads to the disease

Symptoms

The four primary symptoms are:

• Tremor of the hands, arms, legs, jaw, and face.
• Rigidity or stiffness of the limbs and trunk.
• Bradykinesia or slowness of movement.
• Postural instability or impaired balance and coordination.

Diagnosis

It is difficult to make a definite diagnosis of Parkinson’s. There are no imaging or lab tests that show the disease. Often the final diagnosis is made after a medical history has been well established, tests have ruled out other causes of the symptoms and observation over a period of time demonstrates all of the above symptoms.

Current Treatment

Currently, there is no way to stop the loss of nerve cells that produce dopamine or to restore those that have already been lost. The symptoms will progress and worsen over time. The following treatment options can help slow the decline in function; sometimes for a brief period of time, often for longer.

• Medication: There are several medications available for managing Parkinson's Disease. These are used alone and in combination. The most common are: Levodopa, Carbidopa, Stalevo, Symmetrel, Anticholinergics, Eldepryl, Dopamine agonists, and COMT inhibitors.
• Exercise: regular exercise and/or physical therapy is important for maintaining and improving mobility, flexibility, balance, and a range of motion, and for warding off many of the secondary symptoms mentioned above. Exercise is as important as medication for the management of PD.
• Surgery: Deep brain stimulation (DBS), is the preferred surgical option because it has the same, if not better results than pallidotomy and thalamotomy. DBS also leaves open the possibility of other therapies, should they become available in the future. The main benefit of DBS surgery is to reduce motor fluctuations i.e. the ups and downs caused by a decreasing effectiveness of Sinemet. During surgery, a device is implanted to provide an electrical impulse to a part of the brain involved in motor function. The electrodes are connected to wires that lead to an impulse generator or IPG (similar to a pacemaker) that is placed under the collarbone and beneath the skin. Patients have a controller, which allows them to verify whether the DBS is 'on' or 'off'. They can use this device to check the battery and to turn the device 'on' or 'off'. An IPG battery lasts for about 3 to 5 years and is relatively easy to replace under local anesthesia.

How Can Physical Therapy Help

A Physical therapist can:

• Design exercise program to help increase range of motion, flexibility and strength.
• Evaluate and treat mobility and walking problems.
• Evaluate and treat joint or muscle pain which interferes with the activities of daily living.
• Help with poor balance or frequent falling.
• Teach family members or caregivers how to assist someone with PD be as functional as possible.
• Help patients be as independent as possible with activities of daily living (ADL) such as eating, dressing, bathing. May teach compensatory techniques.
• Recommend and teach the use of appropriate assistive devices (such as canes, walkers, etc).
• Teach new movement patterns and techniques or strategies to combat symptoms of disease.
• Refer patient to movement and exercise programs, as well as support groups in the community.

Patient Resources

National Parkinson’s Foundation
Parkinson’s Disease Foundation
National Institute of Neurological Disorders and Stroke
Michael J. Fox Foundation
American Parkinson’s Disease Association

Disease Process
Causes
Symptoms
Diagnosis
Treatment
Physical Therapy
Patient Resources

Facts

As many as one million Americans suffer from Parkinson's disease.

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.

PD usually affects people over age 50.

People with Parkinson's lose an average of 80% of the dopamine producing cells in their brain.

Average cost of Parkinson's Medications is more than $2500 a year