Neurology, Geriatric Medicine

Parkinson’s Disease

Introduction to Parkinson’s Disease

Parkinson’s is a progressive movement disorder of the central nervous system.

Written by Doctify Team 27/04/2020

What is Parkinson’s Disease?

Parkinson’s is a progressive movement disorder of the central nervous system. It often affects those over 60 years, and men more than women. However, it can be early-onset and therefore affect people of a younger age, though this is much rarer. The disease is slow progressing and is characterised by the loss of neurones in an area of the brain called the substantia nigra. Currently there is no cure for Parkinson’s, but there are a variety of medical treatments and surgical interventions available to help people manage the condition and symptoms. 1 in 500 people are affected by Parkinson’s in the UK and so currently there are an estimated 127, 000 people with the condition.

What are the causes for Parkinson’s Disease?

Parkinson’s disease is caused by the degeneration of neurones in the substantia nigra which produce dopamine. Dopamine is essential for regulating movement pathways in the brain and so the reduction of dopamine in the brain produces the motor symptoms seen in Parkinson’s. There is no definitive reason for the loss of the neurones in the substantia nigra but it is believed to be due to a combination of genetic changes and environmental factors.

Genetics: Certain genetic changes increase a person’s risk of getting Parkinson’s but it does not mean that everyone with these changes will get the disease. However, in rare circumstances, Parkinson’s disease can run in families as a result of faulty genes being passed to a child by their parents.

Environmental factors: Since most people with the genetic changes do not get Parkinson’s, it is believed that there are environmental factors which could also contribute. It has been suggested that herbicides and pesticides in farming, traffic and industrial pollution may contribute to the condition. But it is worth noting that this is not conclusive.

There are other less common conditions which are classed as Parkinson’s. Drug-induced Parkinsonism develops after taking antipsychotic medication. This usually resolves once the medication is stopped. Strokes which occur in areas of the brain controlling movement can also result in the same symptoms as Parkinson’s.

What are the symptoms of Parkinson’s Disease?

Initial symptoms can include tremor or shaking at rest, slow movement (bradykinesia), stiff muscles and trouble initiating movement, a low or soft voice, lack of expression on your face. As symptoms progress, your posture can become more stooped and walking becomes more of a shuffle. People often find it hard to balance and may need assistance when standing/walking.

How is Parkinson’s Disease treated?

Since there is no cure for Parkinson’s, the aim of treatment is to reduce the symptoms and maintain s good quality of life. The initial medication given is Levodopa, aimed at increasing the dopamine which is lacking in Parkinson’s patients. This can be given in combination with Carbidopa or Benserazide to make Levodopa more effective. Either in addition to Levodopa or as an alternative therapy, Selegiline, a monoamine oxidase B inhibitor, can be given. In patients with early onset Parkinson’s, Ropinirole which acts like dopamine (DA receptor agonists), can be given as mono therapy. As the disease progresses, Levopoda becomes less effective as a form of treatment. COMT inhibitors such as Entacapone can be given to stop the breakdown of Levodopa so more of it works in the body. But once the majority of the neurones have degenerated, other drugs acting as DA receptor agonists such as Bromocriptine or Apomorphine can be given.

Under certain conditions, surgery can be considered to help lessen symptoms. The procedure, deep brain stimulation, acts to promote the pathways controlling movement in your brain. It works by implanting a pulse generator into your brain which stimulates the part of your brain affected by Parkinson’s.

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