(PD; Paralysis Agitans; Shaking Palsy)
Parkinson's disease (PD) is a progressive movement disorder that causes:
- Muscle rigidity
- Tremor at rest
- Slowing down of movements (bradykinesia)
- Difficulty moving and gait instability
It is caused by a loss of nerve cells in the brain. This includes loss in an area called the substantia nigra . The loss decreases the amount of dopamine in the brain. Low dopamine results in PD symptoms.
Substantia Nigra—Yellow Section
Factors that cause the loss may be from the genes, the environment, or some combination of the two. A small amount of people with PD have an early onset form. This type is caused by an inherited gene defect.
Secondary PD has similar symptoms but is caused by several factors such as:
- Antipsychotic drugs, such as haloperidol]]> (Haldol), ]]>fluphenazine]]> (Prolixin), ]]>trifluoperazine]]> (Stelazine), and ]]>chlorpromazine]]> (Thorazine)
- Cardiovascular drugs such as some calcium channel blockers and antiarrhythmic drugs
- ]]>Carbon monoxide poisoning]]>
- Manganese poisoning
- ]]>Brain tumors]]>
- Intravenous drug abuse of MPTP (a type of neurotoxin)
- ]]>Reserpine]]> (medicine to treat schizophrenia and high blood pressure)
- Insecticide exposure
Factors that increase the chance of PD include:
Symptoms of PD begin mildly. They will worsen over time.
- "Pill-rolling" tremor in the hands
- Tremors are present at rest, improve with movement, and are absent during sleep
- Stiffness and rigidity of muscles, usually beginning on one side of the body
- Difficulty and shuffling when walking
- Short steps
- Slowness of purposeful movements
- Trouble performing usual tasks, due to shaking in hands
- Trouble speaking (often speaking with a low volume)
- Flat, monotonous voice
- Shaky, spidery, or small handwriting
- Poor balance
- Difficulty with rising from a sitting position
- Seborrhea (a skin problem that causes a red rash and white scales)
- Loss of smell
- Urinary symptoms (frequency and urgency)
- Bowel movement symptoms (straining, constipation)
- Tendency to fall
- Stooped posture
- Increasingly mask-like face, with little variation in expression
- Trouble chewing and swallowing
- Drooling and excessive salivation
- Difficulty thinking, problems with memory
- Decreased sense of smell
- Sleep problems such as REM-behavior disorder
The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no tests to definitively diagnose PD. The doctor will ask many questions. This will help to rule out other causes of your symptoms.
Tests to rule out other conditions may include:
Currently, there are no treatments to cure PD. There are also no proven treatments to slow or stop its progression. Some medications are used to improve symptoms. Over time the side effects may become troublesome. The medications may lose their effectiveness.
- Levodopa/carbidopa ( Sinemet]]> )
- ]]>Amantadine]]> (Symmetrel)
- Anticholinergics: ]]>benztropine]]> (Cogentin) and biperiden (Akineton)
- Monoamine Oxidase inhibitors: ]]>Selegiline]]> (Eldepryl), Rasagaline(Azilect)
(Dostinex), Rotigotine (Neupro), and
- Pergolide (Permax) was withdrawn in March 2007. It had a high risk of serious heart valve damage. Cabergoline (Dostinex) has also been linked to this risk.
- ]]>Apomorphine]]> (Apokyn)
- COMT inhibitors: ]]>entacapone]]> (Comtan) and ]]>tolcapone]]> (Tasmar)
Depression or hallucinations may also occur with PD. Medicine may be given to relieve these. The drugs may include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotic ]]>clozapine]]>
Different brain operations are available, and many more are being researched including:
- Deep brain stimulation (DBS)—implanting a device to stimulate certain parts of the brain; can decrease tremor and rigidity
- Thalamotomy and pallidotomy—destroying certain areas of the brain to improve tremor when medication does not work (not as common as deep brain stimulation)
- Nerve-cell transplants (research only)—to increase amount of dopamine made in the brain
Therapy can improve muscle tone, strength, and balance. It will include exercises and stretches.
Join a support group with other people with PD. It will help to learn how others are learning to live with the challenges of PD.
If you are diagnosed with PD, follow your doctor's instructions .
National Parkinson Foundation
Parkinson's Disease Foundation, Inc.
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4/10/2007 DynaMed's Systematic Literature Surveillance: US Food and Drug Administration. FDA announces voluntary withdrawal of Pergolide products [press release]. March 29, 2007. US Food and Drug Administration website. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01596.html
11/16/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Spinks A, Wasiak J, Bernath V, Villaneuva E. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2009;(4):CD002851.
Last reviewed November 2009 by ]]>J. Thomas Megerian, MD, PhD, FAAP]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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