Tips for Managing Symptoms of Parkinson's
With some health conditions, the frustration factor can be substantialand this is certainly true of Parkinson's disease. A degenerative disorder of the central nervous system, Parkinson's is characterized by four primary symptomstremor of the hands, arms, legs, jaw or head; rigidity or stiffness of the limbs and trunk; slowness of movement; gait and balance instability.
For people with Parkinson's, it can feel as though they just can't make their bodies do what they want them to. "You're kind of trapped because the controller of movements in the brain is out of whack," explains Jerry Vitek, M.D., Ph.D., a professor of neurology and director of the Neuromodulation Research Center at the Cleveland Clinic. "There’s a short-circuit between the intention to do something and the ability to do it."
As the disease progresses, people with Parkinson's also may develop trouble walking, talking, swallowing, or performing other everyday tasks. Depression, anxiety, sleep disturbances, and dementia become fairly common. "Traditionally, we've thought of Parkinson's as purely a movement disorder but over the last five to ten years, we've begun to realize there are all sorts of non-motor manifestations and some of these can precede the onset of Parkinson's," says Andrew Feigin, M.D., an associate professor of neurology at the Feinstein Institute for Medical Research, LIJ Health System in Manhasset, New York. "These include loss of smell, REM behavior disorder, in which a person acts out dreams with movements, and problems with the autonomic nervous system such as getting lightheaded or dizzy when you stand up quickly or having constipation or urinary problems."
While the underlying cause of Parkinson's remains a mystery, a small percentage of cases seem to have a hereditary element. With all cases, Parkinson's occurs when nerve cells in a part of the brain called the substantia nigra become impaired and stop producing enough dopamine, a chemical messenger that relays signals to the corpeus striatum in the brain to coordinate smooth, purposeful body movements. "By the time early Parkinson's disease is diagnosed, the person has lost 70 percent of the cells that produce dopamine," notes Tanya Simuni, M.D., an associate professor of neurology and director of the Parkinson's Disease and Movement Disorders Center at the Northwestern University Feinberg School of Medicine in Chicago. Because there aren't any blood or laboratory tests that indicate someone has Parkinson's, the disorder is diagnosed based on medical history and neurological examination.
At this point in time, there isn't a cure for Parkinson's but a variety of medications and other treatmentsincluding physical therapy, occupational therapy, and speech therapycan often provide significant relief from symptoms. The most commonly used medications are levodopa and dopamine agonists, though MAO-B inhibitors, COMT inhibitors, anticholinergic drugs, and amantadine (an antiviral drug) are sometimes used as well. The trouble is, "as you get further along in the disease, it may no longer be predictable how long or when the medication will work for you," says Dr. Vitek. "The unpredictability is very difficult for patients because they feel like they can't go anywhere."
Sometimes surgery is an option, and in recent years, a therapy called deep brain stimulation (DBS) has been a major breakthrough for people with Parkinson's. With DBS, electrodes are surgically implanted into the brain and connected to a small electrical stimulator device that’s implanted in the chest; the system works like a pacemaker for the brain. Besides decreasing tremors, rigidity, and slowness of movements, DBS can reduce the need for medications, which is helpful since many of these drugs cause side effects such as involuntary movements. Unfortunately, though, DBS doesn't help with speech problems, difficulty swallowing, "freezing," or emotional symptoms, Dr. Feigin says. "And it doesn't slow the progression of Parkinson's."
In fact, "the majority of interventions are aimed at improving symptoms without addressing the natural progression of the disease," notes Dr. Simuni. But an area of rapidly growing research is looking into neuroprotective or disease-modifying therapies that could delay the onset or slow the progression of Parkinson's disease. "There's some suggestion that rasagiline, an MAO-B inhibitor that's used to treat Parkinson's, may also alter the course of the disease in a beneficial way," Dr. Feigin says. "And research is being done to see if high doses of coenzyme Q10 or creatine may help," among other promising treatments.