Parkinson's disease: What to know about it, what to do about it

By Dr. Julia Stasich, Ochnser Health

Parkinson’s disease is named after James Parkinson, the English physician who described this degenerative disease of later life. Here are the history, symptoms, causes and treatment options for Parkinson's.

What characterizes Parkinson’s disease?

• Slowness of movement with slow, shuffling gait, short steps
• Rigidity or stiffness of the limbs and trunk
• Impaired balance and coordination
• Head held forward, and body stooped forwards
• Drooping eyelids, open mouth, drooling

What are some of the biggest misunderstandings seen in Parkinson’s disease? Not all Parkinson’s patients have tremor, and Parkinson’s disease does not shorten lifespan, but the symptoms can affect quality of life.

Who first identified Parkinson’s disease? The disease we call Parkinson’s was known to ancient eastern Indians as “Kampavata.” A man by the name of Charaka is known to have described this disease as “kampa” meaning shaking and “vata” meaning decreased muscle movement or weakness. About 500 years later in Greece, Galen, a student of Hippocrates, also described a “shaking palsy.” But it wasn’t until the 1800s when Dr. Parkinson described the criteria of patients with the “shaking palsy” and separated out other diseases that may shake or have weakness. We actually still call the syndromes that look like Parkinson’s disease by the name “Parkinsonism.”

What are the brain changes we see in Parkinson’s disease? Parkinson’s patients experience a slow, progressive loss of cells that make dopamine in the brain. Dopamine, in the right amount and right places, plays a vital role by making our bodies move faster, including arms, legs, mind and even bowels. It also makes us feel good when it is released, like during social events, eating or sex. It is also released as a reward during events such as fishing, hunting, shopping or gambling.

What are the early signs of Parkinson’s? Early Parkinson’s disease is easy to miss by doctors because the symptoms can mimic common ailments:

• Feeling “dizzy” or easily off balance
• Loss of sense of smell
• Loss of arm swing on one side of the body
• Daytime sleepiness
• Depression
• Constipation

What are some of the symptoms of Parkinson’s disease? As the disease progresses and more dopamine-producing cells are lost, more symptoms arise and may include muscle stiffness, tremor, choking and excess saliva.

What causes a loss of dopamine? We don’t know. Certainly, there are familial forms of Parkinson’s, but these are much less common than the sporadic type.

How do we treat Parkinson’s disease?

• Promote the release of dopamine
• Replace dopamine with medication
• Alternatives/additions to dopamine treatment
• Deep brain stimulation surgery

What you can be doing to increase your own dopamine levels? You can do this through regular exercise such as dancing, walking or activities such as Tai Chi. You will also feel better if you sleep better and are well-rested. Massage makes everyone feel good, but there is research that suggests that massage may reduce the symptoms of Parkinson’s disease. A loving, supportive relationship improves both lives, but the Parkinson patient may even notice improved physical effects.

What your doctor can do for you to help increase dopamine? We can directly replace that dopamine with a dopamine precursor, Levodopa. Levodopa was found to be effective in the 1950s by a Swedish scientist, Arvid Carlsson, who later won a Nobel Prize for that work. It is now available in several formulations and is always paired with carbidopa to help absorption.

We can mimic dopamine with drugs called “dopamine agonists.” Pramipexole, ropinerole and rotigatine patch are all in this category.

We can limit the breakdown of your own dopamine using drugs belonging to a family called the MAO-B inhibitors. Two examples are selegiline and rasagiline.

As with some medications, there can be side effects, so be sure to talk to your doctor about a treatment plan that is going to be right for you.