Parkinson’s Disease: Etiology Clinical manifestations, Diagnosis, Complication, Management, & Treatment

Parkinson’s disease is a degenerative process of nerve cells in the extra-pyramidal system which is slowly progressing neurologic movement disorder that eventually leads to disability. Usually affects men more than women. Symptoms usually first appear in the fifth decade of life, however, cases have been diagnosed as early as 30 years of age.

The degenerative or idiopathic form of Parkinson’s disease is the most common; there is also a second form with a known or suspected cause.

Etiology of Parkinson’s disease

Parkinson’s disease affects men and women about equally and usually occurs after the age of 50 with a median age of onset of about years. Actual etiology of the disease remains unknown. The possible causes of the Parkinson’s disease may be

  1. A genetic component has recently been proposed. The disease usually begins insidiously and then progresses.
  2. Primary Parkinson’s disease is idiopathic, but variety of other categories exist
  3. Symptoms of Parkinson’s disease may develop in response to the use of antipsychotic drugs (or neurotic drugs) following an encephalitis infection in response to brain trauma, tumor, hydrocephalus or ischemia, in association with rare metabolic disorders; and in response to arteriosclerosis
  4. Neurotoxins such as cyanide, carbon dioxide have also been proposed as possible cause of disease
  5. Idiopathic
  6. Defective blood supply to the basal ganglia
  7. Post encephalic
  8. Post-traumatic
  9. Toxic
  10. Drug-induced

Clinical manifestations of Parkinson’s disease

Parkinson’s disease has a gradual onset and symptoms progress slowly over a chronic, prolonged course. The cardinal signs are tremors rigidity, bradykinesia, and postural instability.

  • Tremors: although symptoms are variable, a slow, unilateral resting tremor is present in the majority of the patient at the time of diagnosis. Resting tumor characteristically disappears with purposeful movement but is evident when the extremities are motionless. The tremor may manifest as a rhythmic, slow turning motion of the forearm.
  • Rigidity: resistance to passive limb movement characterize muscles rigidity. Passive movement of extremities may cause the limb to move in jerky movements, referred to cog-wheel movements.
  • Bradykinesia: one of the most common features of Parkinson’s disease which refers to the overall slowing of active movements. Patients may also take longer to complete activities and have difficulty initiating movement, such as rising from a sitting position or turning in bed.
  • Postural instability: patient commonly develops postural and gait problems. A loss of postural reflexes occurs and the patient stands with the head bent forward and walks with a propulsive gait.
  • Speech becomes rapid, unpunctuated and incomprehensible
  • Facial expression becomes mask like with fixed stare
  • Other symptoms include insomnia, dysphagia, weight loss, drooling and rapid eyelid blinking.

Diagnosis

Laboratory data are of little value. Diagnosis is based on patient’s age, history, and clinical features.

Therapeutic measures

Although there is no known treatment that can stop the degeneration of the basal ganglia, drug therapy offers an effective method for relieving many symptoms of Parkinson’s disease. The need for surgery is rare because drug control is adequate.

  1. L-DOPA (L-dihydroxyphenylalanine)

L-dopa 100 to 250mg 3 or 4 times daily is prescribed. It converts to dopamine in the basal ganglia, thereby relieving the symptoms of rigidity and bradykinesia. The drug is effective for the long-term management of the disease.

Most L-Dopa taken by mouth is destroyed before reaching the brain so carbidopa (sinemel) 10-25mg is also given.

Precaution while taking L-Dopa

  • Patients on L-Dopa therapy should not take vitamin B6 or multivitamin preparation which include B6
  • Heavy drinking of alcohol should be avoided
  • High protein intake such as milk, meat, fish, poultry, cheese, eggs, nuts, sunflower seeds, whole grain and soya bean products should be avoided(large protein blocks the effect of L-Dopa)
  • L-Dopa should be taken with meal to decrease nausea
  • Wearing elastic stocking will help to avoid orthostatic hypotension
  • Anti-cholinergic drugs

Complication

Many complications of Parkinson’s disease is caused by the deterioration and loss of spontaneity of movements.

  • Dysphagia leading to malnutrition or aspiration
  • Decreased mobility affects gait
  • Lack of mobility leads to constipation, ankle edema, and contractures
  • Orthostatic hypotension with loss of postural reflexes lead to fall on injury
  • Venereal debilitation leads to pneumonia, urinary tract infection and skin breakdown
  • Bothersome complications include seborrhea, dandruff, excessive sweating, conjunctivitis, difficulty in reading, insomnia, incontinence, and depressions

The complication may be secondary manifestations of Parkinson’s disease as follows:

  1. Facial appearance: expressionless, eye store straight ahead, blinking  much frequent than normal
  2. Speech problems: low volume, monotone, slurred, muffled
  3. Visual problems: blurred vision, blepharospasm
  4. Fine motor function: decreases manual dexterity, clumsiness and decreased coordination, freezing
  5. Autonomic disturbance: constipation, urinary frequency, dysphagia, drooling, oily skin, excessive perspiration
  6. Cognitive/ behavioral: depression slowed responsiveness memory deficits visual deficits dementia

Management of Parkinson’s disease

The diagnosis of Parkinson’s disease is made directly from the patient history and symptoms. No definite diagnostic test exists and the diagnosis may be confirmed primarily form the patient’s response to medication.

  • First aid treatment: Rolling a person with an active tonic-clonic seizure onto their side and into sidelining position helps prevent fluids from getting into the lungs. To prevent further self-injury, efforts should be taken. If a seizure lasts longer than 5 minutes or if there are more than two seizures in our without a return to a normal level of consciousness between them, then it is considered as a medical emergency called as status epilepticus which require medical help to keep the airway open and protected. There should be hospitalized as soon as possible
  • Anticholinergic drugs to relieve tremors
  • Antiviral amantadine (symmetrical) block the uptake and storage of catecholamines, allowing for the accumulation of dopamine
  • Dopamine agonists to reduce bradykinesia, tremor, and rigidity
  • Dopaminergic reduce bradykinesia, tremor, and rigidity
  • Monoamine oxidase inhibitors (MAO) block the metabolism of dopamine, may slow the underlying disease process

Prognosis of Parkinson’s disease

Epilepsy cannot be cured, but seizures can be controlled effectively by the use of medication in about 70% of cases.

Prevention of Parkinson’s disease

Since the cause of epilepsy is not clear, it is a degenerative process so generally is not possible to prevent it. Head injury is the common cause of epilepsy, may be preventable. Always wear a helmet while biking, seatbelt while driving, provide good care around the birth time will help to reduce the risk of head injury and reduce the environmental parasites such as pork tapeworm may be effective.

How much water should I drink? Why is it most necessary for pregnant women?

Heart Palpitations: Causes, Symptoms & Treatment