Topic Overview
What is Parkinson's disease?
Parkinson's disease
affects the way you move. It happens when there is a problem with certain nerve
cells in the brain.
Normally, these nerve cells make an important
chemical called
dopamine. Dopamine sends signals to the part of your
brain that controls movement. It lets your muscles move smoothly and do what
you want them to do. When you have Parkinson's, these nerve cells break down.
Then you no longer have enough dopamine, and you have trouble moving the way
you want to.
Parkinson's is progressive, which means it gets
worse over time. But usually this happens slowly, over a period of many years.
And there are good treatments that can help you live a full life.
What causes Parkinson's disease?
No one knows for
sure what makes these nerve cells break down. But scientists are doing a lot of
research to look for the answer. They are studying many possible causes,
including aging and poisons in the environment.
Abnormal
genes seem to lead to Parkinson's disease in some
people. But so far, there is not enough proof to show that it is always
inherited.
What are the symptoms?
The four main symptoms of
Parkinson's are:
- Tremor, which
means shaking or trembling. Tremor may affect your hands, arms, or legs.
- Stiff muscles.
- Slow movement.
- Problems with balance or walking.
Tremor may be the first symptom you notice. It is one of
the most common signs of the disease, although not everyone has it. More
importantly, not everyone with a tremor has Parkinson's disease. Tremor often
starts in just one arm or leg or only on one side of the body. It may be worse
when you are awake but not moving the affected arm or leg. It may get better
when you move the limb or you are asleep.
In time, Parkinson's
affects muscles all through your body, so it can lead to problems like trouble
swallowing or constipation. In the later stages of the disease, a person with
Parkinson's may have a fixed or blank expression, trouble speaking, and other
problems. Some people also have a decrease in mental skills (dementia).
People usually start to have
symptoms between the ages of 50 and 60. But in some people symptoms start
earlier.
How is Parkinson's disease diagnosed?
Your doctor
will ask questions about your symptoms and your past health and will do a
neurological exam. A neurological exam includes questions and tests that show
how well your nerves are working. For example, your doctor will watch how you
move, check your muscle strength and reflexes, and check your vision. In some
cases, your doctor may have you try a medicine. How this medicine works may
help your doctor know if you have Parkinson's disease. He or she will also ask
questions about your mood.
There are no lab or blood tests that
can help your doctor know whether you have Parkinson's. But you may have tests
to help your doctor rule out other diseases that could be causing your
symptoms. For example, you might have an
MRI to look for signs of a
stroke or
brain tumor.
How is it treated?
At this time, there is no cure
for Parkinson's disease. But there are several types of medicines that can
control the symptoms and make the disease easier to live with.
You may not even need treatment if your symptoms are mild. Your doctor
may wait to prescribe medicines until your symptoms start to get in the way of
your daily life. Your doctor will adjust your medicines as your symptoms get
worse. You may need to take several medicines to get the best results.
Levodopa (also called L-dopa) is the best drug for controlling symptoms
of Parkinson's disease. But it can cause problems if you use it for a long time
or at a high dose. Sometimes doctors use other medicines to treat people in the
early stages of the disease. This lets them delay the use of levodopa. But
other medicines have more side effects and don't control symptoms as well as
levodopa. And the long-term problems caused by medicine are the same, no matter
what medicine is used first.1 The decision to start
taking medicine, and which medicine to take, will be different for each person
with Parkinson's disease. Your doctor will be able to help you make these
choices.
In some cases, a treatment called deep brain stimulation
may also be used. For this treatment, a surgeon places wires in your brain. The
wires carry tiny electrical signals to the parts of the brain that control
movement. These little signals can help those parts of the brain work
better.
There are many things you can do at home that can help you
stay as independent and healthy as possible. Eat healthy foods. Get the rest
you need. Make wise use of your energy. Get some exercise every day. Physical
therapy and occupational therapy can also help.
How will Parkinson's disease affect your life?
Finding out that you have a long-term, progressive disease changes your
life. It is normal to have a wide range of feelings. You may feel angry,
afraid, sad, or worried about what lies ahead. It may help to keep a few things
in mind:
- No one can know for sure how your disease
will progress. But usually this disease progresses slowly. Some people live for
many years with only minor symptoms, such as a tremor in one hand.
- Many people who have Parkinson's disease can and do keep working
for years. As the disease gets worse, you may need to change how you work. You
can get support to learn ways to adapt.
- It is important to take
an active role in your health care. Learn all you can about the disease. Find a
doctor you trust and can work with. Go to all your appointments, and get all
the treatment your doctor suggests.
- Depression is common in
people who have Parkinson's. If you feel very sad or hopeless, talk to your
doctor or see a counselor. Antidepressant medicines can help.
- It
can make a big difference to know that you are not alone. Ask your doctor about
Parkinson's support groups, or look for online groups or message
boards.
- Parkinson's affects more than just the person who has it.
It also affects your loved ones. Be sure to include them in your decisions.
Help them learn about the disease and get the support they need.
Frequently Asked Questions
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Learning about Parkinson's disease:
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Being diagnosed:
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Getting treatment:
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Living with Parkinson's disease:
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Cause
Low levels of
dopamine, a brain chemical (neurotransmitter) involved
in controlling movement, cause symptoms of Parkinson's disease. The shortage of
this brain chemical occurs when nerve cells in a part of the brain (substantia
nigra) that produces dopamine fail and deteriorate. The exact cause of this
deterioration is not known.
The links between
Parkinson's disease and factors such as genetics,
aging, toxins in the environment, and
free radicals are all under investigation. Although
these studies are beginning to provide some answers, experts do not know the
exact cause of the disease.
Studies are ongoing to determine
whether there is a genetic cause of Parkinson's disease. Only a small
percentage of people with Parkinson's disease have a parent, brother, or sister
who has the disease. But abnormal
genes do seem to be a factor in a few families where
early-onset Parkinson's disease is common.
Symptoms
The type and severity of symptoms experienced
by a person with
Parkinson's disease vary with each individual and the
stage of Parkinson's disease. Symptoms that develop in
the early stages of the disease in one person may not develop until later—or
not at all—in another person.
- Symptoms of Parkinson's disease typically begin
appearing between the ages 50 and 60. They develop slowly and often go
unnoticed by family, friends, and even the person who has them.
- A
small number of people have symptoms on only one side of the body that never
progress to the other side.
The most common symptoms
include:
- Tremor, or shaking, often in a hand,
arm, or leg. Tremor caused by Parkinson's disease occurs when the person is
awake and sitting or standing still (resting tremor) and subsides when the
person moves the affected body part.
- Stiff muscles (rigidity) and aching muscles. One of the most
common early signs of Parkinson's disease is a reduced arm swing on one side
when the person is walking that is caused by rigid muscles. Rigidity can also
affect the muscles of the legs, face, neck, or other parts of the body and may
cause muscles to feel tired and achy.
- Slow, limited movement
(bradykinesia), especially when the person tries to move from a resting
position. For instance, it may be difficult to get out of a chair or turn over
in bed.
- Weakness of face and throat muscles. Talking and
swallowing may become more difficult, and the person may choke, cough, or
drool. Speech becomes softer and monotonous. Loss of movement in the muscles in
the face can cause a fixed, vacant facial expression, often called the
"Parkinson's mask."
- Difficulty with walking (gait disturbance) and
balance (postural instability). A person with Parkinson's disease is likely to
take small steps and shuffle with his or her feet close together, bend forward
slightly at the waist (stooped posture), and have trouble turning around.
Balance and posture problems may result in frequent falls. But these
problems usually do not develop until later in the course of the
disease.
Tremor is often the first symptom that people with
Parkinson's disease or their family members notice. Initially, the tremor may
appear in just one arm or leg or only on one side of the body. The tremor also
may affect the chin, lips, and tongue. As the disease progresses, the tremor
may spread to both sides of the body. But in some cases the tremor remains
on just one side.
Emotional and physical stress tend to make the
tremor more noticeable. Sleep, complete relaxation, and intentional movement or
action usually reduce or stop the tremor.
Although tremor is one
of the most common signs of Parkinson's disease, not everyone with tremor has
Parkinson's disease. Unlike tremor caused by Parkinson's disease, tremor caused
by other conditions gets better when your arm or hand is not moving and gets
worse when you try to move it. The most common cause of non-Parkinson's tremor
is essential tremor, a treatable condition that is often
wrongly diagnosed as Parkinson's disease.
Other symptoms
Parkinson's disease can cause many other symptoms. These can be disabling and may include:
- Decreased dexterity and coordination. Changes
in handwriting are common, with writing becoming smaller. Athletic abilities
decline, and daily activities such as dressing and eating become harder.
- Cramps in the muscles and joints.
- Oily skin
or increased dandruff.
- Digestive and urinary problems.
Constipation is common. Controlling urination (incontinence)
may be difficult, and urination may be frequent and at times urgent. Drugs used
to treat Parkinson's disease may help or may sometimes make these symptoms
worse.
- Problems with involuntary or automatic body functions, such
as increased sweating, low blood pressure when the person stands up
(orthostatic hypotension), and problems with
sexual function. These symptoms may also be caused by
Parkinson's-plus conditions or drugs used to treat
Parkinson's disease.
- Freezing, a sudden, brief inability to move. It most
often affects walking.
Problems with sleep, mood, and thought also are common in
people who have Parkinson's disease.
- Problems falling asleep or staying asleep
(insomnia) can result from anxiety, depression, or physical restlessness.
People with Parkinson's disease may not be able to sleep well because they
cannot easily turn over or change position in bed.
- A person with
Parkinson's disease may slowly become more dependent, fearful, indecisive, and
passive. The person may talk less often than he or she used to, withdraw from
family and friends, and remain inactive unless encouraged to move about.
Depression is very common in people with this disease and can be caused by
chemical changes in the brain or can be a reaction to having a disabling
disease. Depression often improves with proper treatment.
- Up to
one-third of people with Parkinson's disease may develop
dementia and confusion, similar to Alzheimer's
disease, late in the course of the disease. Depression can further contribute
to memory loss and confusion. Memory loss, hallucinations (seeing or hearing
things that aren't really there), and vivid dreams may sometimes be caused by
drugs taken to treat Parkinson's disease.
There are many
other conditions with similar symptoms. Some of these
may be reversible.
What Happens
Treatment may help control
symptoms during the early
stages of Parkinson's disease and is usually started
as soon as symptoms begin to affect a person's ability to work or do daily
activities. As the
disease progresses, drugs may become less effective. Parkinson's disease also
can cause a variety of
other symptoms as it advances.
Early disease
Tremor is
usually the first symptom of
Parkinson's disease, appearing in just one limb (arm
or leg) or on only one side of the body. Tremor may also occur in the lips,
tongue, jaw, and eyelids. As the disease progresses, the tremor usually spreads
to both sides of the body, although in some cases the tremor remains on just
one side. Joint pain, weakness, and fatigue may occur.
Slow
movement, stiff muscles, and poor coordination may occur early on in the
disease. Problems with fine motor skills can affect tasks such as writing,
shaving, or brushing teeth. Changes in handwriting are common. A person in the
early stages of Parkinson's disease may move slowly and may not make normal,
frequent posture adjustments.
Advanced disease
As the disease progresses, problems
with posture and balance develop. A person with Parkinson's disease tends to
walk in a stooped manner with quick, shuffling steps.
After
several years, as muscle stiffness and tremor increase, the person may become
unable to care for himself or herself. Weak, stiff muscles eventually may
confine the person to a wheelchair or bed.
People who have taken levodopa for several years
may not only notice their symptoms getting worse but also may develop additional movement problems. These
motor fluctuations can be reduced somewhat by making changes in the person's
medicine, but they can be difficult to control and may further complicate
treatment.
Dementia may develop in up to one-third
of people who have late-stage Parkinson's disease.2
Dementia symptoms may include disorientation at night, confusion, and memory
loss. Medicines that are used to treat Parkinson's disease can also
contribute to this problem.
What Increases Your Risk
Risk factors for
Parkinson's disease are hard to identify, because
the cause of the disease is unknown. Advancing age is the only known risk
factor for typical Parkinson's disease (not including early-onset Parkinson's).
Most instances of Parkinson's disease occur after age 50, although the illness
does occur in people between the ages of 30 and 50, or in rare cases at a
younger age.
A very small number of people with Parkinson's have a
close relative who also has the disease. But it does not appear that a family
history of typical Parkinson's disease significantly increases your risk for the disease. Having a family history of the disease is a more
significant risk factor in cases of early-onset Parkinson's disease, but this
form of the disease is not common.
Some research suggests that
long-term exposure to certain environmental factors such as pesticides,
chemicals, or well water may increase a person's risk of developing Parkinson's
disease. But this has not been proved.
There are many other causes
of parkinsonism, which is a group of symptoms that includes tremor, muscle
stiffness, slow movement, and unsteady walking. Parkinsonism mimics Parkinson's
disease, but in fact is not Parkinson's disease.
When To Call a Doctor
Call 911 or other emergency services immediately if signs of a
stroke develop suddenly. These may include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
The symptoms of Parkinson's disease develop slowly over months.
If you think you may have symptoms of
Parkinson's disease, see your doctor. Urgent medical
care is not needed if you have had a tremor for some time. But you should
discuss the tremor at your next doctor's appointment. If a tremor is affecting
your daily activities or if it is a new symptom, see your doctor sooner.
If you have been diagnosed with Parkinson's disease, call your doctor if:
- You notice any significant change in your
symptoms, such as severe episodes of freezing—a sudden loss of mobility—which
may affect walking.
- Your response to your medicine
changes.
- Any other
symptoms occur, such as constipation, sexual problems, or incontinence.
- You have
symptoms of depression, such as feeling sad and hopeless and losing interest in daily activities.
- You or your family
notice that you have problems with memory and thinking ability.
If you have been diagnosed with Parkinson's disease, you
will need to see members of your health care team regularly (every 3 to 6
months, or as directed) for adjustments in your treatment as your condition
changes.
Watchful waiting
If you notice a
tremor developing, watch and record its development.
Discuss it with your doctor at the next possible opportunity. A written
description will help your doctor make a correct diagnosis. In writing your
description, consider the following questions:
- Did the tremor start suddenly or
gradually?
- What makes it worse or better?
- What parts of
your body are affected?
- Have there been any recent changes in the
medicines you are taking or how much you are taking?
For more questions that will help your doctor make an
accurate diagnosis, read about
medical history and Parkinson's disease.
Who to see
The following health professionals can help diagnose or
treat Parkinson's disease:
Other health professionals who may be involved in your
care include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
A diagnosis of
Parkinson's disease is based on your
medical history and a thorough
neurological exam. Your doctor also may check your
sense of smell. Sometimes, your doctor will have you try a medicine for
Parkinson's disease. If that medicine helps your symptoms, it may help the
doctor find out if you have Parkinson's disease.
There are no lab
tests that can diagnose Parkinson's disease. If your symptoms and the doctor's
findings during the examination are not entirely typical of Parkinson's
disease, certain tests may be done to help diagnose
other conditions with similar symptoms. For instance,
blood tests may be done to check for abnormal thyroid hormone levels or liver
damage. An imaging test (such as a
CT scan or an
MRI) may be used to check for signs of a
stroke or brain tumor.
Another type of
imaging test, called
PET, sometimes may detect low levels of dopamine in
the brain, a key feature of Parkinson's disease. But PET scanning is not
commonly used to evaluate Parkinson's disease because it is very expensive, is
not available in many hospitals, and is only used experimentally.
Early detection
For some diseases, doctors can do tests to look
for problems or diseases before you have any symptoms. This is called
screening. But there is no screening test for Parkinson's disease at this
time.
Treatment Overview
No known treatment can stop or
reverse the breakdown of nerve cells that causes
Parkinson's disease. But drugs can relieve many
symptoms of the disease. Surgery also can be effective in a small number of
people to treat symptoms of Parkinson's disease.
Treatment is
different for every person, and the type of treatment you will need may change
as the disease progresses. Your age, work status, family, and living situation
can all affect decisions about when to begin treatment, what types of treatment
to use, and when to make changes in treatment. As your medical condition
changes, you may need regular adjustments in your treatment to balance
quality-of-life issues, side effects of treatment, and treatment costs.
Parkinson's disease causes a wide range of symptoms and complications.
This topic covers the overall management of the disease. This topic does not
discuss managing specific symptoms.
Initial and ongoing treatment
If your symptoms are mild, you
may not need treatment for
Parkinson's disease. Your doctor may wait to prescribe
treatment with drugs until your symptoms begin to interfere with your daily
activities. Other treatment methods (such as exercise, physical therapy,
and occupational therapy) can be helpful at all stages of Parkinson's disease
to help you maintain your strength, mobility, and independence.
There are many measures you
can take at home to make dealing with the symptoms of Parkinson's disease
easier. Simplify your daily activities so that you have the energy for those
that are most necessary. And arrange your furniture and other commonly used
items so that it is easier for you to move around and get to things in your
home. This can help keep you functioning independently.
Getting
regular exercise and eating a healthy,
balanced diet are important parts of treating
Parkinson's disease. Exercise can help you keep your strength,
coordination, and endurance as well as control your weight and reduce the
likelihood that you will become constipated. And although a balanced diet is
important, people who take levodopa should talk to their doctor about when to
eat protein, because levodopa may not work as well if you take it at the same
time that you eat protein.
Depression is common in people with
Parkinson's disease.
Recognizing and dealing with depression is an
important part of home treatment. There are medicines that can help the
symptoms of depression in people with Parkinson's disease. Your doctor, other health
professionals, or Parkinson's disease support groups can help you get emotional
support and education about the illness. This is important both early and
throughout the course of the disease.
As
Parkinson's disease progresses, the symptoms usually
become more disabling. Most people develop mild to moderate tremor. Movement is
often slow and limited due to muscular rigidity and the slowing down and loss
of automatic and spontaneous movement (bradykinesia). Treatment in this stage
is determined by weighing the severity of the symptoms against the side effects
of drugs.
The symptoms of Parkinson's disease change as the
disease progresses. Because of this, your doctor will adjust your drugs to deal
with the symptoms as they appear.
Levodopa is the most commonly used drug for
Parkinson's disease. It works better than any other drug used to treat
Parkinson's disease symptoms and has fewer side effects. But after using
levodopa for over 5 years, many people start to have problems with
motor complications (times when the medicine suddenly stops working or when
you have uncontrollable jerking movements). Because of this, your doctor may
prescribe
dopamine agonists such as pramipexole or ropinirole to
delay the point at which you need to begin taking levodopa. Studies have
suggested that this may delay the onset of levodopa's side effects.3 But in the longest study done, people who started treatment
with a dopamine agonist had just as many problems with motor fluctuations at 14
years as people who started treatment with levodopa.1
Your doctor may also prescribe levodopa along with a dopamine agonist.
Treatment when the condition gets worse
A person
in the advanced stages of
Parkinson's disease is significantly limited in
movement and activity. Symptoms can change daily, and the side effects of drugs
can limit their effectiveness. Your doctor may change your drug in order to
deal with the symptoms as they arise.
A speech therapist can
suggest breathing and speech exercises that can help you overcome the soft,
imprecise speech and monotone voice that develop in advanced Parkinson's
disease. Changing how and what you eat can help you overcome problems with
eating. For example, sitting upright, taking small bites and sips, and eating
moist, soft foods can help you avoid nutrition problems and lessen your chance
of choking. Keeping your chin up, swallowing often, and not eating sugary foods
can help reduce drooling.
Freezing, or motor blocks, can be dealt
with through purposeful movement. Stepping toward a specific target on the
ground and making your first step a precise, long, marching-style stride can
help you overcome freezing episodes. A
physical therapist or
occupational therapist may be able to offer some
helpful advice to improve your walking and reduce your risk of falling.
Other common symptoms that appear during Parkinson's disease include
depression and sexual dysfunction. Talk to your doctor about ways to overcome
these problems. There are medicines that can help these symptoms in people with
Parkinson's disease.
You or your family members may notice that
you begin to have problems with memory, problem solving, learning, and other
mental functions. When these problems keep you from doing daily activities, it
is called
dementia. There are medicines that can help treat
dementia in people with Parkinson's disease.
Surgeries such as
deep brain stimulation may be done during this
stage of the disease.
Prevention
There is no known way to prevent
Parkinson's disease.
Research has shown
that people who eat more fruits and vegetables, high-fiber foods, fish, and
omega-3 rich oils (sometimes known as the Mediterranean diet) and who eat less
red meat and dairy may have some protection against Parkinson's disease. But
the reason for this is still being studied.4
Home Treatment
Early on,
Parkinson's disease may not greatly disrupt your life. But for most people, the
disease becomes more disabling over time. Home treatment can help you adjust as
the disease progresses and help you stay independent for as long as possible.
The quality of your life may depend in part on
your ability to continue working, take care of a home, care for your family, and
remain independent. You may need adaptive devices such as canes or walkers as the disease progresses.
Aspects of home treatment
that are important for a person with Parkinson's disease include:
- Modifying your activities and your home, such as simplifying your daily activities and changing the
location of furniture so that you can hold on to something as you move around
the house.
- Eating healthy foods, including plenty
of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and
low-fat dairy products.
- Exercising and doing physical therapy,
which have benefits in both early and advanced stages of the
disease.
- Dealing with tremor, which may include putting a
little weight on the hand to help reduce tremor and restore control.
- Improving speech quality by working with a speech
therapist (also called a speech-language pathologist).
- Reducing problems with eating and drooling by changing how and what you eat.
- Dealing with "freezing" by various means, such as stepping toward a specific
target on the ground.
- Dealing with sexual function problems.
Talk to your doctor about your specific issues. He or she may be
able to suggest a change in your treatment, such as a change in your medicine
or exercise.
- Dealing with depression. If you are
feeling sad or depressed, ask a friend or family member for help. If these
feelings don't go away, or if they get worse, talk to your doctor. He or she
may be able to suggest someone for you to talk to or give you medicine that
will help.
- Dealing with
dementia. Dementia is common late in Parkinson's
disease. Symptoms may include confusion and memory loss. If you or a family
member notices that you are confused a lot or have trouble thinking clearly,
talk to your doctor. There are medicines that can help dementia in people with
Parkinson's disease.
Medications
Medicines are the most common treatment
for
Parkinson's disease. The goal is to correct the
shortage of the brain chemical (neurotransmitter)
dopamine, which causes the symptoms of Parkinson's
disease. Treatment with drugs is usually started when symptoms become disabling
or disrupt a person's daily activities.
Drugs for
Parkinson's disease are prescribed with specific
instructions about when to take them. It is important to follow your doctor's
instructions concerning how and when to take your drugs so that they will be
effective and safe. Increasing, decreasing, or stopping
the medicines you are taking may cause big changes in your symptoms and can be
dangerous. Even if a medicine doesn't seem to be working, when you stop taking
it, your symptoms of Parkinson's disease may be worse.
Treatments may differ
based on a person's symptoms and age and how the person responds to a certain
drug. Drugs often improve symptoms, but they also may cause side effects. It
may take some time to find the best combination of drugs for a particular
person.
Currently, levodopa is thought to be the most effective drug
for controlling symptoms of Parkinson's disease and for many years was the
preferred drug for treating newly diagnosed people.5
But because long-term use of levodopa at high dosages often leads to
motor complications that can be difficult to manage, sometimes doctors use dopamine agonists (such as pramipexole and ropinirole)
to treat people during the early stages of Parkinson's disease. Using these
drugs in the early stages of the disease may allow treatment with levodopa to
be delayed. But dopamine agonists have more side effects and don't control
symptoms as well as levodopa. And in the long term, the same amount of people
have motor complications no matter what medicine is used first.1
The decision about whether it is better to use
levodopa or a dopamine agonist as the first treatment
has not been fully resolved. The choice will most likely be different for each
person. It is
important to work with your doctor to find the medicines that work the best for
you.
Medication choices
Several drugs may be used to treat Parkinson's disease at
different stages of the disease.
In general, treatment of early
Parkinson's starts with one or more of these medicines:
What to think about
Early in the disease, it might be helpful to take pills with food to help
with nausea, which may be caused by some medicines taken for Parkinson's
disease. Later in the disease, taking the medicines at least 1 hour before
meals (and at least 2 hours after meals) may help them work best. Some
medicines for Parkinson's disease don't work as well if you take them at the
same time you eat food with protein in it, such as meat or cheese. The protein
can block the medicine and keep it from working as well as it should.
Surgery
Brain surgery may be considered when drugs
fails to control symptoms of
Parkinson's disease or cause severe or disabling side
effects.
Surgery is not a cure for Parkinson's disease. Drugs are usually still
needed after surgery. But surgery can reduce the number and amount of drugs
needed to control symptoms. This reduces the side effects caused by drugs while
at the same time controlling symptoms.
Surgery choices
- Deep brain stimulation affects movement by using
electrical impulses to stimulate a target area in the brain. The electrical
impulses are generated by wire electrodes surgically placed in the brain. Deep
brain stimulation may be used in addition to therapy with levodopa or other
drugs when drugs alone do not control symptoms adequately. This technique is
the preferred surgical method of treating most cases of advanced Parkinson's
disease. It does not destroy brain tissue and has fewer risks than older, more
destructive surgical methods, such as pallidotomy and thalamotomy.
- Pallidotomy involves
the precise destruction of a very small area in the deep part of the brain (the globus pallidus) that
causes symptoms.
- Thalamotomy involves
the precise destruction of very small area in the deep part of the brain (the thalamus) that
causes symptoms.
Neurotransplantation is an experimental procedure being studied for the treatment of
Parkinson's disease. It involves implanting cells that produce dopamine into
the brain. Information about the effectiveness of neurotransplantation is
limited. And it is not a proven treatment or a realistic option for most people
at this time.
What to think about
A neurologist with special
training in Parkinson's disease is most often the best kind of doctor to make a
decision about surgery. If you might benefit from surgery or deep brain
stimulation, your neurologist can refer you to a brain surgeon with experience
doing these operations.
People who have
extremely advanced Parkinson's or who have other serious conditions (such as
heart or lung disease, cancer, or kidney failure) are not usually good
candidates for surgery. Surgery is usually not considered for people who have
dementia or psychiatric disorders.
Other Treatment
Physical therapy,
speech and language therapy, and
occupational therapy can all be helpful for people
who have
Parkinson's disease.
Several nutritional
therapies have been suggested as treatments for Parkinson's disease. None of
these has been proved effective. But it is important to maintain general
health and to eat a
balanced diet.
Before trying a
complementary treatment, such as a special diet, talk with your doctor about
the safety and potential side effects of the treatment. Talking
with your doctor can help you both decide whether a treatment is safe and
effective. Complementary treatments should not replace the use of drugs to
treat Parkinson's disease if you are a candidate for treatment with these
drugs.
Depression that does not respond to drugs may improve with
electroconvulsive therapy (ECT). ECT can also improve
movement for a short period of time, though the reason for this improvement is
not understood.
In March 2007 the National Institutes of Health
(NIH) National Institute of Neurological Disorders and Stroke (NINDS) announced
that it is starting a large clinical trial to see if the nutritional
supplement creatine can slow the progression of Parkinson's disease. Results
from this study are expected in 5 to 7 years.
Other Places To Get Help
Organizations
| National Institute of Neurological Disorders and
Stroke |
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: |
1-800-352-9424 |
| Phone: |
(301) 496-5751 |
| TDD: |
(301) 468-5981 |
| Web Address: |
www.ninds.nih.gov |
| |
|
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
|
|
| American Parkinson Disease Association
(APDA) |
| 135 Parkinson Avenue |
| Staten Island, NY 10305 |
| Phone: |
1-800-223-2732 |
| Phone: |
(718) 981-8001 |
| Fax: |
(718) 981-4399 |
| Email: |
apda@apdaparkinson.org |
| Web Address: |
www.apdaparkinson.org |
| |
|
This not-for-profit organization has information and
referral centers in most states to provide information on local health
services, availability of doctors experienced with the disease, and updated
information on medications. APDA has 90 fundraising chapters and more than 400
support groups nationwide.
|
|
| National Parkinson Foundation (NPF) |
| 1501 NW 9th Avenue / Bob Hope Road |
| Miami, FL 33136-1494 |
| Phone: |
1-800-327-4545 |
| Phone: |
(305) 243-6666 |
| Fax: |
(305) 243-6073 |
| Email: |
contact@parkinson.org |
| Web Address: |
www.parkinson.org |
| |
|
The National Parkinson Foundation provides information
on problems related to Parkinson's disease. It also maintains the Bob Hope
National Parkinson Research and Rehabilitation Institute. NPF conducts research
on Parkinson's disease, provides doctor referrals, and sponsors a variety of
educational programs.
|
|
| Parkinson's Disease Foundation |
| 1359 Broadway |
| Suite 1509 |
| New York, NY 10018 |
| Phone: |
1-800-457-6676 |
| Phone: |
(212) 923-4700 |
| Fax: |
(212) 923-4778 |
| Email: |
info@pdf.org |
| Web Address: |
www.pdf.org |
| |
|
This national not-for-profit organization is dedicated
to research on the cause, prevention, treatment, and cure of Parkinson's
disease and related conditions. It maintains laboratories and grants
postdoctoral and student fellowships. It also provides referrals to support
groups and neurologists.
|
|
| WE MOVE |
| 5731 Mosholu Avenue |
| Bronx, NY 10471 |
| Email: |
wemove@wemove.org |
| Web Address: |
www.wemove.org |
| |
|
WE MOVE is an Internet resource for movement disorder
information. This nonprofit organization is dedicated to educating people about the latest
treatment options for neurologic movement disorders. WE MOVE also has
information on support groups and hosts discussions and chat rooms on the website.
|
|
References
Citations
- Katzenschlager R, et al. (2008). Fourteen-year final
report of the randomized PDRG-UK trial comparing three initial treatments in
PD. Neurology, 71(7): 474–480.
- Buter TC, et al. (2008). Dementia and survival in
Parkinson disease: A 12-year population study. Neurology, 70(13): 1017–1022.
- Clarke CE, Moore AP (2007). Parkinson's disease,
search date November 2006. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
- Sofi F, et al. (2008). Adherence to Mediterranean diet
and health status: Meta-analysis. BMJ. Published online
September 11, 2008 (doi:10.1136/bmj.a1344).
- Miyasaki JM, et al. (2002). Practice parameter:
Initiation of treatment for Parkinson's disease: An evidence-based review.
Neurology, 58(1): 11–17.
Other Works Consulted
- Deuschl G, et al. (2006). A randomized trial of
deep-brain stimulation for Parkinson's disease. New England Journal of Medicine, 355(9): 896–908.
- Miyasaki JM, et al. (2006). Practice parameter:
Evaluation and treatment of depression, psychosis, and dementia in Parkinson
disease (an evidence-based review). Report of the Quality Standards
Subcommittee of the American Academy of Neurology. Neurology, 66(7): 996–1002.
- Olanow CW, et al. (2009). A double-blind, delayed-start trial of rasagiline in Parkinson's disease. New England Journal of Medicine, 361(13): 1268–1278.
- Stowe R, et al. (2010). Evaluation of the efficacy and safety of adjuvant treatment to levodopa therapy in Parkinson's disease patients with motor complications. Cochrane Database of Systematic Reviews (7).
- Suchowersky O, et al. (2006). Practice parameter:
Diagnosis and prognosis of new onset Parkinson disease (an evidence-based
review). Report of the Quality Standards Subcommittee of the American Academy
of Neurology. Neurology, 66(7): 968–975.
- Suchowersky O, et al. (2006). Practice parameter:
Neuroprotective strategies and alternative therapies for Parkinson disease (an
evidence-based review). Report of the Quality Standards Subcommittee of the
American Academy of Neurology. Neurology, 66(7):
976–982.
- Weintraub D, et al. (2010). Impulse control disorders in Parkinson disease. Archives of Neurology, 67(5): 589–595.
- Zesiewicz TA, et al. (2010). Practice parameter: Treatment of nonmotor symptoms of Parkinson's disease: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 74(11): 924–931.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer |
G. Frederick Wooten, MD - Neurology |
| Last Revised |
August 22, 2011 |
