Parkinson’s Disease

General Information

Parkinson’s disease, sometimes called paralysis agitans, is a problem caused by changes in a portion of the brain. The cause of Parkinson’s disease is not well understood. A few cases occur after viral infections, but the interval between infection and onset of Parkinson’s disease may be very long. Parkinson’s disease affects older people, with most cases occurring after age 50. The most visible sign of the disease is a tremor. Often the tremor will affect only one side of the body at the beginning. The tremor is but one manifestation of the underlying problem. Patients with Parkinson’s disease also experience muscular rigidity, slowness of movement, and disturbed posture.

Parkinsonian tremor may involve one or both hands. The tremor is present at rest and is less evident with movement. It is a rhythmic movement. In the fingers, this produces a rubbing of the fingers over the thumb, which is often called a pill-rolling tremor. The tremor can also affect the arms, legs, head, and mouth.

Important Points in Treatment
A variety of agents are useful in the treatment of various stages of Parkinson’s disease. In addition, a number of other health problems can simulate Parkinson’s disease, and a number of drugs can have parkinsonian side effects. Your physician will first evaluate you to ensure that drug effects or other diseases are not underlying the development of the tremor. Treatment is individualized to meet the specific needs of each patient. Selection of treatment will vary with the stage of the disease and the age of the patient.

• Treatment of Parkinson’s disease depends on careful dosing with selected drugs. Memory aids should be used to ensure that the proper numbers of pills are taken regularly.
• Parkinson’s disease may cause some unsteadiness. Adjust the household environment to reduce the likelihood of falls. This might include rearrangement of furniture, removal of throw rugs, installation of strategically placed handholds, and use of a cane or walker.
• The medications used may have side effects that change the posture or cause movements that are different from the tremor. The medications may also produce mental changes such as confusion.
• Depression may also occur with Parkinson’s disease. It may interfere with treatment and thus may need treatment itself.

Surgical Treatment
The disability caused by Parkinson’s disease has made it the focus of much research. A number of surgical operations have been tried. These have proven to be of help in only a minority of patients. Some forms of therapy for parkinsonism remain experimental and are controversial. Your physician is your best guide to the opportunities that might be suited to your individual needs.

Two general kinds of operations are performed for the treatment of Parkinson’s disease: (1) the destruction of very selective tiny areas of the brain and (2) the implantation of other tissues into the brain. In addition, there is an operation that involves placement of an electronic device to stimulate selected areas of the brain.

The effectiveness of the operations that involve destruction of tiny selective areas of the brain depends on the ability of the surgeon to find exactly the right location within the brain. The problem is the difficulty in locating this spot. With new tools available to make images of the brain, this surgical treatment is once again being used. It is most useful for patients with a tremor on only one side of the body. For these patients, it can be effective, but complications occur in 1 of 10 patients.

There have been many newspaper reports of the implantation of tissues, particularly fetal tissue, into the brain to relieve the changes of Parkinson’s disease. Early studies are promising, but this is still a research operation and not recommended or generally available.

A trial is being conducted regarding the use of tiny electrodes implanted in the brain to allow stimulation of an area that will, in turn, cause the tremor to subside. This operation also is under research study and is not recommended or generally available.

The most effective treatment for Parkinson’s disease is still drug therapy. In a few patients who fail to respond to drug therapy or who cannot take the most useful drugs, the possibility of surgical treatment may be considered.

Notify Our Office If ...

• You have complications of drug treatment. These include blurring of vision, difficulty with urination, and confusion. Drug treatment for Parkinson’s disease must be tailored to each patient. The various drugs used each have side effects that, if neglected, can result in complications. Visits to your physician may need to be more frequent during the initial period of therapy. Once treatment is established, regular but less frequent visits will be necessary.