Parkinson’s Disease

It is a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills and speech characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia).

• It is also called “primary parkinsonism” where the symptoms may result from toxicity, drugs, genetic mutation, head trauma, or other medical disorders.
• Idiopathic – where cause is not known .

• • Tremor- when the limb is at rest, and decreased with voluntary movement. It is typically unilateral at onset.
  • Rigidity- stiffness; increased muscle tone. In combination with a resting tremor, this produces a “cogwheel” rigidity when the limb is passively moved.
  • Bradykinesia/akinesia- slowness or absence of movement. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude. Also “dysdiadochokinesia”, which is the loss of ability to perform rapid alternating movements
  • Postural instability- failure of postural reflexes, which leads to impaired balance and falls.

Other motor symptoms include:

• Gait and posture disturbances:
  • Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to trip the patient
  • Decreased arm swing
  • Rather than the usual twisting of the neck and trunk and pivoting on the toes, patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
  • Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk
  • Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
  • Gait freezing: inability to move the feet, especially in tight, cluttered spaces or when initiating gait.
  • Dystonia : abnormal, sustained, painful twisting muscle contractions, usually affecting the foot and ankle.
• Speech and swallowing disturbances in form of soft, excessively rapid speech, drooling and impaired ability to swallow which can lead to aspiration, pneumonia.
• Fatigue ,a mask-like face with infrequent blinking, difficulty in rolling in bed or rising from a seated position, small, cramped handwriting, impaired fine and gross motor coordination;

Mood disturbances, depression,cognitive disturbances,dementia, hallucinations, delusions, short term memory loss, sleep disturbances(excessive daytime sleep),sensation disturbances and autonomic disturbances like urinary incontinence,constipation and weight loss.

Parkinson’s disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy,speech therapy, exercise, and nutrition. At present, there is no cure , but medications like Levodopa , dopamine-agonists like bromocriptine and MAO-B inhibitors like Selegiline and rasagiline or in extreme cases surgery can provide relief from the symptoms.