Parkinson’s Disease

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is Parkinson’s disease?

If you’ve recently been diagnosed with Parkinson’s disease, you are probably already displaying some symptoms: maybe a slight trembling (tremor) in your hands, legs, or face, or muscle stiffness, coordination problems, or a slowness of movement (bradykinesia). These and other Parkinson’s symptoms indicate that nerve cells (neurons) in a relatively tiny part of your brain called the substantia nigra have started to die off. This causes a drop in dopamine, a nerve chemical that carries the signals that allow your muscles to move quickly and smoothly.

Whether your symptoms start when you’re young or old, the cause of Parkinson’s disease remains a mystery. One theory is that naturally occurring oxygen molecules called free radicals damage nerve cells in the brain. Research has shown that some Parkinson’s patients have a 30% to 40% decrease in complex I, an enzyme that normally controls this free radical onslaught. Genetic factors are occasionally involved as well. If you have a close relative with Parkinson’s disease, your chances of getting it are three times greater than those of someone without a family link. It’s also possible that exposure to herbicides and pesticides plays a role, but this has not been proven.

Whether you’ve had Parkinson’s disease for years or have just learned your diagnosis, the outlook is good. Among the degenerative diseases of the nervous system, Parkinson’s is one of the most treatable. Symptoms worsen over time as dopamine steadily decreases, but many individuals continue to live full, active lives.

Who is at risk for Parkinson’s disease?

Parkinson’s disease usually occurs between the ages of 55 and 70, and men get it slightly more often than women. Up to 10% of those afflicted, however, are under age 40. They have what’s called “young-onset” Parkinson’s.

Treatment for Parkinson’s disease

There isn’t a definitive test for Parkinson’s disease, but neurologists have little trouble recognizing it once symptoms progress beyond the earliest stages. Early symptoms are often so mild that people don’t bother to call their doctors. That’s unfortunate, because early treatment can make a difference in how you function.

The goals of Parkinson’s treatment are to relieve your symptoms and effectively balance the challenges of the disease with medication side effects that can be troubling. Treatment is extremely individualized. As the disease progresses, you’ll need to work closely with a neurologist to customize your program. Parkinson’s disease can’t be prevented or cured, but there have been exciting breakthroughs. A number of new drugs (and combinations of old ones) can control or even eliminate symptoms for a time. And as the disease progresses, a mix of lifestyle adjustments and drug and surgical options can help keep symptoms from taking over your life.

Medications for Parkinson’s disease

The main treatment for Parkinson’s disease is a drug called levodopa (L-dopa), which the brain converts to muscle-controlling dopamine. It’s most effective against rigidity and slowness. Most levodopa preparations (such as Sinemet and Atamet) include the drug carbidopa. It helps levodopa work more efficiently and helps reduce nausea or other side effects. The drawback to levodopa is that the “honeymoon” usually lasts only five years on average. After that, the drug may gradually stop working.

A relatively new class of drugs, the catechol-O-methyltransferase (COMT) inhibitors, are taken along with levodopa to block a liver enzyme that breaks down levodopa before it reaches your brain. These drugs, which include tolcapone (Tasmar) and entacapone (Comtan), prolong the effects of levodopa and allow you to manage on smaller doses.

Because levodopa works for only a short time, your doctor may not want to start you on it right away. So as an initial treatment, some doctors are trying another class of drugs—the dopamine agonists. These include bromocriptine (Parlodel), pergolide (Permax), and pramipexole (Mirapex). These drugs mimic the effects of dopamine to reduce Parkinson’s symptoms by activating certain chemical receptor sites in the brain.

Your doctor can also choose among a variety of other drugs to control specific Parkinson’s symptoms. For muscle tremors in the early stages, for example, you might need to take an anticholinergic drug, such as trihexyphenidyl (Artane). To reduce tremor, muscle rigidity, and slowness, an antiviral drug called amantadine (Symadine, Symmetrel), often prescribed for treating bouts of the flu, may be recommended.

Lifestyle Changes

Because Parkinson’s disease affects muscle movement, it’s important to stay as strong and fit as you can. Regular exercise is essential. It improves your mobility, balance, and range of motion and keeps up your strength. Any physical activity, such as stretching, walking, swimming, or even weight-lifting, will help you move better and could enhance your endurance. If you’re new to exercise or could simply use some extra motivation, begin by working with a physical therapist who can design an exercise plan that will be effective for you.

To prevent falls, safety-proof your home. Install handrails along stairways, and grab rails in the shower and next to the toilet. Keep electrical or phone cords out of the way. Once the disease progresses, carry a small cellular phone with you in case you fall and can’t get up.

Diet is another self-care cornerstone. If you’re taking L-dopa medications, limit protein to about 12% of total daily calories. More than this makes it harder for the levodopa to reach your brain. Eat plenty of fibre-rich foods, such as vegetables, fruits, and legumes. Fibre prevents constipation, a common symptom of Parkinson’s disease. Plant foods are also rich in vitamin C and other antioxidant nutrients, which may help curtail nerve-cell damage caused by free radicals. Consider working with a nutritionist.

Don’t forget that a good mental attitude can be just as important as keeping yourself physically healthy. One good way to avoid dwelling on your condition is to take up a hobby. Tasks that involve both the mind and the hands, such as sewing, carpentry, or even playing cards, may slow the progression of the disease. Joining a Parkinson’s support group can also be beneficial for you as well as family members and caregivers.

Related Procedures for Parkinson’s Disease

Surgery for Parkinson’s disease fell out of favour when scientists developed levodopa and other medications. But a number of procedures have been revived as advances in magnetic imaging provide new understanding of how motor information is processed. You may be a candidate for one of the surgeries below if drugs become ineffective or side effects unbearable.

• Pallidotomy. This procedure uses electrical current to destroy cells in the globus pallidus, the part of the brain responsible for some Parkinson’s symptoms. The procedure is sometimes used to reduce involuntary movements such as twitching, nodding, or jerking (called dyskinesias), which may be due to taking large doses of levodopa for a long time.
• Thalamotomy. The surgery that actor Michael J. Fox underwent in 1997, thalamotomy uses the same technique as pallidotomy, but it reduces tremors by destroying a small amount of tissue in the thalamus, the brain’s message relay center. It has successfully eliminated tremors in 80% to 90% of patients.
• Deep brain stimulation (DBS). This procedure involves inserting an electrode in the brain’s thalamus. Connected to a pacemaker-like device that’s implanted in your chest and that you control, the electrode delivers electrical signals to the brain to interrupt tremor-causing nerve signals. The advantage of DBS over pallidotomy and thalamotomy is that it is reversible.

Questions for Your Doctor

• Is there any way to slow the progression of my symptoms?
• Will this disease shorten my life span?
• Do I need physical therapy or a special diet?
• Would surgery help reduce my symptoms?

Living with Parkinson’s Disease

If you are living with Parkinson’s disease, here are a few quick tips to help you take control:

• Eat more fava beans. If you’re at the earliest stages of Parkinson’s disease and aren’t yet taking medications, your doctor might advise you to eat these legumes. They contain a hefty amount of levodopa, the same therapeutic compound that’s used in some medications. If you’re already taking drugs, however, don’t add favas to your diet without checking with your doctor. You could wind up getting too much of the active ingredient.
• Work on “muscle freezing.” If, like many Parkinson’s sufferers, you literally freeze in place and find it hard to take a step, you can usually break free by rocking from side to side or by pretending you’re stepping over a small object. You can also divide each movement into several steps. For example, if you’re going to walk through a door, approach the door, pause, open the door, pause, then walk through. Some people also have success improving their gait by walking to the ticking of a metronome.
• Wear clothes that are easy to get on and off. As Parkinson’s disease progresses, you may have trouble even with simple activities like dressing. Make it easy on yourself by buying pants and skirts with elastic waistbands and simple slip-on tops. Avoid hard-to-fasten buttons or snaps.
• Take small bites when eating. It puts less strain on your chewing and swallowing muscles, which may become less responsive over time.

Prevention of Parkinson’s disease

• Limit protein. Avoid high-protein foods such as meats and fish if you’re undergoing L-dopa therapy. Protein diminishes the effectiveness of L-dopa.
• Increase fibre. Adding fibre to your diet can help control constipation related to Parkinson’s disease. Eat five to 10 servings of fruits and vegetables daily.
• Soften up. In the later stages of Parkinson’s, difficulty chewing can make mealtime more aggravating than enjoyable. Choose soft foods including pasta, yogurt, and applesauce.
• Get moving. Make exercise, in the form of stretching and walking, a part of your daily routine. It will improve your strength, balance, and muscle coordination.
• Therapy helps. A physical therapist can teach you how to move your body so you can reduce your chances of falling.
• Nutrition is key. Researchers suspect vitamin E (400 IU per day) may slow the progression of Parkinson’s disease. Calcium (1,500 mg per day) aids in nerve impulse transmission. Vitamin B6 (25 mg, three times daily) speeds the transmission of messages between brain cells, and omega-3 fatty acids, found in flaxseed oil, may reduce tremors (ask your doctor how much to take).
• Herbal help. Visit your local health-food store for Tibetan saffron and tree peony formulations, which may help alleviate tremors. Polygaia can help enhance your mood.
• Try alternatives. Acupuncture has been used to control tremors and loosen rigidity as well as to ease depression.
• Dress accordingly. Choose clothing you can put on and take off with ease. Zippers and Velcro are easier to maneuver than buttons, snaps, and laces.
• Keep it safe. Install handrails in your home—especially in the shower and next to the toilet. Get rid of throw rugs and any loose cords, which are easy to trip over. Carpeting is best for cushioning a fall.
• Helping hands. Parkinson’s disease can take its toll on your emotional health. You may feel embarrassed or depressed by the symptoms. A support group can help ease the emotional burden. Sharing your concerns with others in the same situation can help you cope with the disease.