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Parkinson's disease

Parkinson's disease causes certain brain cells to die. They are the cells that help control movement and coordination. The disease leads to shaking (tremors ) and trouble walking and moving .

Alternative Names

Paralysis agitans; Shaking palsy

Causes

Nerve cells use a brain chemical called dopamine to help control muscle movement. With Parkinson's disease, the brains cells that make dopamine slowly die. Without dopamine, the cells that control movement can’t send messages to the muscles. This makes it hard to control your muscles. Slowly over time, this damage gets worse. No one knows what causes these brain cells to waste away.

Parkinson's disease most often develops after age 50. It is one of the most common nervous system problems in older adults.

  • The disease tends to affect men more than women, although women also get the disease. Parkinson's disease sometimes runs in families.
  • The disease can occur in younger adults. When a younger person gets Parkinson's, it is often due to that person’s genes.
  • Parkinson's disease is rare in children.
Parkinson's disease
Parkinson's disease

Symptoms

Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg is stiff and dragging. Symptoms may affect one or both sides of the body.

General symptoms may include:

  • Problems with balance and walking
  • Rigid or stiff muscles
  • Muscle aches and pains
  • Low blood pressure when you stand up
  • Stooped posture
  • Constipation
  • Sweating and not being able to control your body temperature
  • Slow blinking
  • Difficulty swallowing
  • Drooling
  • Slowed, quieter speech and monotone voice
  • No expression in your face (like you are wearing a mask)

Movement problems may include:

  • Difficulty starting movement, such as starting to walk or getting out of a chair
  • Difficulty continuing to move
  • Slowed movements
  • Loss of small hand movements. Your writing may become small and difficult to read.
  • Difficulty eating

Symptoms of shaking (tremors):

  • Usually occur when your limbs aren't moving; this is called resting tremor
  • Occur when your arm or leg is held out
  • Go away when you move
  • May be worse when you are tired, excited, or stressed
  • Can cause you to rub your finger and thumb together without meaning to (called pill-rolling tremor)
  • Eventually may occur in your head, lips, tongue, and feet

Other symptoms may include:

Exams and Tests

Your health care provider may be able to diagnose Parkinson's disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse.

The examination may show:

  • Difficulty starting or finishing a movement
  • Jerky, stiff movements
  • Muscle loss
  • Shaking (tremors)
  • Changes in your heart rate
  • Normal muscle reflexes

Your doctor may do some tests to rule out other conditions that can cause similar symptoms.

Treatment

There is no cure for Parkinson's disease. However, treatment can help control your symptoms.

MEDICINE

Your health care provider will prescribe medicines to help control your shaking and movement symptoms. These drugs work by increasing dopamine in your brain.

At certain times during the day, the medicine often wears off and symptoms can return. If this happens, your health care provider may need to change the:

  • Type of medicine
  • Dose
  • Amount of time between doses
  • How the medicine is taken

You may also need to take medicines to help with:

  • Mood and thinking problems
  • Pain relief
  • Sleep problems

Parkinson’s medicines can cause severe side effects. They may include:

Tell your doctor right away if you have these side effects. Never change or stop taking any medicines without talking with your doctor. Work with your doctors and other providers to find a treatment plan that works for you.

As the disease gets worse, symptoms such as stooped posture, frozen movements, and speech problems may not respond to the medicines.

SURGERY

Surgery may be an option for some people. Surgery does not cure Parkinson’s disease, but may help ease symptoms. Types of surgery include:

  • Deep brain stimulation . This involves placing electric stimulators in areas of the brain that control movement.
  • Surgery to destroy brain tissue that causes Parkinson’s symptoms.
  • Stem cell transplant and other procedures are being studied.

LIFESTYLE

Certain lifestyle changes  may help you cope with Parkinson's disease:

  • Stay healthy by eating a healthy diet and not smoking.
  • You may need to make changes in what you eat or drink if you have swallowing problems .
  • Speech therapy can help you adjust to changes in your swallowing and speech.
  • Stay active as much as possible when you feel good. Don’t overdo it when your energy is low.
  • Rest as needed during the day and avoid stress.
  • Physical therapy and occupational therapy can help you be independent and reduce the risk of falls.
  • Place handrails throughout your house to help prevent falls . Place them in bathrooms  and along stairways.
  • Where needed, use assistive devices to make movement easier. These may include special eating utensils, wheelchairs, bed lifts, shower chairs, and walkers.
  • Social workers or other counseling services can help you and your family cope with the disorder. They can also help you get outside help, such as Meals on Wheels.

Support Groups

Parkinson’s disease support groups can help you cope with the changes caused by the disease.

Outlook (Prognosis)

Medicines can help most people with Parkinson’s disease. How well medicines relieve symptoms and for how long can be different in each person.

If not treated, the disorder gets worse until a person is totally disabled. Parkinson’s disease may lead to a deterioration of all brain functions and an early death.

Possible Complications

  • Difficulty performing daily activities
  • Difficulty swallowing or eating
  • Disability (differs from person to person)
  • Injuries from falls
  • Pneumonia from breathing in saliva
  • Side effects of medications

When to Contact a Medical Professional

Call your health care provider if:

  • You have symptoms of Parkinson's disease
  • Symptoms get worse
  • New symptoms occur

If you take medicines for Parkinson's disease, tell your health care provider about any side effects, which may include:

  • Changes in alertness, behavior or mood
  • Delusional behavior
  • Dizziness
  • Hallucinations
  • Involuntary movements
  • Loss of mental functions
  • Nausea and vomiting
  • Severe confusion or disorientation

Also call your health care provider if the condition gets worse and home care is no longer possible.

References

American Parkinson Disease Association. Be independent: a guide for people with Parkinson disease. Staten Island, NY: American Parkinson Disease Association, Inc. 2009. Accessed September 26, 2013.

Jankovic J. Movement disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 71.

Lang AE. When and how should treatment be started in Parkinson disease? Neurology. 2009;72(7 Suppl):S39-43.

Suchowersky O, Gronseth G, Perlmutter J, et al. 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. 2006;66;976-982.

Weaver FM, Follett K, Stern M, et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009;301:63-73.

Zesiewicz TA, Sullivan KL, Arnulf I, et al. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:924-931.

Updated: 9/25/2013

Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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