Health Library

Parkinson's Disease

(PD; Paralysis Agitans; Shaking Palsy)

by Rosalyn Carson-DeWitt, MD

En Español (Spanish Version)
More InDepth Information on This Condition

Definition

Parkinson's disease (PD) is a movement disorder. The symptoms get worse over time and can include:

Muscle rigidity
Tremor at rest
Slowing down of movements (bradykinesia)
Difficulty moving and gait instability

Part of the Brain Affected by PD—Yellow Section

Causes

PD is caused by a loss of certain nerve cells in the brain. The loss of these cells causes a decrease in the amount of a brain chemical called dopamine. Low dopamine levels cause PD symptoms.

The brain cells may be lost because of genetic defects, the environment, or some combination of the two. A small amount of people with PD have an early-onset form. This type is caused by an inherited gene defect.

Secondary PD has similar symptoms but is caused by several factors such as:

Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)

Antinausea/gastric motility medications such as prochlorperazine and metoclopramide

Cardiovascular drugs, such as some calcium channel blockers and antiarrhythmic drugs

Valproic acid (a medication used for seizures, migraines, and bipolar disorder)
Carbon monoxide poisoning
Manganese poisoning
Hydrocephalus
Brain tumors
Stroke
Encephalitis
Meningitis
IV drug abuse contaminated by MPTP (a type of neurotoxin)
Reserpine (medicine to treat schizophrenia and high blood pressure)
Insecticide exposure
Trauma
AIDS

Risk Factors

Factors that increase the chance of PD include:

Age: 50 years or older

History of polio
Gender: men (slightly more likely to develop PD)
Family members with PD
Nonsmokers
Exposure to toxins, drugs, or conditions listed above
High cholesterol
Melanoma skin cancer

Symptoms

Symptoms of PD begin mildly. They will worsen over time.

Symptoms include:

"Pill-rolling" tremor in the hands

Tremors are present at rest, improve with movement, and are absent during sleep

Stiffness and rigidity of muscles, usually beginning on one side of the body

Difficulty and shuffling when walking

Short steps

Slowness of purposeful movements

Trouble performing usual tasks, due to shaking in hands and slowness of movement

Trouble speaking (often speaking with a low volume)

Flat, monotonous voice

Stuttering

Shaky, spidery, or small handwriting

Poor balance

Difficulty with rising from a sitting position

“Freezing”

Anxiety
Seborrhea (a skin problem that causes a red rash and white scales)
Loss of smell
Urinary symptoms (frequency and urgency)
Bowel movement symptoms (straining, constipation)
Tendency to fall
Stooped posture
Increasingly mask-like face, with little variation in expression
Trouble chewing and swallowing
Drooling and excessive salivation
Depression
Dementia
Hallucinations
Difficulty thinking, problems with memory
Decreased sense of smell
Sleep problems such as REM-behavior disorder

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. There are no tests to definitively diagnose PD. The doctor will ask many questions. This will help to rule out other causes of your symptoms.

Tests to rule out other conditions may include:

Blood tests

Urine tests

CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
MRI scan—a test that uses magnetic waves to make pictures of structures inside the head
PET scan—a scan that makes images that show the amount of activity in the brain. A special kind of PET scan called a DAT scan may be used in the evaluation of PD.

Treatment

Currently, there are no treatments to cure PD. There are also no proven treatments to slow or stop its progression. Some medications may help to improve symptoms. Over time, the side effects of the medication may become troublesome. The medications may also lose their effectiveness.

Examples of medicines include:

Levodopa/carbidopa (Sinemet)
Amantadine (Symmetrel)
Anticholinergics: benztropine (Cogentin) and biperiden (Akineton)
Monoamine oxidase inhibitors, such as selegiline (Eldepryl)
Dopamine agonists: bromocriptine (Parlodel), pramipexole (Mirapex), Cabergoline (Dostinex), Rotigotine (Neupro), apomorphine (Apokyn), and ropinirole (Requip)
COMT inhibitors: entacapone (Comtan) and tolcapone (Tasmar)

Depression or hallucinations may also occur with PD and its treatment. Medicines may be prescribed to attempt to treat these conditions. The drugs may include:

Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressant (such as, nortriptyline)
Antipsychotic medicine (such as, clozapine)

Hip fractures are common in those with PD. Bisphosphonates are medications that may help reduce this risk.

Constipation, drooling, and lightheadedness when standing are common and may improve with medications or other treatments.

Different brain operations are available, and many more are being researched including:

Deep brain stimulation (DBS)—implanting a device to stimulate certain parts of the brain; can decrease tremor and rigidity
Thalamotomy and pallidotomy—destroying certain areas of the brain to improve tremor when medication does not work (not as common as deep brain stimulation)
Nerve-cell transplants (research only)—to increase amount of dopamine made in the brain

Therapy can improve muscle tone, strength, and balance. It will include exercises and stretches.

Consider joining a support group with other people with PD. It will help to learn how others are learning to live with the challenges of PD.

If you are diagnosed with PD, follow your doctor's instructions.

Prevention

There are no guidelines for preventing PD.

National Parkinson Foundation

http://www.parkinson.org

Parkinson's Disease Foundation

http://www.pdf.org

Health Canada

http://www.hc-sc.gc.ca

Parkinson Society Canada

http://www.parkinson.ca

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Last reviewed September 2012 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.