Parkinson’s disease (PD) is a movement disorder of the nervous system that changes over time. PD starts by a noticeable tremor of one hand, foot or jaw and then progresses to a generalized movement disorder that can causes balance problem, leading to falls. Over 60,000 people are diagnosed each year with PD .

In an earlier article in River Reporter, I described other causes of shaking hands. Essential tremor is a common condition that affects one or more hands. The cause is not known but does respond to drugs such as propranolol (Inderal), or primidone (Mysoline) along with Gabapentin. Each of the conditions listed in the table at top right responds differently to various medications. PD has its own unique presentation and responds to specific medications. 

Early PD presentations

Risk factors for PD include age (found in 50 and above), family history, male sex and history of exposure to herbicides and pesticides.

Early PD can cause facial changes, loss of swinging arms when you walk, slurred speech or loss of speech volume. As time progresses, other symptoms occur such as a tremor of one or both hands and rubbing your thumb and forefinger together (“pill rolling”). Your shaking can be increased when you are at rest and decrease when you are using your hand.

Progressive symptoms of PD

PD as it progresses begins to affect your walking, getting out of a chair and dressing. People will notice decreased rate of walking and movement in general (bradykinesia). Other progressive changes include rigid muscles in any part of your body with pain accompanying movement, poor posture leading to tripping and falling, and loss of automatic movements such as blinking or swinging arms.

Nonmotor symptoms associated with PD include constipation, daytime sleepiness, depression, sleep disturbances and urinary incontinence. 

Causes of PD

Source: www.aafp.org2020 

At this time, there is no known cause of PD. Symptoms are caused by loss of neurons that produce dopamine. Depending on the location of the brain affected, it can cause a range of movement disorders. In addition to loss of dopamine, PD can also decrease norepinephrine, which controls blood pressure and other body changes.

Diagnosis is made by physical exam primarily. Other diagnostic tests that are run include using MRIs to look for Lewy bodies and altered mitochondria. Again, this is early research. 

Treatment for PD symptoms

Medication management of early state of PD includes amantadine for people younger than 65 amd carbidopa/levodopa for people over 65. Monoamine oxidase-B inhibitors (Zelapar) and nonergot dopamine agonists (Maraplex) are used for young patients with PD presentation.

Nonmotor symptoms need to be addressed at each visit. Constipation is a common and persistent problem.  

Deep brain stimulation uses a surgical implant in a section of the brain that will supress serious tremors and movement disorders. 

Physical therapy is important to maintain motor skills and strength and has been shown to slow the progress of the disease.

Diet is important because PD can increase chances of osteoporosis. There should be 30 to 45 minute separation of taking medication and eating a high protein meal. There should be adequate intake of Vitamin D and calcium.

New medications and treatments

There is a great deal of research in the pipeline at this time. The Michael J. Fox Foundation is currently following over 150 potential drugs and treatment. The newest medication coming on the market is Crexont (Amneal Pharmaceuticals), which reduces the number of pills that needs to be taken each day.

Another procedure being studied is the use of focused ultrasound treatment that reduces tremors without the need of surgery.