Parkinson's Disease

Parkinson's Disease Overview

Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified).

In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease. These disorders, described as Parkinson's Syndrome, Atypical Parkinson's, or, simply, parkinsonism, may include the following:

drug-induced parkinsonism - prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset.
toxin-induced parkinsonism - manganese and carbon monoxide poisoning.
repeated head trauma
parkinsonism that accompanies other neurological conditions - such as Multiple System Atrophy (Shy-Drager syndrome, oliviopontocerebellar atrophy, cortico-basal ganglionic degeneration), progressive supranuclear palsy, Wilson's disease, Huntington's disease, Hallervorden-Spatz syndrome, Alzheimer's disease, Creutzfeldt-Jakob disease, olivopontocerebellar atrophy, and post-traumatic encephalopathy.
postencephalitic parkinsonism - a viral disease that causes "sleeping sickness."
tumors in the brain (rarely)

What are the four primary symptoms of Parkinson's?

The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:

rigidity - stiffness when the arm, leg, or neck is moved back and forth.
resting tremor - tremor (involuntary movement from contracting muscles) that is most prominent at rest.
bradykinesia - slowness in initiating movement.
loss of postural reflexes - poor posture and balance that may cause falls; gait or balance problems.

As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination.

The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is Parkinson's disease diagnosed?

Currently, there are no specific tests for diagnosing PD. Instead diagnosis is based upon neurological examination. Making an accurate diagnosis in the early stages of Parkinson's disease can be difficult, and may require observation of the patient for some time. There are times, if indicated, your doctor may order diagnostic studies such as MRI imaging to rule out secondary causes.

Treatment for Parkinson's disease:

Specific treatment for Parkinson's disease will be determined by your physician based on:

your age, overall health, and medical history
extent of the condition
type of condition
your tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference

With today's medicine, we have yet to find a cure for Parkinson's disease. However, based upon the severity of the symptoms and medical profile, the physician will establish an appropriate treatment protocol. Treatment for Parkinson's disease may include medications or surgery.

Medication for Parkinson's disease:

Once the diagnosis of PD has been made, the next decision is whether a patient should receive medication. No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms. Proper treatment of PD is truely individualized therapy.

Surgery for Parkinson's disease:

Based on the severity of the condition and the medical profile, the physician may recommend surgery as one treatment option for Parkinson's disease.

There are several types of surgery performed that may help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of PD. Currently there are 2 types of surgical procedures approved for the treament of PD:

deep brain stimulation (DBS)

With this type of surgery, a small electrode is placed in the critical parts of the brain that help to control movement. The electrode is attached to a small battery in the chest wall and is connected by wires that are placed under the skin. The stimulator is then turned on and interrupts the normal flow of information in the brain and can help to decrease symptoms of Parkinson's disease.

lesion surgery (burning of tissue, ablation)

In this procedure, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help control movement. The surgery may be done while the patient is awake to help determine the exact placement of the lesion. The lesion is placed to help control, or stop, the area of the brain that is causing the tremor.

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Last Reviewed: Dec 21, 2006

Karen M. Thomas, DO
Formerly:
Department of Neurology
College of Medicine
The Ohio State University

George W. Paulson, MD
Medical Advisor and Consultant
Department of Neurology
College of Medicine
The Ohio State University