About parkinson's disease
What is parkinson's disease?
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
In the early stages of Parkinson's disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson's disease symptoms worsen as your condition progresses over time.
Although Parkinson's disease can't be cured, medications might significantly improve your symptoms. Occasionally, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.
What are the symptoms for parkinson's disease?
Parkinson's disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.
Parkinson's signs and symptoms may include:
- Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest.
- Slowed movement (bradykinesia). Over time, Parkinson's disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
- Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
- Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease.
- Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
- Speech changes. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
- Writing changes. It may become hard to write, and your writing may appear small.
When to see a doctor
See your doctor if you have any of the symptoms associated with Parkinson's disease — not only to diagnose your condition but also to rule out other causes for your symptoms.
What are the causes for parkinson's disease?
In Parkinson's disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson's disease.
The cause of Parkinson's disease is unknown, but several factors appear to play a role, including:
Your genes. Researchers have identified specific genetic mutations that can cause Parkinson's disease. But these are uncommon except in rare cases with many family members affected by Parkinson's disease.
However, certain gene variations appear to increase the risk of Parkinson's disease but with a relatively small risk of Parkinson's disease for each of these genetic markers.
- Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson's disease, but the risk is relatively small.
Researchers have also noted that many changes occur in the brains of people with Parkinson's disease, although it's not clear why these changes occur. These changes include:
- The presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease.
- Alpha-synuclein is found within Lewy bodies. Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (a-synuclein). It's found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus among Parkinson's disease researchers.
What are the treatments for parkinson's disease?
Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some more advanced cases, surgery may be advised.
Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.
Medications may help you manage problems with walking, movement and tremor. These medications increase or substitute for dopamine.
People with Parkinson's disease have low brain dopamine concentrations. However, dopamine can't be given directly, as it can't enter your brain.
You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent. You can usually still control your symptoms fairly well.
Medications your doctor may prescribe include:
Carbidopa-levodopa. Levodopa, the most effective Parkinson's disease medication, is a natural chemical that passes into your brain and is converted to dopamine.
Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside your brain. This prevents or lessens side effects such as nausea.
Side effects may include nausea or lightheadedness (orthostatic hypotension).
After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off").
Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.
- Inhaled carbidopa-levodopa. Inbrija is a new brand-name drug delivering carbidopa-levodopa in an inhaled form. It may be helpful in managing symptoms that arise when oral medications suddenly stop working during the day.
Carbidopa-levodopa infusion. Duopa is a brand-name medication made up of carbidopa and levodopa. However, it's administered through a feeding tube that delivers the medication in a gel form directly to the small intestine.
Duopa is for patients with more-advanced Parkinson's who still respond to carbidopa-levodopa, but who have a lot of fluctuations in their response. Because Duopa is continually infused, blood levels of the two drugs remain constant.
Placement of the tube requires a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.
Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in your brain.
They aren't as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.
Dopamine agonists include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro, given as a patch). Apomorphine (Apokyn) is a short-acting injectable dopamine agonist used for quick relief.
Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa. But they can also include hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medications and you behave in a way that's out of character for you, talk to your doctor.
MAO B inhibitors. These medications include selegiline (Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Selegiline given with levodopa may help prevent wearing-off.
Side effects of B inhibitors may include headaches, nausea or insomnia. When added to carbidopa-levodopa, these medications increase the risk of hallucinations.
These medications are not often used in combination with most antidepressants or certain narcotics due to potentially serious but rare reactions. Check with your doctor before taking any additional medications with an B inhibitor.
Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) and opicapone (Ongentys) are the primary medications from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.
Side effects, including an increased risk of involuntary movements (dyskinesia), mainly result from an enhanced levodopa effect. Other side effects include diarrhea, nausea or vomiting.
Tolcapone (Tasmar) is another inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.
Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.
However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.
Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control involuntary movements (dyskinesia) induced by carbidopa-levodopa.
Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.
Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson's disease symptoms.
Your doctor may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, strokes or brain hemorrhage. Some people experience problems with the system or have complications due to stimulation, and your doctor may need to adjust or replace some parts of the system.
Deep brain stimulation is most often offered to people with advanced Parkinson's disease who have unstable medication (levodopa) responses. can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesia), reduce tremor, reduce rigidity, and improve slowing of movement.
is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesia that doesn't improve with medication adjustments.
However, isn't helpful for problems that don't respond to levodopa therapy apart from a tremor. A tremor may be controlled by even if the tremor isn't very responsive to levodopa.
Although may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.
Because there have been infrequent reports that the therapy affects the movements needed for swimming, the Food and Drug Administration recommends consulting with your doctor and taking water safety precautions before swimming.
What are the risk factors for parkinson's disease?
Risk factors for Parkinson's disease include:
- Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
- Heredity. Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
- Sex. Men are more likely to develop Parkinson's disease than are women.
- Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease.
Is there a cure/medications for parkinson's disease?
7 drugs to treat symptoms of Parkinson's
1. Carbidopa-Levodopa (Sinemet)
Levodopa that is taken in a pill moves from the digestive tract to the brain, converting to dopamine in the brain.
Dopamine itself cannot cross blood-brain barrier, but levodopa can. After the conversion to dopamine, levodopa is used to boost dopamine levels depleted by the Parkinson’s disease process.
When this treatment was first discovered in the 1950s, levodopa was given to people on its own, and large doses were needed. These large doses caused severe side effects like nausea, so carbidopa was added.
Carbidopa improved the effect of levodopa. This allowed people who used levodopa to use 80 percent less of the medication to achieve the same results.
Today, carbidopa-levodopa remains a first-line treatment for Parkinson’s disease and is available in extended- and controlled-release forms.
Carbidopa-levodopa is available as a pill or liquid that’s taken orally. Formulations vary by manufacturer, with available options including:
- Sinemet: 10mg/100mg, 25mg/100 mg, 25mg/250mg oral tablet
- Parcopa: 10mg/100mg, 25mg/100mg, 25mg/250mg oral tablet
- Sinemet controlled release (CR): 25mg/100mg, 50mg/200mg oral tablet
- Rytary extended release (ER): 23.75mg/95mg, 36.25mg/145mg, 48.75mg/195mg, 61.25mg/245mg oral tablet
- Duopa extended release (ER): 4.63mg/20mg liquid suspension
These medications are taken several times per day depending on the formulation. Traditional Sinemet is taken every 6 to 8 hours.
Dose changes must be done gradually by your doctor.
Carbidopa-levodopa medications help replace depleted dopamine levels to control Parkinson’s symptoms.
This medication can help lessen symptoms like slowness, tremors, and movement problems, but it is not likely to cure them completely.
How long does it take to work?
Traditional Sinemet takes about 30 minutes to reach its peak effect, while extended- or controlled-release formulas take about 2 hours.
- abnormal, uncoordinated movements (dyskinesia)
- abdominal pain
- heart rate or blood pressure changes
Since no carbidopa-levodopa formulations offer constant dosing, people who take this medication will have “on” and “off” times where symptoms become better and worse.
Levodopa is not effective on some symptoms of Parkinson’s that affect balance, speech, or swallowing. Dosages usually need to be increased over time as the disease progresses.
2. Dopamine agonists
Dopamine agonists are another medication group that helps make up for the lack of dopamine in people with Parkinson’s disease.
While these medications do notconvert to dopamine in the brain, they have the same effect.Administration
- Pramipexole (Mirapex): 0.125-mg, 0.25-mg, 0.5-mg, 0.75-mg, 1-mg, or 1.5-mg oral tablets three times per day, or 0.375-mg, 0.75-mg., 1.5-mg, 2.25-mg, 3-mg, 3.75-mg, or 4.5-mg oral extended-release tablets once per day
- Ropinirole (Requip): 0.25-mg, 0.5-mg, 1-mg, 2-mg, 3-mg, 4-mg, or 5-mg oral tablets three times per day, or 2-mg, 4-mg, 6-mg, 8-mg, or 12-mg extended-release tablets once per day
- Apomorphine (Apokyn): 30-mg/3-ml vial for injection, 0.2 mg per dose
- Apomorphine (Kynmobi): sublingual film, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg
- Rotigotine (Neupro): 1-mg, 2-mg, 3-mg, 4-mg, 6-mg, or 8-mg transdermal patches, 4 mg–8 mg max per day
Dopamine agonists can improve the motor symptoms that come with Parkinson’s disease but are not as effective as levodopa.
Typically used early in the disease process, dopamine agonists may be combined with carbidopa-levodopa as the disease progresses. These medications help most with stiffness and tremors.How long does it take to work?
Injectable dopamine agonists like apomorphine work as quickly as 10 minutes.
Oral medications reach their peak effectiveness in about 2 hours.Side effects
- leg swelling or discoloration
- compulsive behaviors
These are the most frequently used medications to treat Parkinson’s disease after carbidopa-levidopa.
They can also be combined with carbidopa-levidopa in later stages of the disease to aid in movement and tremor control.
3. MAO-B inhibitors
Monoamine oxidase Type B (MAO-B) is an enzyme that breaks down dopamine in the brain. By blocking this enzyme, MAO-B inhibitors leave more dopamine for the body to use.Administration
- Selegiline (I-deprenyl, Eldepryl): 5-mg oral tablet taken twice per day
- Selegiline HCL (Zelapar): 1.25-mg and 2.5-mg orally disintegrating tablet taken once daily
- Rasagiline (Azilect): 0.5-mg and 1-mg oral tablet taken once per day
- Safinamide (Xadago): 500-mg and 100-mg oral tablet taken once per day
This medication reduces the amount of dopamine that is broken down in the brain and can also help with some motor symptoms.How long does it take to work?
These medications take time to build up in your system before they begin to have the full effect.
It can take weeks before you notice any changes.Side effects
- dry mouth
While MAO-B inhibitors can help Parkinson’s symptoms, they are not usually used as a primary treatment.
Instead, they are an adjunctive (or add-on) therapy used alongside other medications.
4. COMT inhibitors
COMT inhibitors help prevent an enzyme called catechol-O-methyl transferase (COMT) from deactivating levodopa before it has a chance to be absorbed into the bloodstream.Administration
- Entacapone (Comtan): 200-mg oral tablet taken four to eight times per day with levodopa doses
- Tolcapone (Tasmar): 100-mg or 200-mg oral tablets taken one to three times per day
- Carbidopa/levodopa/entacapone tablets (Stalevo): 12.5/50/200-mg, 18.75/75/200-mg, 25/100/200-mg, 31.25/125/200-mg, 37.5/150/200-mg, or 50/200/200-mg oral tablets taken multiple times daily
- Opicapone (Ongentys): 25-mg and 50-mg oral capsules taken once daily
This medication is used alongside levodopa to treat motor fluctuations and “off” time.How long does it take to work?
This medication reaches its peak in about 1 hour.Side effects
- urine discoloration
This medication is only effective when taken alongside levodopa.
Originally developed as an antiviral treatment, amantadine was accidentally discovered to reduce tremors.
Its exact function is not fully understood, but it’s believed to act on a number of receptors in the brain.Administration
- Amantadine (Symmetrel): 100-mg capsules, 100-mg tablets, 50-mg/5-ml syrup taken two to three times per day
- Amantadine ER capsules (Gocovri): 68.5-mg and 137-mg capsules taken once per day at bedtime
- Amantadine ER tablets (Osmolex ER): 129-mg, 193-mg, and 258-mg tablets taken once per day in the morning
Amantadine can reduce tremors and other movement problems.How long does it take to work?
Amantadine takes about 48 hours to begin taking full effect from the time the medication is started.Side effects
- low blood pressure
- leg discoloration
This medication can be helpful alone or taken with other medications like levodopa to decrease muscle problems and tremors from Parkinson’s.
Anticholinergics decrease the power of acetylcholine, a neurotransmitter that helps regulate movement.
This medication can also help reduce abnormal contractions and oral secretions.Administration
- Benzotropine (Cogentin): 0.5-mg, 1-mg, 2-mg oral tablets taken two to three times daily
- Trihexyphenidyl HCL: 2-mg or 5-mg tablets, or a 2-mg/5-ml liquid taken two to three times daily
Anticholinergics can help reduce involuntary muscle contractions and tremors.How long does it take to work?
These medications begin working immediately.Side effects
- decreased memory
- dry mouth
- blurry vision
- urinary retention
Anticholinergics have the greatest benefit in younger patients whose primary symptom is tremors.
7. Adenosine A2a antagonists
Adenosine A2a antagonists manipulate the receptor in the brain that is responsible for slowed movement in Parkinson’s disease. While the exact way the adenosine A2a antagonists work is unknown, when combined with Levadopa they can improve motor function.
This medication can also increase the sensitivity of dopamine receptors to help reduce motor symptoms in Parkinson’s.Administration
- Istradefylline (Nourianz): 20-mg or 40-mg oral tablets taken once per day
This medication reduces motor symptoms of Parkinson’s when used with other medications.How long does it take to work?
This medication reaches its peak time in about 4 hours, but it requires several weeks to achieve lasting effects.Side effects
These medications work well in combination with other Parkinson’s treatments, but people who smoke 20 cigarettes or more per day will require larger doses.
Is there a cure for Parkinson’s?
There is currently no known cure for Parkinson’s disease, and treatment focuses on relieving the symptoms caused by the disease.
Numerous research studies are underway investigating both curative therapies as well as new strategies to manage Parkinson’s symptoms.
What future medications may be available for Parkinson’s?
There are numerous studies investigating new treatments for Parkinson’s disease.
There has been new information about the role of autoimmunity and T-cells in the development of Parkinson’s disease, possibly opening the door to a role for biologics.
Stem cells are also being investigated as a treatment option for Parkinson’s disease.