I knew very little about Parkinson’s Disease at the time of my diagnosis. I had always associated it with elderly people, and thought it was an inherited gene. I knew about Michael J. Fox and his foundation, but thought he was the rare exception for young-onset disease. As far as physical symptoms, I kind of knew about the tremor but that was it.
I checked into my genealogy on both sides of my family, and there was no history of Parkinson’s on either side! I was baffled, and thought the doctor had surely made a mistake. I went into a period of denial, and rationalizing. Trying to find my own explanation for the symptoms.
So began my intensive research into the black hole of medical articles, trying to make sense of this bizarre label I had been given. I first learned about Parkinson’s Disease & it’s history.
Parkinson’s Disease & It’s History
“Parkinson’s Disease is a progressive disorder that is caused by degeneration of nerve cells in the part of the brain called the substantia nigra, which controls movement. These nerve cells die or become impaired, losing the ability to produce dopamine. Studies have shown that symptoms of Parkinson’s develop in patients with an 80% or greater loss of dopamine-producing cells in the substantial nigra.” (*which means that by the time you develop a tremor or other symptom that can be diagnosed, you’ve lost 80% or more of these brain cells!!!!!!) (from AANS.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Parkinsons-Disease) (American Association of Neurological Surgeons)
“The cause of Parkinson’s essentially remains unknown. However, theories involving oxidative damage, environmental toxins, genetic factors and accelerated aging have been discussed as potential causes for the disease. In 2005, researchers discovered a single mutation in a Parkinson’s disease gene (first identified in 1997), which is believed to be responsible for 5% of inherited cases” (in other words…..this is NOT a genetic disease like we’ve been told!)
“Parkinson’s Disease (PD) occurs when brain cells that make dopamine a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a “movement disorder.” But constipation, depression, memory problems, and other non-movement symptoms can also be part of Parkinson’s. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time. The experience of living with Parkinson’s over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you get them, or how severe they will be. Even through broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others. Estimates suggest that Parkinson’s affects nearly 1 million people in the United States and more than 6 million people worldwide (as of 2023).” (from www.MichaelJFox.org/parkinsons-101)
Common Symptoms
Common symptoms can include: Tremor, or involuntary movements of the hands, arms, legs and jaw. Muscle rigidity or stiffness of the limbs (most common in arms, shoulders, neck). Gradual loss of spontaneous movement, leading to slower reaction time, voice changes, decreased facial expression, etc. Gradual loss os automatic movement, which may lead to decreased blinking, swallowing etc. A stooped, flexed posture with bending at elbows, knees & hips. Unsteady walk or balance. Depression or dementia. (from AANS.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Parkinsons-Disease) (American Association of Neurological Surgeons)
Diagnosis
Presently (2023), the diagnosis of Parkinson’s is primarily based on the common symptoms outlined above. There is no X-ray or blood test that can confirm the disease. However, noninvasive diagnostic imaging, such as positron emission tomography (PET) can support a doctor’s diagnosis. Conventional methods for diagnosis include:
- The presence of two of the three primary symptoms
- The absence of other neurological signs upon examination
- No history of other possible causes of Parkinsonism, such as the use of tranquilizer medications, head trauma, or stroke
- Responsiveness to Parkinson’s medications, such as levodopa
Treatment With Medication
The first line of treatment that is offered by your neurologist is medication, to help relieve some of the symptoms of PD. These medications work by stimulating the remaining living cells in the substantial nigra to produce more dopamine, or by inhibiting things that are causing an imbalance in the brain. Side affects vary greatly from patient to patient and it is advised to work closely with your doctor to develop a customized plan for you, that will change and adapt over time as the disease progresses.
LEVODOPA is the “gold standard” for treating the majority of the motor symptoms of PD, and was developed over 30 years ago. Levodopa works by crossing the blood-brain barrier, where it is converted into dopamine (it’s the precursor to dopamine). Levodopa is now combined with carbidopa, which prevents certain blood enzymes from breaking down the levodopa before it can reach the brain. This combination also helps with nausea and vomiting, which is often experienced as a side effect of levodopa. For most people, levodopa can reduce symptoms of slowness, stiffness/ rigidity, and tremor, but it does not slow or stop the progression of the disease.
DOPAMINE AGONISTS are medications that mimic the role of chemical messengers in the brain, causing neurons to react as they would to dopamine. They can be used alone, or with levodopa therapy. These medications usually have more side effects than levodopa, so that is taking into consideration before doctors will prescribe it. Side effects my include: drowsiness, nausea, vomiting, dry mouth, dizziness, confusion, hallucinations, or psychosis. (Examples of dopamine agonists: Bromocriptine, Pergolide, Pramipexole, Ropinirole)
COMT INHIBITORS are medications that are used to treat fluctuations in response to levodopa. COMT is an enzyme that metabolizes levodopa in the bloodstream. By blocking COMT, more levodopa can penetrate the brain and increase the effectiveness. (Examples of COMT Inhibitors: Opicapone, Entacapone, Tolcapone).
SELEGILINE slows down the activity of the enzyme monoamine oxidase B (MAO-B), the enzyme that metabolizes dopamine in the brain, delaying the breakdown of naturally occurring dopamine and dopamine formed from levodopa. It may enhance the effectiveness of levodopa when taken together. Side effects may include heartburn, nausea, dry mouth, dizziness, confusion, nightmares, hallucinations, and headache.
ANTICHOLINERGIC MEDICATIONS work by blocking acetylcholine, a chemical in the brain whose effect becomes more pronounced when dopamine levels drop. These medications are most useful in the treatment of tremor & muscle rigidity, but are generally not recommended for extended use in older patients because of complications and serious side effects. Side effects may include dry mouth, blurred vision, sedation, delirium, hallucinations, constipation, urinary retention, and confusion. (Examples of this type of medication: Trihexyphenidyl, Benztropine Mesylate, Biperiden HCL, and Procyclidine).
AMANTADINE is an antiviral medication that helps reduce symptoms of Parkinsons, and is often used in the early stages of the disease. Side effects may include difficulty concentrating, confusion, insomnia, nightmares, agitation, hallucinations, leg swelling, and mottled skin.
Other Medical Treatment Options
For many patients with Parkinson’s, medications are effective for maintaining a good quality of life. As the disorder progresses, however, some patients develop variability in their response to treatment, known as “motor fluctuations.” During “on” periods, a patient may move with more ease, with reduced stiffness and tremor. During “off” periods, patients may have more difficulty controlling movements. “Off” periods may occur just before the next dose of medication, and these episodes are called “wearing off.” Dyskinesias may result (uncontrolled writhing movements). These problems can usually be managed with changes to medications.
DEEP BRAIN STIMULATION (DBS) offers a safer surgical alternative to pallidotomy and thalamotomy. It utilizes electrodes which are implanted to provide an electrical impulse to either the sub thalamic nucleus of the thalamus or the globespallidus, deep parts of the brain involved in motor function…………..
STEM CELL THERAPY:………………….
OTHER OPTIONS…………………