Neuroscience Services - Parkinson's Disease
Parkinson's Disease is a progressive disorder of the central nervous system. It is a chronic disease process that affects over one million people in the United States, men as well as women, adults who are generally over 40, with an average age of 60.
The cause is still unknown, although medical experts believe the symptoms are related to a loss of brain cells or neurons that produce a vital chemical known as dopamine. Dopamine acts as a messenger that controls movements. Later in the disease, cells in other portions of the brain and nervous system also degenerate.
Symptoms
Symptoms vary from patient to patient. They may also appear slowly and in no particular order. Many years may pass before early symptoms progress to the point where they interfere with normal activities. It is also important to note that a patient may have only one or two of these symptoms; very few will experience all of them.
The four hallmark symptoms of Parkinson's Disease are:
'*Rigidity: stiffness when the arm, leg or neck is moved back and forth.
*Resting tremor: tremor in the hand or pill rolling movement of thumb and fingers at rest.
*Bradykinesia: slowness in initiating movement.
*Loss of postural reflexes: patients have poor balance and may fall.
Other, more subtle symptoms may include:
*small cramped hand-writing
*lack of ability to swing arm on the affected side
*decreased facial expression
*lowered voice volume
*feelings of depression or anxiety
*episodes of feeling 'stuck in place' when initiating a step ('freezing' in position)
*slight foot drag on the affected side
*increase in dandruff or oily skin
*less frequent blinking or swallowing.
Testing
Patients are assessed for Parkinson's based on their presenting symptoms. Your doctor may also order an MRI or CT scan. CT (Computed Tomography) scan: This is a combination of an x-ray device and a computer. X-rays are taken of the brain, and this information is fed into a computer which transforms the data into a picture. In some cases, the patient is injected with a dye material to make abnormal tissue more evident.
MRI (Magnetic Resonance Imaging): This procedure uses a tunnel-shaped piece of equipment that contains a magnetic field and radio energy; no x-rays are involved. Magnetic signals are fed into a computer which assembles a picture. Because the MRI ignores bone, which can obstruct CT images, this device provides a clearer picture of tumors located near the bone, and can provide a wider variety of image angles. It can detect edema (swelling), but has difficulty distinguishing edema from a tumor. MRI imaging takes longer than a CT scan, and is very noisy. Patients with cardiac monitors, pacemakers or surgical clips cannot take an MRI because of conflict with the magnetic fields. MRI and CT testing is usually negative in people with Parkinson's Disease.
' Sentara Norfolk General Hospital has been identified as an investigational/testing beta site to test for basic movement (which is used in daily living) of arms and legs related to the functional disorders associated with Parkinson's Disease.
Treatment
There is no known prevention or cure for Parkinson's Disease, and no definitive lab test or brain scan to verify it as a clinical diagnosis. The good news is that physicians now have a much clearer profile of the condition, and there are many effective medications available to treat the symptoms. Proper medical management can help restore lost functions, and protect against secondary symptoms that could otherwise develop.
Medical
Current therapy consists primarily of dopamine replacement, using Levodopa and other dopamine-enhancing agents. These help the majority of Parkinson's patients reduce disability.
Surgical
Pallidotomy and thaladotomy are surgical treatments that, for many patients, are generating exceptional results. Unlike traditional brain surgery, the patient is awake through the entire process. This enables the surgeons to monitor how closely the patient is responding to the treatment by asking him or her to perform certain tasks, such as moving a hand or foot. The goal of the surgery is to pinpoint the place in the brain that is the source of the uncontrollable movement, and destroy the overactive cells using five, 30-second currents. This re-establishes chemical balance and markedly improves most symptoms - many patients are able to walk steadily out of the surgical suite - often for the first time in years. Pallidotomy places the lesion in the neural posterior globus pallidus; thaladotomy places the lesion in the vim nucleus of the thalamus.
Another promising and relatively new treatment is called Deep Brain Stimulation. It involves placing electrodes in the thalamus and using a pacemaker-like device (implanted in the chest) to issue mild electric pulses that stimulate the brain and block the signals that cause tremor. Deep Brain Stimulation surgery was performed at Sentara in June 1999 - the first medical center to do so in southeastern Virginia.
Research
There are many exciting experimental treatments in the U.S. that are currently being tested. These include fetal tissue transplants (that can replace the brain cells that have died as a result of the disease); and drugs such as dopamine agonists and COMT (Catechol-O-Methytransferese) inhibitors.
Support Groups/Resources
Many patients and families find great comfort and support in talking with other patients, families and caregivers who have had (or are having) similar experiences. Support group meetings are free of charge, and are facilitated by a trained peer or qualified professional. The following numbers can offer more information about Parkinson's and can help you find a support group nearest you:
The American Parkinson's Disease Association:
1-800-223-2732
The National Parkinson's Foundation, Inc.:
1-800-327-4545
The United Parkinson's Foundation: (312) 664-2344
The Parkinson's Disease Foundation: (212) 305-3480
The Parkinson's Educational Program: 1-800-344-7872
|