Parkinson’s disease

February 3, 2017

Parkinson’s Disease is a chronic and progressive neurodegenerative brain disorder. Parkinson’s disease (PD) was first described by Dr. James Parkinson. Earlier, the condition was known popularly as the shaking palsy and in the medical community by its Latin equivalent, paralysis agitans. These terms are misleading, however, implying that people are paralyzed with this disorder, which is not the case. It is sometimes called idiopathic parkinsonism (the term idiopathic means that the cause is unknown), but more commonly today it is simply called Parkinson’s disease, to honor the physician who first described it.

PD is a disorder of the central nervous system, involving primarily a degeneration of certain nerve cells in deep parts of the brain called the basal ganglia, and in particular a loss of nerve cells (or neurons) in a part of the brainstem called the substantia nigra. These cells make the neuro-chemical messenger dopamine, which is partly responsible for starting a circuit of messages that coordinate normal movement. In the absence (or with substantial reduction, more than 80% of the normal level) of dopamine, the neurons in the receiving area (called dopamine receptors) in the next part of the basal ganglia circuit called the striatum are not adequately stimulated, and the result is impairment of movement with tremor, slowness, stiffness, or balance problems, among other symptoms, which will be discussed in the later section.

Nearly one million people in the US are living with Parkinson’s disease.PD occurs in roughly the same proportions in men and women, althoughthere may be a slight preponderance of affected men throughout the world.Initial symptoms may appear at any age, although under 40 is uncommon and under 20 is very rare (but it happens!). Most commonly, the first symptoms are noted in the 60’s or 70’s. The average age of onset of PD is about 59.


The exact causes of PD remain unknown, despite decades of intensive study. Many experts suggest that the disease is caused by a combination of genetic and environmental factors, which may vary from person to person.

In some people, genetic factors may play a role; in others, illness, an environmental toxin or other event may contribute to PD.

  • Genetic Factors – The vast majority of Parkinson’s cases are not directly inherited. About 15 to 25 percent of people with Parkinson’s report having a relative with the disease.

Researchers have discovered several gene mutations that can cause the disease directly, but these affect only a small number of families. Some of these mutations involve genes that play a role in dopamine cell functions. Parkinson’s has developed at an early age in individuals with mutations in genes for parkin, PINK1, LRRK2, DJ-1, and glucocerebrosidase, among others.


  • Environmental Factors – Several studies suggest that Parkinson’s disease may result from exposure to an environmental toxin or injury. Several factors can be linked to Parkinson’s, including rural living, well water, manganese and pesticides.

Prolonged occupational exposure to certain chemicals is associated with an elevated risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb.

It is to be noted that, a simple exposure to an environmental toxin is never enough to cause Parkinson’s. Most people exposed to a toxin do not develop the disease. In fact, there is no conclusive evidence that any environmental factor, alone, can be considered a cause of the disease.


  • Less common causes include poisoning by carbon monoxide or manganese (a type of mineral), lesions and tumors in the brainstem, and a rare illicit drug called N-MPTP.


  • Drugs & Medications – Medications that can cause secondary Parkinsonism include:
    • Haloperidol* and other medications used to treat hallucinations
    • Metoclopramide (an anti-nausea medication)


  • 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.


  • Food Allergies – Hidden food allergies and chemical sensitivities contribute to most degenerative diseases. However, in Parkinson’s disease the body generally is insensitive and does not readily react even when specifically testing for hidden allergies. Nevertheless, it has been shown that the intestinal barrier becomes increasingly inefficient with advancing age and degenerative diseases. This allows only partly digested protein fragments or peptides to enter the bloodstream and reach the brain, causing chronic Inflammation and long-term degeneration of brain cells.



  • Heavy Metals – Brain deterioration can be caused by accumulations of the heavy metals cadmium, lead and mercury. Of these, mercury is generally the greatest brain hazard, coming mainly from amalgam tooth fillings. Organic mercury compounds are strong nerve poisons, which may kill nerve cells, cause tremors and reportedly also symptoms of multiple sclerosis. Finally, iron overload, especially in inorganic form, can intensify Parkinson problems.


  • Aluminium-A contributing factor greatly facilitating the passage of toxic chemicals into the brain is aluminium. The brain is normally protected from undesirable chemicals in the bloodstream by a filter barrier. High aluminium levels have been shown to allow toxic chemicals to cross this barrier, which would otherwise be kept out.


  • Gastrointestinal Involvement – Endotoxins are toxic chemicals produced by harmful intestinal bacteria. Undesirable changes in the composition of the intestinal flora and resulting overgrowth of the small intestine with undesirable bacteria and fungi commonly results from antibiotics and other immune-suppressive drugs, from low gastric acidity and from frequently drinking alcohol.



Each person is affected differently by Parkinson’s disease and no two people will experience exactly the same symptoms. The impact of Parkinson’s disease can be unpredictable and it is common for people to have good days and bad days.

The main symptoms of Parkinson’s disease are:

  • tremor (involuntary trembling or shaking movements; the most common symptom)
  • rigidity (stiffness)
  • slowness of movement (bradykinesia)
  • balance problems
  • problems with posture (particularly a tendency to stoop forwards)

Other symptoms include –

  • Freezing
  • Micrographia – shrinkage in handwriting
  • Less Expressive Face
  • Unwanted Acceleration
  • Stooped posture, a tendency to lean forward
  • Dystonia
  • Impaired fine motor dexterity and motor coordination
  • Impaired gross motor coordination
  • Poverty of movement (decreased arm swing)
  • Akathisia
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
  • Difficulty swallowing
  • Sexual dysfunction
  • Cramping
  • Drooling

There are 5 stages of Parkinson’s Disease –

  • Stage 1 – Unilateral involvement only, usually with mini9mal or no functional impairment.
  • Stage 2 – Bilateral or midline involvement, without impairment of balance.
  • Stage 3 – First signs of impaired righting reflexes. This is evident as thepatient turns or is demonstrated when he or she is pushed from standing equilibrium with the feet together and eyes closed.
  • Stage 4 – Fully developed, severely disabling disease; the patient is stillable to walk and stand unassisted but is markedly incapacitated.
  • Stage 5 – Confinement to bed or wheelchair unless aided.



There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease.

It is common for people with PD to take a variety of these medications – all at different doses and at different times of day – in order to manage the symptoms of the disease.

These include –

  • Carbidopa/Levodopa (Sinemet) – The most potent medication for Parkinson’s is levodopa. Its development in the late 1960s represents one of the most important breakthroughs in the history of medicine. Plain levodopa produces nausea and vomiting. It is now combined with carbidopa to prevent this side effect. The well-known combined carbidopa/levodopa formulation is called Sinemet.
  • Dopamine agonists – These are the drugs that stimulate the parts of the human brain influenced by dopamine. In effect, the brain is tricked into thinking it is receiving the dopamine it needs. The two most commonly prescribed oral pill agonists in the US are pramipexole (Mirapex) and ropinirole (Requip). A third, rotigotine transdermal system (Neupro), was recently re-approved after several years of being off the market. Bromocriptine (Parlodel® ) is available, but is less commonly used.
  • Anticholinergics – Anticholinergics can be helpful for tremor and may ease dystonia associated with wearing-off or peak-dose effect. They have little effect on other symptoms of Parkinson’s. The drugs in this class include trihexyphenidyl (Artane),benztropinemesylate (Cogentin) and procyclidine (no longer available in the US), among others.
  • MAO-B inhibitors — Selegilinealso called deprenyl, with trade names Eldepryl and Zelapar and rasagiline (Azilect) — block an enzyme in the brain that breaks down levodopa. These drugs have a modest effect in suppressing the symptoms of Parkinson’s.


Alternative Treatment

  • Vitamin E – Vitamin E can fight damage in the brain caused by free radicals, and has been suggested to lower the risk of PD. But taking vitamin E alone did not seem to have the same effect. More studies are needed to know whether there is any real benefit. Vitamin E supplements can increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Selenium is an antioxidant that works with vitamin E. It also helps to increase circulation and tissue oxygenation, thereby limiting damage to nerve cells.
  • Gamma-aminobutyric acid (GABA) is an amino acid that acts as a neurotransmitter. It helps both to strengthen and relax the nervous system.
  • Acidophilus and bifidobacteria are friendly bacteria that ensure a healthy gastrointestinal tract. Probiotics are especially helpful for preventing constipation, which is often a problem for people with Parkinson’s disease.
  • Alpha-lipoic acid is an antioxidant that also helps to “recharge” other antioxidants in the body.
  • Calcium and magnesium are imperative for maintaining a healthy nervous system.
  • Coenzyme Q10 is an oxygenating antioxidant that helps prevent free-radical damage and important for cell renewal.
  • Evening primrose oil and flaxseed oil contain valuable essential fatty acids (EFAs), which are often deficient in people with Parkinson’s disease.
  • Green-foods supplements supply chlorophyll and important trace minerals.
  • Marine alginate concentrate and N-acetylcysteine may help in the process of chelating (binding to) heavy metals in the body so that they can be excreted.
  • Nicotinamide adenine dinucleotide hydrogren (NADH) is an enzyme that helps to improve neurotransmitter function.
  • Phosphatidylserine is a type of lipid important for normal brain function and the effective transmission of nerve impulses. Low levels of phosphatidylserine are associated with Parkinson’s disease.
  • Soy Lecithin is rich in phosphatidylcholine. Choline is a vital building block for acetylcholine.
  • Pine-bark and grape-seed extracts fight free-radical damage and have anti-inflammatory properties. Many people consider Parkinson’s disease to be a consequence of degeneration of nerve cells due to free-radical damage.
  • The B vitamins are very important for brain and nerve function.
  • Vitamin C and the bioflavonoids are powerful antioxidants that fight free radicals.
  • Creatine– Some studies suggest that taking creatine, an amino acid that helps supply energy to muscles, may help slow progression of Parkinson’s among people who are in the early stages, and who do not need medication to control symptoms.
  • Exercise – Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety.
    • Massage. Massage therapy can reduce muscle tension and promote relaxation. These services, however, are rarely covered by health insurance.
    • Acupuncture. During an acupuncture session, a trained practitioner inserts tiny needles into many specific points on the body, which may reduce the pain.
    • Tai chi. An ancient form of Chinese exercise, tai chi employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.
    • Yoga. In yoga, gentle stretching movements and poses may increase theflexibility and balance.
    • Alexander technique. This technique — which focuses on muscle posture, balance and thinking about how you use muscles — may reduce muscle tension and pain.
    • Meditation. In meditation, body quietly reflects and focuses on mind, on an idea or image. Meditation may reduce stress and pain and improve the sense of well-being.
    • Music or art therapy. Music or art therapy may help to relax. Music therapy helps some people with Parkinson’s disease to improve their walking and speech. Participating in art therapy, such as painting or ceramics, may improve the mood.


As Parkinson’s disease is a long-term condition and symptoms worsen over time, it is important to treat it on time.



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