Its symptoms are so subtle and develop so slowly that is usually takes 5 to 10 years before you even know there's a problem. Even then, this disease can almost always be managed, often for decades, with specialised medications and good self-help.
More than 300,000 Australians and 4000 New Zealanders have Parkinson's disease, making it the second most common degenerative neurological condition after Alzheimer's. If you've recently been dignosed, your are probably already displaying some symptoms--may be a slight trembling (tremor) in your hands, legs or face or possibly muscle stiffness, coordination problems or a slowness of movement (bradykinesia). These and other Parkinson's symptoms indicate that nerve cells (nuerones) in a relatively tiny part of your brain called the substantia nigra have started to die off. This results in a drop in dopamine, a nerve chemical that carries the signals that allow your muscles to move quickly and smoothly.
Parkinson's disease usually occurs between the ages of 55 and 70 and men get it slightly more often than women. Up to 10 percent of those afflicated, however, are under age 40--and have what's called 'young-onset' Parkinson's. But whether your symptomsstart when you're young or old, what causes Parkinson's remains as mystery. One theory is that naturally occuring oxygen molecules called free radicals damage nerve cells in the brain. Research has shown that some Parkinson's patients have a 30 to 40 percent decrease in an enzyme called complex I, which normally controls this free radicals onslaught. Genetic factors are occasionally involved as well. If you have a close relative with Parkinson's disease, your chances of getting it are three times greater than someone without a family link. It's also possible that exposure to herbicides and pesticides plays a role, but this is yet to be proven.
Whether you've had Parkinson's for years or have just found out your diagnosis, the outlook is good. Among the degenerative diseases of the nervous system, Parkinson's is one of the most treatable. Symptoms do get worse over time as dopamine steadily decreases, but many individuals go on to live full, active lives.
LIKELY FIRST STEPS
Medications
The main treatment for Parkinson's is a drug called levodopa (L-dopa), which is converted in the brain to muscle-controlling dopamine. It's most effective against rigidity and slowness. Most levodopa preparations (such as Sinemet, Madopar) include the drug carbidopa. It helps levodopa work more efficiently and it also helps reduce nausea or other side effects. The drawback to levodopa is that the 'honeymoon' usually lasts only five years on average. After that, it may gradually stop working.
A relatively new class of drugs called the catechol-O-methyl-transferase (COMT) inhibitors is taken along with levodopa to block a liver enzyme that breaks down levodopa before it reaches your brain. These drugs, which include entacapone (Comtan), not only prolong the effects of levodopa but also allow you to manage on smaller doses of it.
Because levodopa works for only a short time, your doctor may look for ways to delay starting you on it. So as an initial treatment, some doctors are trying another class of drugs, the dopamine agonists, which include bromocirptine (Parlodel), pergolide (Permax) and carbergoline (Cabaser). These mimic the effects of dopamine and activate certain chemical receptor sites in brain cells to reduce Parkinson's symptoms.
Your doctor can also choose a variety of other drugs to control Parkinson's symptoms. For muscle tremors early on, you might need to take an anticholinergic drug. If involuntary movements are a problem, the monoamine oxidase, selegiline (Eldepryl, Selgene), may be prescribed. To reduce tremor, muscle rigidity and slowness, an antiviral drug amantadine (Symmetrel), may be recommended (it also increases the amount of dopamine in the brain).
What is happening
More than 300,000 Australians and 4000 New Zealanders have Parkinson's disease, making it the second most common degenerative neurological condition after Alzheimer's. If you've recently been dignosed, your are probably already displaying some symptoms--may be a slight trembling (tremor) in your hands, legs or face or possibly muscle stiffness, coordination problems or a slowness of movement (bradykinesia). These and other Parkinson's symptoms indicate that nerve cells (nuerones) in a relatively tiny part of your brain called the substantia nigra have started to die off. This results in a drop in dopamine, a nerve chemical that carries the signals that allow your muscles to move quickly and smoothly.
Parkinson's disease usually occurs between the ages of 55 and 70 and men get it slightly more often than women. Up to 10 percent of those afflicated, however, are under age 40--and have what's called 'young-onset' Parkinson's. But whether your symptomsstart when you're young or old, what causes Parkinson's remains as mystery. One theory is that naturally occuring oxygen molecules called free radicals damage nerve cells in the brain. Research has shown that some Parkinson's patients have a 30 to 40 percent decrease in an enzyme called complex I, which normally controls this free radicals onslaught. Genetic factors are occasionally involved as well. If you have a close relative with Parkinson's disease, your chances of getting it are three times greater than someone without a family link. It's also possible that exposure to herbicides and pesticides plays a role, but this is yet to be proven.
Whether you've had Parkinson's for years or have just found out your diagnosis, the outlook is good. Among the degenerative diseases of the nervous system, Parkinson's is one of the most treatable. Symptoms do get worse over time as dopamine steadily decreases, but many individuals go on to live full, active lives.
- Medications to preserve or replace the natural nerve chemical dopamine in the brain.
- Regular exercise to improve coordination and strenght.
- Nutritious diet to prevent constipation and increase antioxidant levels.
- Surgery to reduce symptoms, only if drugs don' t work or side effects are unbearable.
QUESTIONS TO ASK
- Is there any way to slow the progression of my symptoms?
- Will this disease shorten my life span?
- Do I need physical therapy or a special diet?
- Would surgery help reduce my symptoms?
Treatments
Although there isn't a definitive test for Parkinson's disease, neurologists have little trouble recognising it once symptoms have progressed beyond the earliest stages. Often symptoms have progressed beyon the earliest stages. Often symptoms are so mild at first, people don't bother to call their doctors. It's unfortunate because early treatment can make a difference in how you function.
The goals of Parkinson's treatment are to relieve your symptoms and effectively balance the challenges of the disease with the often troubling side effects of the medications. Treatment is extremely individualised and as the disease progresses you'll need to work closely with a neurologist to customise a program for you. So far, Parkinson's can't be prevented or cured. Yet there have been exciting breakthroughs. A number of new drugs (and combinations of old ones) can control or even eliminate symptoms for a time. And even when symptoms get worse, a mix of lifestyle adjustments and drug and surgical options can help keep them from taking over your life.
Although there isn't a definitive test for Parkinson's disease, neurologists have little trouble recognising it once symptoms have progressed beyond the earliest stages. Often symptoms have progressed beyon the earliest stages. Often symptoms are so mild at first, people don't bother to call their doctors. It's unfortunate because early treatment can make a difference in how you function.
The goals of Parkinson's treatment are to relieve your symptoms and effectively balance the challenges of the disease with the often troubling side effects of the medications. Treatment is extremely individualised and as the disease progresses you'll need to work closely with a neurologist to customise a program for you. So far, Parkinson's can't be prevented or cured. Yet there have been exciting breakthroughs. A number of new drugs (and combinations of old ones) can control or even eliminate symptoms for a time. And even when symptoms get worse, a mix of lifestyle adjustments and drug and surgical options can help keep them from taking over your life.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Levodopa First-line therapy; often with carbidopa.
------------------------------------------------------------------------------------------------------------------------------------------
COMT inhibtors Contain prolongs effects of levodopa.
-------------------------------------------------------------------------------------------------------------------------------------------
Dopamine agonists May be prescribed before levodopa.
-------------------------------------------------------------------------------------------------------------------------------------------
Anticholinergics Such as Artane, reduce tremors in early stages.
--------------------------------------------------------------------------------------------------------------------------------------------
Antivirals Symadine, Symmetrel for rigidity, slowness.
LIFESTYLE CHANGES
--------------------------------------------------------------------------------------------------------------------------------------------- Exercise Essential for balance, mobility, strength.
----------------------------------------------------------------------------------------------------------------------------------------------
Diet Low-protein, high-antioxidant best.
----------------------------------------------------------------------------------------------------------------------------------------------
Hobbies & support groups To keep the mind agile, prevent depression.
PROCEDURES---------------------------------------------------------------------------------------------------------------------------------------------
Pallidotomy Treats involuntary movements.
---------------------------------------------------------------------------------------------------------------------------------------------
Thalamotomy For tremor; destroys thalamus tissues.
---------------------------------------------------------------------------------------------------------------------------------------------
Deep brain stimulation To control symptoms via electrode implants.
TAKING CONTROL
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Levodopa First-line therapy; often with carbidopa.
------------------------------------------------------------------------------------------------------------------------------------------
COMT inhibtors Contain prolongs effects of levodopa.
-------------------------------------------------------------------------------------------------------------------------------------------
Dopamine agonists May be prescribed before levodopa.
-------------------------------------------------------------------------------------------------------------------------------------------
Anticholinergics Such as Artane, reduce tremors in early stages.
--------------------------------------------------------------------------------------------------------------------------------------------
Antivirals Symadine, Symmetrel for rigidity, slowness.
LIFESTYLE CHANGES
--------------------------------------------------------------------------------------------------------------------------------------------- Exercise Essential for balance, mobility, strength.
----------------------------------------------------------------------------------------------------------------------------------------------
Diet Low-protein, high-antioxidant best.
----------------------------------------------------------------------------------------------------------------------------------------------
Hobbies & support groups To keep the mind agile, prevent depression.
PROCEDURES---------------------------------------------------------------------------------------------------------------------------------------------
Pallidotomy Treats involuntary movements.
---------------------------------------------------------------------------------------------------------------------------------------------
Thalamotomy For tremor; destroys thalamus tissues.
---------------------------------------------------------------------------------------------------------------------------------------------
Deep brain stimulation To control symptoms via electrode implants.
TAKING CONTROL
- Eat more fava beans. If you're at the earliest stages of Parkinson's disease and aren't yet taking medications, your doctor might advise you to eat these legumes. They contain a hefty amount of levodopa, the same therapeutic compound that's used in some medications. If you're already taking drugs, however, don't add favas to your diet without checking with your doctor. You could wind up getting too much of the advice ingredient.
- Work on 'muscle freezing'. If, like many Parkinson's sufferers, you literally freeze in place and find it hard to take a step, you can usually break free by rocking from side to side or by pretending you're stepping over a small object. You can also divide each movement into several steps. For example, if you're going to walk through a door, approach the door, pause, open the door, pause, then walk on through. Some people also have had success improving their gait by walking to the ticking of a metronome.
- Wear clothes that are easy to get on and off. As the disease progresses you may have trouble even with simple activities like dressing. Make it easy on yourself by buying paints and skirts with elastic waistbands and slip-on tops that have no hard-to-fasten buttons or snaps.
- Take small bites when eating. It puts less strain on your chewing and swallowing muscles, which may become less responsive over time.
Medications
The main treatment for Parkinson's is a drug called levodopa (L-dopa), which is converted in the brain to muscle-controlling dopamine. It's most effective against rigidity and slowness. Most levodopa preparations (such as Sinemet, Madopar) include the drug carbidopa. It helps levodopa work more efficiently and it also helps reduce nausea or other side effects. The drawback to levodopa is that the 'honeymoon' usually lasts only five years on average. After that, it may gradually stop working.
A relatively new class of drugs called the catechol-O-methyl-transferase (COMT) inhibitors is taken along with levodopa to block a liver enzyme that breaks down levodopa before it reaches your brain. These drugs, which include entacapone (Comtan), not only prolong the effects of levodopa but also allow you to manage on smaller doses of it.
Because levodopa works for only a short time, your doctor may look for ways to delay starting you on it. So as an initial treatment, some doctors are trying another class of drugs, the dopamine agonists, which include bromocirptine (Parlodel), pergolide (Permax) and carbergoline (Cabaser). These mimic the effects of dopamine and activate certain chemical receptor sites in brain cells to reduce Parkinson's symptoms.
Your doctor can also choose a variety of other drugs to control Parkinson's symptoms. For muscle tremors early on, you might need to take an anticholinergic drug. If involuntary movements are a problem, the monoamine oxidase, selegiline (Eldepryl, Selgene), may be prescribed. To reduce tremor, muscle rigidity and slowness, an antiviral drug amantadine (Symmetrel), may be recommended (it also increases the amount of dopamine in the brain).
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