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Parkinson's disease

What is Parkinson's disease?

Also known as shaking palsy or paralysis agitans, Parkinson's disease is due to gradual deterioration of nerve cells in the brain that regulate movement. Because these cells do not 'fire' smoothly, various body movements are affected.

How common is the problem?

About 1 person in 1000 develops Parkinson's disease, and these are mainly elderly or in late middle age. It can be caused by some drugs and toxic fumes or substances such as carbon monoxide and lead.

What are the symptoms?

The symptoms are

• stiff and slow movements, causing difficulty starting a movement
• a shuffled walk
• an expressionless face
• slow and flat speech
• difficulty writing
• a tremor, especially on the hands and arms, with a rubbing together of the thumb and forefinger; this is worse at rest and tends to go away when an action such as picking up a pen or other object is performed.

There is no pain, numbness or pins and needles. Later on falls may be a problem.

What causes the symptoms?

The problem is caused by the lack of a special chemical in the brain called dopamine, which the nerve cells need to 'fire'. It is rather like the chemical in a battery gradually running out so that the battery becomes flat.

It is not caused by a brain tumour or a stroke, but in some cases poor circulation to that part of the brain can be responsible for the problem.

What is the outlook?

There are many different grades of severity but most people have a mild problem and are able to cope, even without t need for dopamine-producing drugs. If the disease gets worse, it is usually only a very slow process; it is rare that a person gets severely disabled and confined to a wheelchair. If you develop Parkinson's disease after the age of 60, you may live out your normal life expectancy.

What are the risks?

• The disease is not life-threatening because it does not affect nerves that supply the heart or other vital organs.
• Two common risks are falls and mental depression.

What is the treatment?

Self-help

An important part of managing at home is to keep as active as possible with the help of a caring family, friends and other people. Your mobility can be assisted, for example, by bath rail supports, special banisters where you normally walk and chairs with high seats and arms.

It is important to have regular exercise and to stick to your everyday routine as actively as possible. Your doctor should see you regularly to assess your progress.

Medication

No drug will cure the problem, but there are modern drugs that can do much to relieve symptoms, particularly stiffness and poor mobility. Drugs that lead to higher levels of dopamine in the brain can be prescribed.

The drugs can have side effects such as feeling sick in the stomach (nausea) and a dry mouth, and so your doctor will prescribe them only when necessary.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia