Parkinson's Disease

Causes of Parkinson’s disease

The cause of Parkinson’s disease is unknown, but the disease occurs when the dopamine levels in the brain drop. Dopamine is the chemical in the brain that tells other areas of the brain when and how to move. Factors that can play a role in the development of Parkinson’s disease include:

• Genes — in rare cases where multiple family members have Parkinson’s disease, patients may have a genetic mutation that can cause Parkinson’s disease. In other cases, there are several genetic mutations that can increase your risk of developing Parkinson’s.
• Environment — environmental factors such as extended exposure to Agent Orange, herbicides, pesticides, fungicides and metals or leads used in factories could also play a role in causing Parkinson’s disease.

Risk factors for Parkinson’s disease

• Age — people over 60 years old are more likely to develop Parkinson’s disease, and the risk increases as people age.
• Gender — men are more likely to develop Parkinson’s disease than women.
• Family history — if you have a family history of Parkinson’s disease, you are more likely to develop it yourself.
• Exposure to toxins — research has linked herbicides or pesticides to an increased risk of developing Parkinson’s disease.
• Race — Caucasians are more likely to develop Parkinson’s disease.
• Living in a rural location — people who live in a rural location are more likely to develop Parkinson’s.

Symptoms of Parkinson’s disease

The most common symptoms of Parkinson’s disease are:

• Tremors that are felt in the arms, legs, fingers, head, jaw or neck while at rest
• Slowed movement and walking or dragging feet while walking
• Muscle stiffness in the trunk or limbs that can intensify during movement
• Stooped posture or balance problems
• Inability to perform automatic movements such as blinking or smiling
• Slurred or other speech issues

Diagnosis of Parkinson’s disease

Parkinson’s disease can be diagnosed in an exam with a neurologist. During the exam, he or she will take a full medical history, perform a full physical and neurological exam and evaluate your symptoms. Your doctor may order additional testing to confirm the diagnosis and rule out other conditions that cause similar symptoms. Other testing could include:

• Medication — a medication called carbidopa-levodopa can be tried to see if the brain can turn the medication into dopamine; if your symptoms notably improve while on the medication, you will likely be diagnosed with Parkinson’s disease.
• Blood tests — Parkinson’s disease can’t be diagnosed with a blood test, but blood tests can rule out other conditions that may cause similar symptoms.
• Imaging tests — tests such as PET (positive emission tomography), MRI (magnetic resonance imaging), ultrasound or SPECT (single photon emission computed tomography) scans can rule out other conditions that present with similar symptoms.

Treatment of Parkinson’s disease

There is not a cure for Parkinson’s disease. The goal of treatment is to maintain quality of life and reduce the severity of symptoms. At Mercy Health, a team of specialists including neurologists, neurosurgeons, social workers, speech pathologists, physical therapists, dietitians and internists who work together to treat Parkinson’s disease.

A common treatment for Parkinson's disease in deep brain stimulation. Deep brain stimulation is a neurological procedure used to treat late-stage Parkinson’s disease patients who are not responding to medications. Goals of the procedure are to reduce symptoms such as tremors, rigidity, stiffness, slowed movement and walking problems.

During the procedure, a lead is placed in the area of the brain that is causing your symptoms. The lead is attached to a pulse generator that is implanted in the chest. The pulse generator sends signals to the brain that block the nerve signals that cause Parkinson’s disease symptoms.

Medication for treating Parkinson's disease

The other most common type of treatment for Parkinson's disease is medication. There are a variety of medications that may be used to treat Parkinson’s disease. Parkinson’s disease medications include:

• Carbidopa-levodopa — frequently called levodopa this medication is the most effective drug used to treat Parkinson’s. This natural chemical is changed to dopamine in the brain.
• Carbidopa-levodopa infusion — a newer medication called Duopa is used for patients with late-stage Parkinson’s who are not responding to levodopa. The medication is continuously infused directly into the intestines to provide immediate symptom relief.
• Dopamine agonists — dopamine agonists mimic the effects of dopamine in the brain. Although they are less effective than levodopa, the medication lasts longer and can be used in combination with levodopa to provide symptom relief.
• MAO-B inhibitors — these medications can prevent the brain from breaking down dopamine. There are severe side effects if used in combination with other medications.
• Catechol-O-methyltransferase (COMT) inhibitors — this medication helps block enzymes that break down dopamine.
• Anticholinergics — anticholinergics are effective medications to control tremors caused by Parkinson’s disease.
• Amantadine

Over time, medications may become less effective in treating the condition and may have to be used in conjunction with other medications. Or, dosages may have to be titrated up or down depending on symptoms.