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Parkinson's Disease: Historical Aspects and Current Treatment Approaches

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Parkinson's Disease: Historical Aspects and Current Treatment Approaches

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Parkinsonism is a condition affecting the brain and this article discusses its historical aspects and, the evidence-based approaches for its treatment. Read below.

Medically reviewed by

Dr. Sowmiya D

Published At March 20, 2015
Reviewed AtFebruary 23, 2024

Parkinsonism

Parkinsonism is a syndrome manifested by a combination of six cardinal features. They are:

  • Resting tremors.
  • Increased tone of the muscles (aka rigidity).
  • Loss of postural reflexes.
  • Bent or flexed posture.
  • Freezing of gait (aka motor blocks).

James Parkinson in 1817 wrote '' An Essay on the Shaking Palsy'' in which he described 6 cases which had a combination of the aforementioned features. He had observed these individuals on the streets of London.

Charcot in the nineteenth century acknowledged Parkinson's contribution and referred to this condition as ''maladie de Parkinson''. A century after ''An Essay on the Shaking Palsy'' was written, loss of dopaminergic cells in the substantia nigra was identified as the pathological basis of this disease.

Non-motor Manifestations of Parkinson's Disease (PD)

  • These occur in a staggering 88% of all patients, and are more troublesome than the classic features like tremors, slowness of movement and increased muscle tone.
  • Approximately, 40-48% of these patients go on to develop dementia, which is called Parkinson's Disease Dementia, or PDD.
  • Other non-motor features include excessive day-time sleepiness (narcolepsy and sleep attacks), falls, fractures, drop in blood pressure (postural hypotension), urinary incontinence, inability to articulate properly (aka dysarthria), visual and auditory hallucinations.

Neurobehavioral and Neuropsychiatric Manifestations of Parkinson's Disease

  • These impair the quality of life of the individual and need a comprehensive clinical assessment by a psychiatrist, who can effectively diagnose and offer rationalized treatment solutions.
  • These manifest as anxiety disorders, slowness of thinking, fatigue, a feeling of restlessness and inability to sit at one place (aka akathisia), fatigue, hearing of voices in isolation, and other psychotic features like delusions.

Management of the Illness

  • Modern brain imaging techniques include MRI (functional magnetic resonance), DWI (diffusion weighted imaging) and DAT (dopamine transporter) imaging scans.
  • However, like schizophrenia, parkinson's is a clinical diagnosis in the first place, and no amount of investigation can match the clinical expertise of a neuropsychiatrist or a neurophysician.

Medical and Surgical Treatments of Parkinson's Disease

  • Encourage patients to remain active and mobile.
  • Keep the patient functioning independently as long as possible.
  • Individualize therapy as there is no one-size-fits-all treatment.
  • Some commonly used drugs include Levodopa with Carbidopa or Benserazide, Bromocriptine, Entacapone, Selegiline, Tranylcypromine and Zonisamide.
  • However, these agents come with their own side-effects like causing psychosis, hallucinations, impulse-control disorders, and fluctuations in their efficacy, a feature called ''on-off'' phenomenon.
  • Surgical treatment - This is tried in treatment resistant Parkinson's Disease. The procedures include thalamotomy (removal of the thalamus), ablating a part of the brain called pallidum and subthalamic nucleus (present below the thalamus). However, these procedures have been replaced by what is called Deep Brain Stimulation, or DBS. The disadvantages of the surgical modality include invasiveness of the treatments, unclear long-term outcomes, and the economic burden on the patient.

Frequently Asked Questions

1.

Does Parkinson’s Cause Pain?

Pain in Parkinson's disease is common, but it is often overlooked by non-motor symptoms of Parkinson's disease (PD). It can cause several types of pain associated with physical changes. PD is primarily diagnosed in old age people, so it can be difficult to distinguish between pain related to PD and pain related to old age.

2.

Is It Possible to Prevent Parkinson’s Disease?

The exact cause of Parkinson's disease is unknown, so there is no specific prevention method. However, it is believed that caffeine and green tea may lower the risk of developing Parkinson's disease. Also, doing regular exercise and staying active may lower the risk.

3.

Can Memory Loss Occur Due to Parkinson’s Disease?

Memory problems and thinking difficulties are among the most worrying symptoms of Parkinson's. This can have a significant impact on the quality and functioning of life, and treating the cognitive changes will be a top priority for Parkinson's disease.

4.

Is It Possible to Inherit Parkinson’s Disease?

Parkinson's is very rare to run in families. Only a few cases have been reported as hereditary. Most people with PD have idiopathic Parkinson's, meaning there is no known cause for its development.

5.

Where Is Parkinson’s Disease More Commonly Seen?

Parkinson's disease is considerably more common among the white population and is found more commonly in the Northeastern and Midwest US. However, it is also seen affecting the black population and Asians. The prevalence of this disease is more common in urban countries than in rural countries.

6.

How Did Parkinson’s Disease Get Its Name?

Parkinson's disease is named after James Parkinson, in 1817, who described a shaking palsy disorder. The term was cast by William Rutherford Sanders of Edinburgh in 1865. It was earlier known as shaking palsy or paralysis agitans because of the symptoms the Parkinsons' patients possess.

7.

How Was Parkinson’s Disease Treated in Earlier Days?

Parkinson's disease was treated based on empirical observation and anticholinergic medications during the nineteenth century. Later the discovery of dopaminergic shortage in Parkinson's disease laid the path to the first human trials of Levodopa.

8.

What Is the Commonly Used Treatment for Parkinson’s Disease?

Levodopa, also called L-DOPA, is the most effective drug in treating symptoms of Parkinson's disease. This drug will be suggested to Parkinson's patients at some point. Fatigue, nausea, and orthostatic hypotension are the side effects of this drug.

9.

How Long Do People Affected With Parkinson’s Live?

People with Parkinson's disease have a shorter lifespan when compared to healthy people. They may live between 10 and 20 years after diagnosis of this disease. However, factors like the general health of the patient and the patient's age also play a role.

10.

Is There Any Surgery for Parkinson’s Disease?

In most cases of Parkinson's, management is by medication. However, a surgery called deep brain stimulation is done in some patients. Although this surgery does not help cure Parkinson's, it can ease the symptoms.

11.

Is Parkinson’s Disease Curable?

There is no cure for Parkinson's disease yet. People with Parkinson's do not have enough production of the chemical dopamine, which sends messages to different parts of the body to coordinate movement. The halt in production is because some of the nerve cells that produce it have been damaged.

12.

Which Drug Should Be Avoided by Parkinson’s Patients?

Drugs like Promethazine (Phenergan), Prochlorperazine (Compazine), Tetrabenazine, and Metoclopramide (Reglan) should be avoided by Parkinson's patients as they can worsen the symptoms and cause complications.

13.

Is Parkinson’s Considered a Neuropsychiatric Disorder?

Parkinson's disease (PD) has been considered the prototypical neuropsychiatric disorder as it extends beyond movement and often encompasses a range of psychiatric phenomena. This disease can cause uncontrollable and unintended movements of the body because of motor system disorder.

14.

What Symptoms Do Neuropsychiatric Patients Have?

The cause of neuropsychiatry tends to impact brain function, mood, and emotions. The symptoms range from problems with learning and focusing to sadness, memory problems, irritability, depression, mood problems, and various other neurological and psychiatric symptoms.

15.

Do Parkinson’s Patients Show Personality Changes?

Personality changes like psychosis, depression, and anxiety can happen in Parkinson's patients due to neurological changes in the brain. The changes may be different in each patient. These changes can be noted by family, friends, and caregivers.
Source Article IclonSourcesSource Article Arrow
Dr. Alok Vinod Kulkarni
Dr. Alok Vinod Kulkarni

Psychiatry

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