Introduction:
Parkinson disease is a neurological disorder that causes uncontrollable and unintended movements. It is also called as idiopathic or primary parkinsonism, hypokinetic rigid syndrome, paralysis agitans, and shaking palsy. Parkinson's disease occurs due to the damage of nerve cells or neurons in the substantia nigra of the brain. It is not only caused by damage in the substantia nigra, but it is also due to the degeneration of cells in the nervous system that contains dopamine receptors. Environmental factors such as smoking, pesticide exposure, and caffeine consumption alter the risk of Parkinson disease. The movement disorder arises due to damage in the dopaminergic neurons of the substantia nigra. Substantia nigra is located in the midbrain dopaminergic nucleus, critical in dopamine production. It is characterized by decreased levels of dopamine resulting from degeneration of dopamine storage in the brain's basal ganglia. The exact cause of Parkinson disease is unclear, but many genetic factors contribute.
What Is Facial Masking in Parkinson Disease?
Facial expressions are essential for communication, motivation, and expressing emotional stresses. One of the important symptoms of Parkinson disease is masked facies or diminished facial expression. Some people with Parkinson disease have hypomimia (it limits the expression of emotion in the face), known as masked face or facial masking. Hypomimia and facial bradykinesia are the features of Parkinson disease. They cause the loss of facial expression. Hypomimia is symmetrical on both sides of the face. The symptoms of facial masking vary from person to person. Hypoxemia makes the individual difficult to do some basic expressions such as smiling and eyebrow lifting.
Parkinson disease causes stiffness of the facial muscles. The person affects facial muscles, making it difficult to form simple expressions such as struggling to move lips, smile, and raise eyebrows. So the person can have a masked or expressionless face because it targets the nervous system that impairs movement. The common symptoms of Parkinson disease are tremors and shaking, bradykinesia, and muscle rigidity. Dopamine is a neurotransmitter that transmits information from one nerve cell to other. As the neurons in the substantia nigra do so, the dopamine required for neurotransmission is lowered. The neurotransmitters carry messages from one nerve cell to the other. The transmitted messages help move the limbs, and heartbeat, feel sensations, and respond to all information that the body receives from that environment and internal body parts.
What Are the Characteristics of Facial Masking?
The following characteristics are absorbed in facial masking:
1. Bradykinesia- It is a slow or complex movement. It takes a long time to make everyday movements like lifting or moving the arms or legs. It affects individuals in different ways. Bradykinesia refers to slow motion with a decrease in amplitude and speed. It is a classic symptom of Parkinson disease. It reduces facial responses. It makes it difficult to show visual responses during a conversation.
2. Rigid or Stiff Muscles- Muscle stiffness makes smiling or raising eyebrows hard.
3. Apathy- Lack of emotional responses and depression can affect facial expressions.
4. Fewer Autonomic Movements- Facial movements such as smiling, blinking, and laughing are significantly impaired in Parkinson disease.
What Is the Degree of the Masked Face in Parkinson Disease?
Masked faces occur gradually along with the other symptoms of Parkinson disease. There are numbered degrees of severity with the symptom:
Slight - Normal expression and function in which the patient may blink less than usual.
Mild - Mild symptoms include minimal masked faces and less movement in the lower faces, including smiling and other mouth movements. They can keep their lips closed.
Moderate - Noticeable loss of facial expression. Moderate loss of facial movement. The lips are held in a position when the mouth rests.
Severe - Severe loss of facial movement that is mostly present. The lips are often parted when the mouth is at rest.
What Are the Symptoms of Parkinson Disease?
It becomes difficult for the person to show emotions spontaneously. The difficulties get worse, and the person may not smile properly. It becomes difficult for the patient to move eyebrows and cheeks, and eye blinking also becomes infrequent. The other Parkinson disease symptoms also accompany facial masking, such as:
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Having no facial expressions.
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Dragging the feet while walking.
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Shuffling when walking.
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Difficulty getting read daily, such as brushing teeth, styling hair, and buttoning clothes.
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Difficulty with repetitive tasks like clapping hands or tapping fingers.
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Loss of ability to speak clearly.
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The patient’s voice gets softer day by day.
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Trouble speaking and swallowing.
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Immobile or frozen muscles.
What Is the Treatment for Masked Facies?
The medications given are used to increase dopamine activity. There are no specific treatments for masked faces. Carbidopa and Levodopa combined are used to treat Parkinson disease. Levodopa is the precursor to dopamine. Levodopa is used as a replacement for dopamine in treating Parkinson disease. Because it can cross the blood-brain barrier, it controls slow movements, rigidity, and stiff body parts. A combination of Levodopa and Carbidopa is called Sinemet. Carbidopa prevents the side effects of Levodopa, such as vomiting, nausea, and irregular heart rhythms. INBRIJA is an inhalable form of levodopa, and a tablet called Istradefylline (Nourianz) is approved for those experiencing off-period symptoms. Off periods happen when Parkinson disease returns during periods between regular doses of Carbidopa or Levodopa. Changing the dose and timing can help prevent side effects such as confusion, restlessness, and unusual movements within a few hours of taking medicine.
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Dopamine agonists such as Pramipexole (Mirapex), Rotigotine (Neupro), and Ropinirole (Requip) act like dopamine in the brain. Dopamine agonists are the first treatment choice for Parkinson because they have fewer side effects. They act like dopamine in the brain. But they have short-term side effects such as dizziness, light-headedness, nausea, vomiting, and hallucinations.
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MAO-B inhibitors like Selegiline, Safinamide, and Rasagiline block the brain chemicals that break down Dopamine.
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COMT (catechol-O-methyltransferase) inhibitors such as Entacapone, Opicapone, and Tolcapone. A chemical in the body called COMT blocks the action of Levodopa. The COMT inhibitors block the action of COMT so the brain can use Levodopa more effectively.
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Exercise and occupational therapy can manage rigidity, bradykinesia, and balance problems. The activities include aerobic exercises, stretching regularly, bouncing a ball to keep moving the arms, and practicing yoga.
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Exercising helps strengthen the muscles and relieve pain. Aerobic exercising (such as dancing) is best for reducing rigidity. In addition, reducing stress can help prevent the worsening of the symptoms.
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Warm up before and cooling down after the exercise can help prevent muscles from getting stiff again. A physical therapist can help find the best training and stretching customized for each body type.
Conclusion:
Physical therapy and exercise are less invasive therapy that improves muscle strength and restore neurological functions. It is essential to speak with healthcare professionals to ensure symptom improvement.
