Patient's Query
Hello doctor,
When sitting quietly or watching television, I experience generalized slowness of all movements and increasing stiffness throughout my body, especially in the mornings. My handwriting has become very small, cramped, and nearly illegible, and my voice has become quieter and more monotone, making it hard for people to hear me. I have a shuffling walk with reduced right arm swing, my facial expressions have become flatter and more mask-like, and I am having balance problems and unsteadiness with three falls in the past two months. I also have severe constipation, a complete loss of sense of smell, vivid dreams where I physically act them out, depression, anxiety, and cognitive slowing.
My DaTscan showed reduced dopamine transporter activity in the right striatum, confirming Parkinson's disease. I want to understand the following:
Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern.
Parkinson’s disease happens because the brain cells that make dopamine slowly degenerate, especially in an area called the substantia nigra. Inside these dying cells, abnormal protein clumps called Lewy bodies form, made up of alpha-synuclein. This disrupts normal signaling and causes tremor, stiffness, and slowness.
Most cases are sporadic, meaning not inherited. However, about 10 to 15 percent are linked to gene mutations. Environmental factors such as pesticides or head injury may increase risk in genetically sensitive people.
Parkinson’s disease itself is the classic, slow-progressing form that responds well to Levodopa.
Parkinsonism describes similar symptoms caused by other reasons, such as medications, stroke, or toxins.
Parkinson-plus syndromes progress faster, cause early falls or eye problems, and respond poorly to Levodopa.
Treatment considerations include starting Levodopa or Carbidopa when symptoms begin interfering with work, walking, or self-care. It replaces lost dopamine and provides the best improvement. Over the years, patients may develop wearing-off or on-off fluctuations. Adjusting timing or adding other drugs can help.
Side effects include nausea, low blood pressure, and, over time, dyskinesias. Some dopamine-related drugs may cause impulse-control issues such as gambling or overspending.
Other medicine options include dopamine agonists, MAO-B inhibitors, and COMT inhibitors to prolong Levodopa’s effect. Amantadine can reduce dyskinesias. Deep brain stimulation is a surgical treatment used when medication works but fluctuates too much or causes disabling side effects. Electrodes are placed in specific brain areas to smooth out movements. Most people do not become wheelchair-bound early. With regular treatment and physiotherapy, independence can be maintained for many years. Life expectancy is usually close to normal.
Exercise is one of the most powerful non-drug therapies. Regular aerobic activity, balance training, and stretching help preserve mobility and mood, possibly slowing functional decline. Currently, no proven neuroprotective drug exists, but several clinical trials are exploring antioxidant therapies, anti-alpha-synuclein therapies, and gene or stem-cell treatments. Staying active, following up regularly with a movement disorder specialist, and maintaining mental well-being are key to long-term quality of life.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
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Answered byDr. Prakashkumar P Bhatt
Medically reviewed byiCliniq medical review team
Same symptoms don't mean you have the same problem. Consult a doctor now!
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