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In patients with mild symptoms and little functional impairment, some relief from symptoms can be obtained with anticholinergic agents, such as trihexyphenidyl (Artane), or with antihistamines with anticholinergic properties, such as diphenhydramine (Benadryl). These drugs block the muscarinic effects of acetylcholine in the central nervous system. Tricyclic antidepressants, such as imipramine or amitriptyline, are also effective; they block the reuptake of dopamine from nerve synapses and also have anticholinergic effects.
In patients with more severe symptoms and difficulty with routine daily activities, it is necessary to augment the dopamine level in the brain. This is done by administering levodopa, which crosses the blood-brain barrier and is converted to dopamine by decarboxylation. This reaction also occurs in the peripheral tissues, and the dopamine produced may cause side effects such as cardiac stimulation (tachycardia and arrhythmias) and also nausea and vomiting. A newer drug called Sinemet, which combines carbidopa with levodopa, is now being used to counteract the undesirable effects that may occur when levodopa is used alone. Carbidopa inhibits production of dopamine outside the brain, thus allowing more effective relief of symptoms. A disadvantage to the combination drug is that in some patients it may have only a limited span of effectiveness; therefore, it is usually reserved for more severe cases.
Patients receiving levodopa alone or in combination with carbidopa require nutritional counseling because dietary habits can greatly affect the action of the drug. Protein intake requires special attention because levodopa, an amino acid, must compete with the dietary amino acids for transport through the intestinal epithelium and across the blood-brain barrier. Alcohol intake also must be limited because in large amounts it can antagonize the effects of dopamine. Although the newer combined form of medication offers relief to many persons with Parkinson's disease, it must be given with caution and under continued supervision. Fewer than 10 per cent of patients with Parkinson's fail to respond to some combination of individual drugs.
Some benefits can be derived from physical therapy in the form of applications of heat and massage to alleviate muscle cramps and relieve the tension headaches that often accompany rigidity of the cervical muscles. The patient also is instructed in simple exercises to perform at home. Although depression often accompanies the physical limitations of Parkinson's disease, much psychological benefit can be derived from maintaining mobility and observing social and emotional ties. Patients can be taught to initiate walking by leaning forward to stimulate intact walking reflexes. Family members will need help in dealing with the patient's slowness of speech and communication difficulties. Some minor changes in the home, such as railings and support bars, can encourage independent movement.
Parkinson's disease(pär′kĭn-sənz) also
Parkinson's diseaseParalysis agitans Neurology A condition characterized by tremors and rigidity followed by inhibition of voluntary movement, a shuffling gait due to neuronal degeneration in the basal ganglia–substantia nigra and corpus striatum, focal ↓ of dopamine production and eventually severe mental deterioration Clinical Older subjects with static tremor, plastic rigidity of trunk and extremities, bradykinesia, masklike facies, progressive stoop, slow monotonous voice, slow shuffling gait, often accompanied by autonomic dysfunction–hypersalivation, sweating, rapid, coarse tremor, pill-rolling movements, cogwheel rigidity, drooling, akinesia Management l-Dopa is effective in early PD, as it is transported to the brain and converted into dopamine, but with time, loses efficacy, clozapine; 'brain-graft' surgery was disappointing; fetal nerve graft–mesencephalic dopamine neurons from 8-9 wk fetuses–may be more effective; deprenyl, an MAOI that blocks conversion of MPTP to MPP+; PD may be prevented by 3+ cups of coffee/day. See BDNF, Clozapine, Fetal-brain tissue grafting, MPTP, Unified Parkinson's Disease Rating Scale.
Parkinson's diseaseA SYNDROME featuring involuntary tremor of the hands with ‘pill-rolling’ finger movements, muscle rigidity and slowness of movements. The face becomes mask-like, the speech slow and the voice quiet and monotonous. Hand-writing becomes minute. There is difficulty in starting to walk and a tendency for the body to incline forwards. Steps are short and tottering, as if the affected person were falling forwards. Cognitive loss and psychiatric changes may occur. Parkinson's disease affects about 1 person in 100 over age 60 and becomes progressively more common with advancing age. It is due to brain changes in the area of the connections between the SUBSTANTIA NIGRA and the CORPUS STRIATUM, with loss of pigment and dopamine-producing cells. There are intraneuronal Lewy bodies. It may be a side effect of certain drugs, such as various phenothiazine or designer drugs or the effects of various poisons such as carbon monoxide. It may be caused by brain tumours, ENCEPHALITIS and repeated head injuries, as from boxing. In 2% of cases there is a mutation in the gene LRRK2 that codes for the protein dardarin, and this mutation is present in 5% of familial cases and 7% of autosomal dominant disease. Most cases remain idiopathic. Treatment is by dopamine replacement using the drug levodopa and other drugs which stimulate dopamine receptors in the brain. Deep brain electrical stimulation by an implanted device delivering very short pulses up to 185 times per second greatly reduces tremor and rigidity. Unilateral pallidotomy may be useful in some cases. The status of fetal cell implantation treatment remains uncertain. Also known as paralysis agitans. (James Parkinson, 1755–1824, London physician).
Parkinson's diseasea debilitating, neurological disorder, that results from the degeneration of NERVE CELLS in the region of the BRAIN controlling movement. Limb tremor, particularly when the body is at rest, is an initial symptom of the disease.
Patient discussion about Parkinson's disease
Q. What to expect from a Parkinson's patient? My 70 year old father has been diagnosed with Parkinson's. What will he be like from now on, what to expect?
• Trembling of hands, arms, legs, jaw and face
• Stiffness of the arms, legs and trunk
• Slowness of movement
• Poor balance and coordination
The symptoms usually get worse with time and then people with the disease may have trouble walking, talking or doing simple tasks.
Q. what is the latest on parkinson?
and the "National Parkinson Foundation" also keeps their readers updated and have a jornal you may find useful things in:
Q. How do you tell between temporal shaky hands and parkinson disease? My dear granpa's hands are being a bit shaky lately. I was wondering if I should worry about Parkinson's disease or is it most likely to be something else? How to tell? are there other symptoms for Parkinson's?? Any help...
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