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Parkinson’s Disease 101

Parkinson’s Disease 101

With the recent passing of boxing legend Muhammad Ali after a lengthy battle with Parkinson’s Disease, numerous questions have come up about the disease. Today I’ll help to answer these questions by sharing the history, symptoms, causes and treatment options for Parkinson’s Disease. 

What characterizes Parkinson’s Disease?

  • Tremor of the hands, arms, legs, jaw and face
  • Slowness of movement with slow, shuffling gait, short steps
  • Rigidity or stiffness of the limbs and trunk
  • Impaired balance and coordination
  • Head held forward
  • Drooping eyelids, open mouth, drooling

Who first identified Parkinson’s Disease?

The disease we call Parkinson’s was known to ancient eastern Indians as “Kampavata.” A man by the name of Charaka is known to have described this disease as “kampa” meaning shaking and “vata” meaning decreased muscle movement or weakness. About 500 years later in Greece, Galen, a student of Hippocrates, also described a “shaking palsy.”

But it wasn’t until the 1800’s when a physician by the name of James Parkinson described the criteria of patients with the “Shaking Palsy” and separated out other diseases that may shake or have weakness. We actually still call the syndromes that look like Parkinson’s Disease by the name “Parkinsonism.”

What causes Parkinson’s Disease?

Parkinson’s is caused by the slow, progressive loss of cells that make dopamine in the brain.

Dopamine, in the right amount and right places, plays a vital role by making our bodies move faster, including arms, legs, mind and even bowels. It also makes us feel good when it is released, like during social events, eating or sex. It is also released as a reward during events such as fishing, hunting, shopping or gambling.

What are the early signs of Parkinson’s?

Early Parkinson’s Disease is easy to miss by doctors because the symptoms can mimic common ailments.

  • Feeling “dizzy” or easily off balance
  • Daytime sleepiness
  • Depression
  • Constipation

What are the symptoms of Parkinson’s Disease?

As the disease progresses and more dopamine-producing cells are lost, more symptoms arise and may include the following.

  • Muscle stiffness
  • Tremor
  • Weight loss
  • Limb swelling
  • “Freezing”
  • Worsening vision
  • Dry skin
  • Choking and excess saliva

What causes a loss of dopamine?

Why are brains losing dopamine? Why are these cells dying? The real answer is that we don’t know. Certainly, there are familial forms of Parkinson’s, but these are much less common than the sporadic type. There may be a correlation with exposure to pesticides and possibly head trauma, though the correlation with these is not clear. And we know that certain types of encephalitis will cause Parkinsonism, but not Parkinson’s Disease.

How do we treat Parkinson’s Disease?

  • Promote the release of dopamine
  • Replace dopamine with medication
  • Alternatives/additions to dopamine treatment
  • Surgery

Ways to release Dopamine

What you can be doing to increase your own Dopamine levels:

  • You can do this through regular exercise such as dancing, walking or activities such as Tai Chi.
  • You will also feel better if you sleep better and are well-rested.
  • Massage makes everyone feel good, but there is research that suggests that massage may reduce the symptoms of Parkinson’s Disease.
  • A loving, supportive relationship improves both lives, but the Parkinson patient may even notice improved physical effects.

What your doctor can do for you to help increase dopamine:

  • We can directly replace that dopamine with a dopamine precursor, Levodopa. Levodopa was found to be effective in the 1950’s by a Swedish scientist, Arvid Carlsson, who later won a Nobel Prize for that work. It is now available in several formulations and is ALWAYS paired with carbidopa to help absorption.
  • We can mimic dopamine with drugs called “dopamine agonists.” Pramipexole, ropinerol and rotigatine patch are all in this category.
  • We can limit the breakdown of your own dopamine using drugs belonging to a family called the MAO-B inhibitors. Two examples are selegiline and rasagiline.
  •  As with some medications, there can be side effects, so be sure to talk to your doctor about a treatment plan that is going to be right for you.

If you suspect that you or a family member has symptoms of Parkinson’s Disease, please contact your physician or the Ochsner Movement Disorders program.

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