About Parkinson’s Disease

UNDERSTANDING PARKINSON’S DISEASE

Parkinson's is a disease of the central nervous system. It is progressive, which means that symptoms get worse over time. Tell your doctor how your symptoms are changing, so that you can make changes in your treatment at the right time.

Living well with Parkinson’s means being able to do what’s important to you — taking care of yourself, having lunch with friends, continuing to work or volunteer, enjoying your favorite activity. The right treatment may control your Parkinson’s symptoms, so you can live life your way.

TAKE CONTROL OF YOUR PARKINSON’S SYMPTOMS

Only you can help your doctor understand your symptoms and how you feel each day. If your symptoms change over time or your treatments don’t work as well as they used to, tell your doctor. Together, you can decide when it’s time to try something else.

MOVEMENT SYMPTOMS

Many people with Parkinson’s have movement symptoms, also called motor symptoms. Movement symptoms can make everyday life challenging — walking, writing, drinking from a glass.

Common movement symptoms are:

Tremor — Tremor or shaking is often the most obvious symptom of Parkinson's, though not everyone has it. Tremor usually starts in the fingers, hand, or foot and may eventually spread to the rest of your limb. It may affect one or both sides of the body. Unlike the condition called essential tremor, a Parkinson's tremor usually happens when the part of the body is at rest, instead of when you're moving it.

Slowed movement (bradykinesia) — Parkinson's may slow your movements. When you walk, you may have to take short steps or shuffle your feet. Over time, you may have freezing — sometimes your feet may seem to stick to the floor, or you may have trouble getting up from a chair.

Stiffness (rigidity) — Muscles may become very stiff and difficult to move. This often begins in the legs and neck.

OTHER SYMPTOMS

Parkinson's disease may also affect mood, sleep, digestion (constipation is common), speech, swallowing, thinking, and memory.

WHAT CAUSES THE MOVEMENT SYMPTOMS?

The cause of Parkinson's disease is unknown. Parkinson's gradually causes certain nerve cells in the brain to break down and die. The loss of nerve cells that produce a chemical messenger called dopamine causes many of the symptoms.

PARKINSON'S TREATMENT OPTIONS

Medications and surgical treatments may control movement symptoms of Parkinson's. Exercise, stretches, and balance work also help.

MEDICATIONS

Treatment typically starts with medication. Medications help reduce movement symptoms by increasing dopamine in the brain or mimicking its effects. Work with your doctor to find the medication, or combination, which gives you the most benefit with the fewest side effects.

Types of medications include:

• Dopaminergic drugs (include levodopa) — Have dopamine-like effects
• Decarboxylase inhibitor (include carbidopa) — Work with levodopa to treat symptoms
• Dopamine agonists — Mimic dopamine
• Anticholinergics — Relax smooth muscle to treat tremor
• MAO-B inhibitors — Help prevent the breakdown of dopamine in the brain
• Catechol-O-methyltransferase inhibitors — Bind to dopamine receptors and imitate dopamine

Levodopa is a common medication. After some years, many people find that levodopa becomes less effective at controlling their symptoms. Signs to watch for include:

• More hours a day with symptoms
• Longer waits for relief to kick in after taking a dose
• Wearing off of the medication between doses
• Needing to take it more often, including at night
• Drug-induced side effects like unintended movements (dyskinesia)

SURGICAL OPTIONS

Other treatments for Parkinson's require a surgical procedure.

Deep brain stimulation (DBS) — DBS uses a small, pacemaker-like device, placed under the skin of the chest, to send electrical signals through very thin wires to an area in the brain that controls movement. Learn more about deep brain stimulation.

Levodopa-carbidopa intestinal pump — This treatment for people with advanced Parkinson’s disease uses a tube implanted in your small intestine and a drug pump worn on a belt around the waist. The pump delivers a levodopa/carbidopa gel through the tube.

Pallidotomy and thalamotomy — A surgeon destroys a specific, small area of the brain to help control movement symptoms. These procedures aren't performed very often today, but may be recommended in certain cases.

CHANGING TREATMENT OVER TIME

Since Parkinson's is a progressive disease, the treatment that works for you now may not work later. Talk with your doctor about your current symptoms, what daily activities are important for you to maintain, and what treatments to consider as your disease progresses.

SEEING THE RIGHT DOCTOR

Look for a neurologist who specializes in treating Parkinson's. The right doctor will understand your needs and treatment options and will be your partner through this journey. A movement disorder specialist is a neurologist with extra training in movement disorders, like Parkinson’s disease.

These specialists have experience with the full range of treatment options. They often work at a major university or teaching hospital, which may be involved in Parkinson's research. Some general neurologists are also experienced in treating Parkinson's, though they may also treat more than a hundred other conditions.

TAKE CONTROL OF YOUR CARE

Whether you see a general neurologist or movement disorder specialist, be honest about your symptoms and how your treatment is working. Ask about other options you could try. And don’t hesitate to get another opinion.