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Parkinson's disease is also called primary parkinsonism for which no cause has yet been found.     Learn more...
 
Parkinson has no cure but a variety of medications provide dramatic relief from the symptoms.
 
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Muhammad Ali
“Never lose faith & never stop living each day to the fullest extent possible. I wish all who find themselves part of this courageous battle much luck and I send them my gratitude and love.”

 
Letter to My Family and Friends about Parkinson's
Author: Unknown
 
I have Parkinson's disease.
It is not contagious or hereditary. No one knows what causes it, but some of the dopamine cells in the brain begin to die at an accelerated rate. Everyone slowly loses some dopamine cells as they grow older.
 
If the cells suddenly begin to die at a faster rate, Parkinson's Disease develops. It is a slowly progressive disease usually occurring as people get older. Medicine can help. I'll take newer, stronger kinds over the years. Some make me sick and take lots of adjustments. Stick with me. I have good days and bad days.
 
Emotions: Sometimes I cry and appear to be upset and you think you have done something to hurt my feelings. Probably not. It is the Parkinson's. Keep talking to me. Ignore the tears. I'll be OK in a few minutes.
 
Tremors: You are expecting me to shake. Maybe I do, maybe I don't. Medicine today takes care of the tremors. If my hands, feet, or head are shaky, ignore it. I'll sit on my hands or put them in my pockets. Treat me as you always have. What's a little shakiness between friends?
 
My Face: You think you don't entertain me anymore because I'm not grinning or laughing. If I appear to stare at you, or have a wooden expression, that's the Parkinson's, I hear you. I have the same intelligence; it just isn't easy to show facial expressions. If swallowing, I may drool. This bothers me, so I will mop it up.
 
Stiffness: We are ready to go somewhere and I get up. I can hardly move. Maybe my medicine is wearing off. The stiffness or rigidity is part of Parkinson's. Let me take my time. Keep talking.
 
Exercise: I need to walk each day. Two to three miles is good. Walk with me. Company makes walking fun. It may be a slow walk, but I'll get there. Remind me if I slump or stoop. I don't always know I'm doing this. My stretching, bending and exercises must be done everyday. Help me with them if you can.
 
My Voice: As my deeper tones disappear, you'll notice my voice is getting higher and wispy. That's the Parkinson's I know you can talk louder, faster and finish my sentences for me. I don't care for that. Let me talk, get my thoughts together and speak for myself. I'm still there. My mind's okay. Since I'm slower in movement, my thoughts are slower too. I want to be part of the conversation. Let me speak.
 
Sleeplessness: I may complain that I can't sleep. If I wander around in the middle of the night, that's Parkinson's. It has nothing to do with what I ate or how early I went to bed. I may nap during the day. Let me sleep when I can. I can't always control when I'm tired or feel like sleeping. Be patient, my friends. I need you. I'm the same person; I've just slowed down.
 
It's not easy to talk about Parkinson's, but I'll try if you really want to know. I need my friends. I want to continue to be part of life.
 
Treating Parkinson’s Disease
 
How is the Disease Treated?
At present, there is no cure for Parkinson's disease. But a variety of medications provide dramatic relief from the symptoms.
 
When recommending a course of treatment, the physician determines how much the symptoms disrupt the patient's life and then tailors therapy to the person's particular condition. Since no two patients will react the same way to a given drug, it may take time and patience to get the dose just right. Even then, symptoms may not be completely alleviated. In the early stages of Parkinson's disease, physicians often begin treatment with one or a combination of the less powerful drugs — such as the anticholinergics or amantadine (see section entitled "Are There Other Medications Available for Managing Disease Symptoms?"), saving the most powerful treatment, specifically levodopa, for the time when patients need it most.
Levodopa
Without doubt, the gold standard of present therapy is the drug levodopa (also called L-dopa). L-Dopa (from the full name L-3,4-dihydroxyphenylalanine) is a simple chemical found naturally in plants and animals. Levodopa is the generic name used for this chemical when it is formulated for drug use in patients. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Dopamine itself cannot be given because it doesn't cross the blood-brain barrier, the elaborate meshwork of fine blood vessels and cells that filters blood reaching the brain. Usually, patients are given levodopa combined with carbidopa. When added to levodopa, carbidopa delays the conversion of levodopa into dopamine until it reaches the brain, preventing or diminishing some of the side effects that often accompany levodopa therapy. Carbidopa also reduces the amount of levodopa needed.
Levodopa's success in treating the major symptoms of Parkinson's disease is a triumph of modern medicine. First introduced in the 1960s, it delays the onset of debilitating symptoms and allows the majority of parkinsonian patients — who would otherwise be very disabled — to extend the period of time in which they can lead relatively normal, productive lives.
 
Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.
 
People who have taken other medications before starting levodopa therapy may have to cut back or eliminate these drugs in order to feel the full benefit of levodopa. Once levodopa therapy starts people often respond dramatically, but they may need to increase the dose gradually for maximum benefit.
 
Because a high-protein diet can interfere with the absorption of levodopa, some physicians recommend that patients taking the drug restrict protein consumption to the evening meal.
 
Levodopa is so effective that some people may forget they have Parkinson's disease. But levodopa is not a cure. Although it can diminish the symptoms, it does not replace lost nerve cells and it does not stop the progression of the disease.
 
Side Effects of Levodopa
Although beneficial for thousands of patients, levodopa is not without its limitations and side effects. The most common side effects are nausea, vomiting, low blood pressure, involuntary movements, and restlessness. In rare cases patients may become confused. The nausea and vomiting caused by levodopa are greatly reduced by the combination of levodopa and carbidopa which enhances the effectiveness of a lower dose. A slow-release formulation of this product, which gives patients a longer lasting effect, is also available.
 
Prolonging Levodopa Action
Recent studies revealed that when the drug tolcapone is added to the standard drug treatment for Parkinson's disease, levodopa-carbidopa, symptom relief is prolonged greatly. This promising new drug that blocks the breakdown of dopamine and levodopa would allow patients to take fewer doses and smaller amounts of levodopa-carbidopa and to decrease the problems of the wearing-off effect.
 
Dyskinesias, or involuntary movements such as twitching, nodding, and jerking, most commonly develop in people who are taking large doses of levodopa over an extended period. These movements may be either mild or severe and either very rapid or very slow. The only effective way to control these drug-induced movements is to lower the dose of levodopa or to use drugs that block dopamine, but these remedies usually cause the disease symptoms to reappear. Doctors and patients must work together closely to find a tolerable balance between the drug's benefits and side effects.
 
Other more troubling and distressing problems may occur with long-term levodopa use. Patients may begin to notice more pronounced symptoms before their first dose of medication in the morning, and they can feel when each dose begins to wear off (muscle spasms are a common effect). Symptoms gradually begin to return. The period of effectiveness from each dose may begin to shorten, called the wearing-off effect. Another potential problem is referred to as the on-off effect — sudden, unpredictable changes in movement, from normal to parkinsonian movement and back again, possibly occurring several times during the day. These effects probably indicate that the patient's response to the drug is changing or that the disease is progressing.
 
One approach to alleviating these side effects is to take levodopa more often and in smaller amounts. Sometimes, physicians instruct patients to stop levodopa for several days in an effort to improve the response to the drug and to manage the complications of long-term levodopa therapy. This controversial technique is known as a "drug holiday." Because of the possibility of serious complications, drug holidays should be attempted only under a physician's direct supervision, preferably in a hospital. Parkinson's disease patients should never stop taking levodopa without their physician's knowledge or consent because of the potentially serious side effects of rapidly withdrawing the drug.
 
Are There Other Medications Available for Managing Disease Symptoms?
Levodopa is not a perfect drug. Fortunately, physicians have other treatment choices for particular symptoms or stages of the disease. Other therapies include the following:
  • Bromocriptine, pergolide, pramipexole and ropinirole: These four drugs mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. They can be given alone or with levodopa and may be used in the early stages of the disease or started later to lengthen the duration of response to levodopa in patients experiencing wearing off or on-off effects. They are generally less effective than levodopa in controlling rigidity and bradykinesia. Side effects may include paranoia, hallucinations, confusion, dyskinesias, nightmares, nausea, and vomiting.
  • Selegiline: Studies supported by the National Institute of Neurological Disorders and Stroke (NINDS) have shown that the drug (also known as deprenyl) delays the need for levodopa therapy by an average of nine months. When selegiline is given with levodopa, it appears to enhance and prolong the response to levodopa and thus may reduce wearing-off fluctuations. Selegiline inhibits the activity of the enzyme monoamine oxidase B (MAO-B), the enzyme that metabolizes dopamine in the brain, delaying the breakdown of naturally occurring dopamine and of dopamine formed from levodopa and also provides mild symptomatic relief from parkinsonism in-and-of itself. Selegiline is an easy drug to take, although side effects may include nausea, orthostatic hypotension, or insomnia (when taken late in the day). Also, toxic reactions have occurred in some patients who took selegiline with fluoxetine (an antidepressant) and meperidine (used as a sedative and an analgesic).
  • Anticholinergics: These drugs were the main treatment for Parkinson's disease until the introduction of levodopa. Their benefit is limited, but they may help control tremor and rigidity. They are particularly helpful in reducing drug-induced parkinsonism. Anticholinergics appear to act by blocking the action of another brain chemical, acetylcholine, whose effects become more pronounced when dopamine levels drop. Only about half the patients who receive anticholinergics respond, usually for a brief period and with only a 30 percent improvement. Although not as effective as levodopa or bromocriptine, anticholinergics may have a therapeutic effect at any stage of the disease when taken with either of these drugs. Common side effects include dry mouth, constipation, urinary retention, hallucinations, memory loss, blurred vision, changes in mental activity, and confusion.
  • Amantadine: An antiviral drug, amantadine, helps reduce symptoms of Parkinson's disease. It is often used alone in the early stages of the disease or with an anticholinergic drug or levodopa. After several months amantadine's effectiveness wears off in a third to a half of the patients taking it, although effectiveness may return after a brief withdrawal from the drug. Amantadine has several side effects, including mottled skin, edema, confusion, blurred vision, and depression.
Is Surgery Ever Used to Treat Parkinson's Disease?
Treating Parkinson's disease with surgery was once a common practice. But after the discovery of levodopa, surgery was restricted to only a few cases. Currently, surgery is reserved for patients who have failed to respond satisfactorily to drugs. One of the procedures used, called cryothalamotomy, requires the surgical insertion of a supercooled metal tip of a probe into the thalamus (a "relay station" deep in the brain) to destroy the brain area that produces tremors. This and related procedures, such as thalamic stimulation, are coming back into favor for patients who have severe tremor or have the disease only on one side of the body. Investigators have also revived interest in a surgical procedure called pallidotomy in which a portion of the brain called the globus pallidus is lesioned. Some studies indicate that pallidotomy may improve symptoms of tremor, rigidity, and bradykinesia, possibly by interrupting the neural pathway between the globus pallidus and the striatum or thalamus. Further research on the value of surgically destroying these brain areas is currently being conducted. Restorative surgery, using nerve cell transplants to supplement the patient's own dopamine-producing nerve cells, is also under investigation.
 
Can Diet or Exercise Programs Help Relieve Symptoms?
 
Diet
Eating a well-balanced, nutritious diet can be beneficial for anybody. But for preventing or curing Parkinson's disease, there does not seem to be any specific vitamin, mineral, or other nutrient that has any therapeutic value. A high protein diet, however, may limit levodopa's effectiveness.
 
Despite some early optimism, recent studies have shown that tocopherol (a form of vitamin E) does not delay Parkinson's disease. This conclusion came from a carefully conducted study supported by the NINDS called DATATOP (Deprenyl and Tocopherol Antioxidative Therapy for Parkinson's Disease) that examined, over 5 years, the effects of both deprenyl and vitamin E on early Parkinson's disease. While deprenyl was found to slow the early symptomatic progression of the disease and delay the need for levodopa, there was no evidence of therapeutic benefit from vitamin E.
 
Exercise
Because movements are affected in Parkinson's disease, exercising may help people improve their mobility. Some doctors prescribe physical therapy or muscle-strengthening exercises to tone muscles and to put underused and rigid muscles through a full range of motion. Exercises will not stop disease progression, but they may improve body strength so that the person is less disabled. Exercises also improve balance, helping people overcome gait problems, and can strengthen certain muscles so that people can speak and swallow better. Exercises can also improve the emotional well-being of parkinsonian patients by giving them a feeling of accomplishment. Although structured exercise programs help many patients, more general physical activity, such as walking, gardening, swimming, calisthenics, and using exercise machines, is also beneficial.
 
What are the Benefits of Support Groups?
One of the most demoralizing aspects of the disease is how completely the patient's world changes. The most basic daily routines may be affected from socializing with friends and enjoying normal and congenial relationships with family members to earning a living and taking care of a home. Faced with a very different life, people need encouragement to remain as active and involved as possible. That's when support groups can be of particular value to parkinsonian patients, their families, and their caregivers.
 
Can Scientists Predict or Prevent Parkinson's Disease?
As yet, there is no way to predict or prevent the disease. However, researchers are now looking for a biomarker, a biochemical abnormality that all patients with Parkinson's disease might share that could be picked up by screening techniques or by a simple chemical test given to people who do not have any parkinsonian symptoms.
 
Positron emission tomography (PET) scanning may lead to important advances in our knowledge about Parkinson's disease. PET scans of the brain produce pictures of chemical changes as they occur in the living brain. Using PET, research scientists can study the brain's dopamine receptors (the sites on nerve cells that bind with dopamine) to determine if the loss of dopamine activity follows or precedes degeneration of the neurons that make this chemical. This information could help scientists better understand the disease process and may potentially lead to improved treatments.