Parkinson's Disease

Dr. Prem Pillay , Singapore Brain Spine Nerves Center, Singapore

Senior Consultant Neurosurgeon with super speciality training in Neurosurgical Oncology

(Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA)

What is the Parkinson's Disease?

Parkinson’s disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination.

Parkinson’s symptoms usually begin gradually and get worse over time. As the disease progresses, people may have difficulty walking and talking. They may also experience mental and behavioural changes, sleep problems, depression, memory difficulties, and fatigue.

Both men and women can have Parkinson’s disease. However, the disease affects about 50 percent more men than women.

One clear risk factor for Parkinson’s is age. Although most people develop the disease around age 60, about 5 to 10 percent of people have early-onset Parkinson’s, which begins before age 50. Early-onset forms are often, but not always, inherited and may be linked to specific gene mutations.

What causes Parkinson’s disease?

Parkinson’s disease occurs when nerve cells (neurons) in the area of the brain that controls movement become impaired or die. Normally, these neurons produce dopamine, a critical brain chemical. When they are lost or impaired, dopamine levels drop, causing the movement problems associated with Parkinson’s.

People with Parkinson’s also lose nerve endings that produce norepinephrine, which controls many automatic body functions like heart rate and blood pressure. The loss of norepinephrine may explain non-movement symptoms, such as:

• Fatigue

• Irregular blood pressure

• Slow digestion

• Sudden blood pressure drops when standing up

  
  

Many brain cells of people with Parkinson’s contain Lewy bodies—unusual clumps of the protein alpha-synuclein. Scientists are studying how this protein and certain genetic mutations relate to Parkinson’s and Lewy body dementia.

While some cases are hereditary or linked to genetic mutations, most cases occur randomly and do not run in families. Many researchers believe Parkinson’s results from a combination of genetic and environmental factors, including toxin exposure.

Symptoms of Parkinson’s disease

Parkinson’s disease has four main symptoms:

• Tremor (in hands, arms, legs, jaw, or head)

• Stiffness of the limbs and trunk

• Slowness of movement

• Impaired balance and coordination, sometimes leading to falls

  
  

Other symptoms may include:

• Depression and emotional changes

• Difficulty swallowing, chewing, and speaking

• Urinary problems or constipation

• Skin problems

• Sleep disruptions

  
  

Symptoms and progression vary among individuals. Early symptoms can be subtle and are often dismissed as normal ageing. There are no definitive medical tests for Parkinson’s, making diagnosis challenging.

Early signs may include:

• Mild tremors

• Difficulty rising from a chair

• Soft speech

• Small, cramped handwriting

• Loss of facial expression or arm swing

• Parkinsonian gait: leaning forward, small steps, reduced arm swing

• Trouble initiating or continuing movement

  
  

Symptoms typically begin on one side of the body, eventually affecting both—though often more severely on the original side.

Many people also report early non-motor symptoms, such as:

• Sleep problems

• Constipation

• Reduced sense of smell

• Restless legs

  
  

Diagnosis of Parkinson’s disease

Advanced neuroimaging with PET of the brain

Many disorders mimic Parkinson’s symptoms. When caused by other factors, these are termed parkinsonism. Some may initially be misdiagnosed, but specific tests and responses to medication help distinguish them.

There are currently no blood or lab tests to diagnose non-genetic Parkinson’s.

Diagnosis is based on:

• Medical history

• Neurological examination

• Improvement with medication, a key hallmark of Parkinson’s

  
  

Treatment of Parkinson’s disease

While there is no cure, treatment can relieve symptoms through medications, surgery, and therapies.

Medicines for Parkinson’s disease

Medications may:

• Increase dopamine levels

• Affect other brain chemicals

• Control non-motor symptoms

  
  

Main therapy involves dopamine-replacement drugs, usually taken with medications to reduce side effects (nausea, vomiting, low blood pressure, restlessness).

Warning: Patients should never stop medication without consulting their doctor. Abruptly stopping can cause serious complications, such as immobility or breathing difficulties.

Other medications include:

• Dopamine agonists – mimic dopamine

• MAO-B inhibitors – slow dopamine breakdown

• COMT inhibitors – help dopamine persist

• Amantadine – an old antiviral that reduces involuntary movements

• Anticholinergics – reduce tremors and rigidity

  
  

Deep brain stimulation (DBS)

For patients not responding well to medication, DBS may be appropriate. This involves:

• Implanting electrodes into the brain

• Connecting them to a small device implanted in the chest

• Painlessly stimulating the brain to relieve tremor, slowness, and rigidity

DBS is an established treatment for advanced Parkinson’s.— Dr Prem Pillay, Singapore neurosurgeon trained at the Cleveland Clinic-USA, now Medical Director at Singapore Brain Spine Nerves Center

Other therapies

Supportive therapies include:

• Physical, occupational, and speech therapy

• Neuropsychological assessment and support

• Aquatic physiotherapy

• Table tennis for Parkinson’s disease – helps with muscle coordination and balance

• Healthy diet and quality sleep

Conclusion

Parkinson’s disease is a complex condition, but with early diagnosis and tailored treatments, individuals can continue to lead fulfilling lives. If you or your loved one are experiencing symptoms such as tremors or changes in movement, consult a healthcare professional promptly. For expert care and support, contact the Singapore Brain Spine Nerves Center today.

References and acknowledgements

• National Institutes of Health – USA

• Singapore Brain Spine Nerves Center

• Table Tennis for Good Foundation