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Parkinson’s Disease in India

It is a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine. Exposure to chemicals in the environment might play a role.

Symptoms begin gradually, often on one side of the body. Later they affect both sides. They include

  • Trembling of hands, arms, legs, jaw and face
  • Stiffness of the arms, legs and trunk
  • Slowness of movement

Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking, or doing simple tasks. They may also have problems such as depression, sleep problems, or trouble chewing, swallowing, or speaking.

The treatment for each person with Parkinson’s is based on his or her symptoms.
Treatments include medication and surgical therapy. Other treatments include lifestyle modifications like getting more rest and more exercise.

Stereotactic neurosurgery

Stereotactic neurosurgery is the technique for locating targets of surgical interest within the brain relative to an external frame of reference. Traditionally, that has meant temporarily attaching a mechanical frame to the patient’s skull or scalp. It makes use of a three-dimensional (3D) coordinate system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc.

Deep brain stimulation (DBS)

Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. It involves the implantation of a medical device called a neurostimulator (sometimes referred to as a ‘brain pacemaker’), which sends electrical impulses, through implanted electrodes, to specific parts of the brain (brain nucleus) for the treatment of movement and affective disorders.

Stroke

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke are

  • Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause
  • The strokes can be both prevented and treated

It is a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine. Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Stages of Parkinson’s Disease

Parkinson’s disease is typically divided up into five stages

  • Stage one: Parkinson’s disease symptoms affect only one side of the body.
  • Stage two: Symptoms begin affecting both sides of the body, but balance is still intact.
  • Stage three: Parkinson’s disease symptoms are mild to moderate and balance is impaired, but the person can still function independently.
  • Stage four: People with stage our Parkinson’s disease are severely disabled, but they can still walk or stand without assistance.
  • Stage five: The patient becomes wheelchair-bound or bedridden, unless someone is helping him

Causes Parkinson’s Disease

  • Parkinson’s disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
  • Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.
  • If these nerve cells become damaged, the amount of dopamine in the brain is reduced. This means that the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal.

Genetics

Several genetic changes (mutations) have been identified as increasing a person’s risk of developing Parkinson’s disease. Parkinson’s disease can run in families as a result of faulty genes being passed to a child by their parents, however, inheriting the disease in this way is rare.

Environmental factors

  • Some researchers also feel that environmental factors may increase a person’s risk of developing Parkinson’s disease.
  • It has been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.

Other causes of Parkinsonism

‘Parkinsonism’ is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.
Parkinson’s disease is the most common type of Parkinsonism, but there are also some rarer types where a specific cause can be identified.

These include Parkinsonism caused by:

  • medication (‘drug-induced Parkinsonism’) – wheresymptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped
  • other progressive brain conditions, such as progressive supranuclear palsy, multiple systems atrophy and corticobasal degeneration
  • cerebral infarction – where a severe stroke causes several parts of the brain to die

Symptoms of Parkinson’s disease

  • The symptoms of Parkinson’s disease usually develop gradually and are mild at first.
  • There are many different symptoms associated with Parkinson’s disease, but the order in which these develop and their severity is different for each individual with the condition.
  • Some of the more common symptoms are described below, although it is unlikely that a person with Parkinson’s disease would experience all or most of these.

Main symptoms

The three main symptoms of Parkinson’s disease affect physical movement:

  • tremor – uncontrollable shaking, which usually begins in the hand or arm and is more likely to occur when the limb is at rest
  • slowness of movement (bradykinesia) – where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps
  • muscles stiffness (rigidity) – stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions and can result in painful muscle cramps (dystonia)
  • These main symptoms are sometimes referred to by doctors as ‘Parkinsonism’.

Other symptoms

Parkinson’s disease can also cause a range of other physical and mental symptoms.

Physical symptoms

  • balance problems, which can make someone with the condition more likely to have a fall and injure themselves
  • loss of sense of smell (anosmia), which sometimes occurs several years before other symptoms develop
  • nerve pain, which can cause unpleasant sensations such as burning, coldness or numbness
  • problems with urination, such as having to get up frequently during the night to urinate or urinary incontinence (the unintentional passing of urine)

constipation

  • erectile dysfunction in men – an inability to obtain or sustain an erection
  • sexual dysfunction in women – difficulty becoming sexually aroused and achieving an orgasm
  • dizziness, blurred vision or fainting when moving froma sitting or lying position to a standing one, caused by a sudden drop in blood pressure
  • excessive sweating (hyperhidrosis)
  • swallowing difficulties (dysphagia), which can lead tomalnutrition and dehydration
  • excessive production of saliva (drooling)
  • Mental symptoms
  • depression and anxiety
  • problems sleeping (insomnia), which can result in excessive sleepiness during the day
  • mild cognitive impairment – slight memory problems and problems with activities that require planning and organisation
  • dementia – a group of symptoms including more severe memory problems, personality changes, visual hallucinations (seeing things that are not there) and delusions (believing things that are not true)

How is Parkinson’s Disease Diagnosed

To diagnose Parkinson’s, the physician takes a careful neurological history and performs an examination. There are no standard diagnostic tests for Parkinson’s, so the diagnosis rests on the clinical information provided by the person with Parkinson’s and the findings of the neurological exam.
The doctor looks to see if your expression is animated.

  • Your arms are observed for tremor, which is present either when they are at rest, or extended.
  • Is there stiffness in your limbs or neck?
  • Can you rise from a chair easily?
  • Do you walk normally or with short steps, and do your arms swing symmetrically? The doctor will pull you backwards.
  • How quickly are you able to regain your balance?
  • The main role of any additional testing is to exclude other diseases that imitate Parkinson’s disease, such as stroke or hydrocephalus

Treatment for Parkinson’s Disease

There is currently no cure for Parkinson’s disease, but treatments are available to help relieve the symptoms and maintain your quality of life.
These include supportive therapies (such as physiotherapy), medication and, for some people, surgery.
There are several therapies that can make living with Parkinson’s disease easier and can help you deal with your symptoms on a day-to-day basis

Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier and improve your walking and flexibility. They also try to improve your fitness levels and your ability to manage things for yourself

Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday life, for example dressing yourself or getting to the local shops. They can help you to work out practical solutions and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible

Speech and language therapy

Many people with Parkinson’s disease have swallowing difficulties (dysphagia) and problems their speech. A speech and language therapist can often help you improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.

Diet advice

For some people with Parkinson’s disease, making dietary changes can help improve some symptoms, such as:

  • increasing the amount of fibre in your diet and making sure you are drinking enough fluid to reduce constipation
  • increasing the amount of salt in your diet and eating frequent, small meals to avoid problems with low blood pressure (such as dizziness when you stand up quickly)
  • making changes to your diet to avoid unintentional weight loss
  • Exercise : Regular exercising can ease the symptoms of this disease. Some studies has revealed that patients who do regular exercising do better than who don’t. Physical exercise that increases the heart rate is considered as beneficial.