No known cure for Parkinson’s
DEAR DOCTOR K: My husband was just diagnosed with Parkinson’s disease. Can you discuss it in your column? I don’t know anything about it.
DEAR READER: Parkinson’s disease (PD) is a disease of the central nervous system. It causes problems with body motions and movement. PD worsens over time.
Brain cells “talk” to each other by making and releasing chemicals called neurotransmitters. When one cell releases a neurotransmitter, another picks up the signal. One type of neurotransmitter is dopamine.
Dopamine is made in an area deep in the brain called the basal ganglia. That is also where movements are coordinated. The dopamine made by cells in the basal ganglia is necessary for the basal ganglia to function properly.
PD develops when dopamine-producing nerve cells (neurons) in the brain die and not enough dopamine is produced. This affects movement. (I’ve put an illustration of this process on my website, AskDoctorK.com.)
PD usually begins as a slight tremor or stiffness that is most obvious at rest. When the hands of a PD sufferer are resting in his lap, they may tremble. But when he reaches for a cup of coffee, for instance, his hands may stop trembling.
As the illness worsens, tremors become more widespread. PD also causes rigidity and a slowing of body movements. A person’s face slowly becomes expressionless. Initiating a movement, like sitting up from a chair, may take many seconds to start. A person walks slowly, with short, quick steps.
If your husband’s PD gets much worse, he will likely have difficulty walking and performing daily activities such as dressing or using utensils. But in some people PD progresses very slowly.
There is no cure for PD, but symptoms can be treated with medications. Medication may not be necessary at first. Treatment usually begins when symptoms interfere with work or home life, or when it becomes difficult to walk or maintain balance.
Medications used to treat PD either boost levels of dopamine in the brain or mimic the effects of dopamine. The most commonly used medication is levodopa. It is usually prescribed in combination with another drug called carbidopa. Other medications can also be used, either alone or in combination with levodopa.
Nearly all patients improve after they start taking levodopa. But long-term use often causes side effects and complications.
Depression is fairly common in people with PD. Antidepressant medications can help. Regular exercise and a balanced diet also may help to improve a patient’s sense of well-being and body control. The type of exercise called tai chi has been shown to help.
Surgery is considered only when medications are no longer effective. Surgical options include deep brain stimulation in which electrical stimulation is delivered to targeted areas of the brain to control symptoms. Another option involves destroying precisely targeted areas of the brain that are responsible for the most troubling symptoms.
We can do a great deal more to help people with PD today than when I was in medical school. Based on the progress of research, I expect more effective treatments in the future.
Dr. Komaroff is a physician and professor at Harvard Medical School. Write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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