Parkinson's Disease [PD]- its symptoms, diagnosis, and treatment (February 2025):

 

Parkinson’s Disease (PD) - What is it?

Parkinson’s Disease (PD) is a kind of neurological disorder in which some parts of the brain are progressively damaged or deteriorated over the years. The first signs of PD are problems with movement. It is an age-related degenerative brain condition.   As age increases, the chances of developing PD also increase. Normally, PD starts after the age of 60. However, some people may feel it after the age of 50, also. It is rarely found in young adults.

Symptoms of Parkinson’s Disease [PD]: Parkinson’s disease has several non-motor (non-movement) symptoms and motor (movement-related) symptoms. Non-motor symptoms sometimes appear several years ahead of motor symptoms, which may be considered potential warning signs.   Both types of signs are listed below: Possible early non-motor (nonmovement-related) symptoms: Loss of sense of smell (Anosmia). Depression Unintentional flow of saliva from the mouth ( Drooling). Parkinson-related Dementia or other cognitive problems - Memory, thinking,  focussing, learning, remembering, visuospatial skills, attention, language, reasoning, or other mental and cognitive skills may be affected. Cognitive problems become more severe in the late stages of PD, and some people are diagnosed with Parkinson's disease dementia.  Mask-like facial expression (hypomimia) - The person’s face may be less expressive ( known as the masked face). Some of the symptoms of the Autonomic nervous system are listed below: Orthostatic hypotension: Irregular blood pressure and heart rate. Blood pressure drops all of a sudden when a person stands up from a lying down or seated position. It causes dizziness and lightheadedness. Loss of balance or fainting is also possible in extreme cases. Constipation Gastrointestinal problems Urinary incontinence Sexual dysfunctions - PD affects nerve signals from the brain; therefore, it can cause sexual dysfunction. Depression due to PD or the use of certain medications may also cause decreased sex drive and other sexual dysfunction. Slow, cramped, and small handwriting  (Micrographia) - This is due to poor control of hand muscles. Changes in the voice Stooped posture (forward-bent position of head and trunk). Major primary motor-related difficulties: (Motor impairment; movement-related) symptoms: Slowed movement (Bradikensia)-  It is not due to muscle weakness but instead due to poor control of muscle movement. It is a slowing down of spontaneous and automatic movement. It can make simple tasks more difficult, and activities that a person could once perform quickly and easily, such as washing or dressing, may take much longer. Tremors (involuntary shaking of body parts) and rhythmic (back and forth motion) movement of muscles at rest : Tremors in hands, arms, jaw, legs, and/or head. It happens in 80% of people with PD. It is the rhythmic shaking of muscles when they are not in use. It is different from essential tremors, which usually do not happen when muscles are at rest. Mostly, the tremor will cause the person to rub their thumb and forefinger together, which may appear as pill-rolling. It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep and may improve when the person makes a purposeful, intended movement. Muscle rigidity,  inflexibility,  stiffness of the limbs, arms, legs, and trunk- or resistance to the movement -  Most common in the arms, shoulders, or neck. The muscles stay tense and tight, causing the person to ache or feel stiff. If another person tries to move the individual's arm, it moves only in short, jerky movements. Muscle stiffness if contracted for a long time. Lead-pipe rigidity and Cogwheel stiffness are the common symptoms of PD. In lead-pipe rigidity, it is felt that limbs are stuck in one position, and the symptom of continuous resistance throughout the range of motion is observed. In Cogwheel stiffness, you may feel the symptoms of tremors and lead pipe rigidity together. Limbs move with jerks like the second hand of a mechanical clock. Balance problem and tendency to fall - It is caused by abnormal movement of legs and/or arms, uncontrolled and unintended movements like shaking, stiffness, difficulty in balance, and mis-coordination of body parts. Secondary Symptoms: Some of the secondary symptoms of PD are listed below: Blank facial expression. Decreased blinking due to poor facial muscle control. Unusually soft speaking voice (Hypophonia) - Muffled, low-volume speech: Most individuals with PD have speech difficulties, which may include speaking quietly or in a monotone. Some people may hesitate before speaking, slur, or speak too quickly. This is due to poor control of the muscles of the chest and throat.  Difficulties in swallowing (Dysphagia)- This is due to poor control of throat muscles, and it may lead to pneumonia or choking. Unstable posture or walking gait (Parkinsonian gait) : Parkinsonian gait includes tendencies to take shuffling steps while walking to lean forward, taking small, quick steps as if hurrying (called festination),  initiating and continuing the movement of arms, and reduced swinging in one or both arms. It will be visible when they walk because they will use shorter, stuffing strides and move their arms less. During turn on-walk, they may take several steps. They may have trouble initiating movement (called start hesitation) and stop suddenly as they walk ( freezing in place). Tendency to fall backward. Reduced arm swinging when walking. A tendency to get stuck when walking. Symptoms may start on one side of a limb or body part. Gradually, it may spread to all; however, it may remain more serious on one side. It happens as the PD progresses. Other associated symptoms of Parkinson’s Disease [PD]: There may be several other associated symptoms of PD, some of which are listed below: Skin problems - Increased facial oil, especially on the forehead, at the sides of the nose, and on the scalp. An oily scalp makes dandruff. Some people's skin may be dry, and they may sweat more than usual. Flaky white or yellow scales on oily parts of the skin, known as Seborrheic Dermatitis. Increased risk of Melanoma, a serious type of skin cancer. Muscle cramps and Dystonia:  The rigidity and lack of normal movement may cause muscle cramps, especially in the legs and toes.  Sustained muscle contractions that cause forced or twisted positions are also noticed in PD patients. It is called Dystonia. Fatigue and loss of energy: Fatigue, especially late in the day, is also noticed in PD cases. It may be due to depression or sleep disorders, but it may be due to other reasons like motor control issues such as trouble initiating or carrying out movement, tremors, or stiffness.  Sleep problems:  Sleeping disorders (insomnia)  Difficulty staying asleep during the night Emotional dreams Nightmares, Drowsiness, Suddenly falling asleep during the daytime. Periodic Limb Movement Disorder (PLMD) Rapid Eye Movement (REM) behavior disorder. People act out their dreams.   It may be harmful to themselves or their bed partners. Restless legs syndrome. Sleep disturbances include vivid dreams, talking, and movement during sleep. Mental and behavioral/emotional changes: Anxiety (insomnia), fatigue, and memory problems. Hallucinations. Psychosis. Problems with attention and memory. Difficulty with visual-spatial relationships. Difficulties in chewing, moving, talking, and stretching. Slow movement of food through the digestive tract. Difficulty in getting out of the chair. Loss of control of muscles. Pain: Due to rigidity and abnormal postures. The PD patients may have aches and pain in muscles and joints. As the disease progresses, people may develop Parkinson's dementia or Lewy body dementia. Gradual loss of spontaneous movement -  It leads to decreased mental skill or reaction time, voice changes, decreased facial expression, etc. Gradual loss of automatic movement -  It leads to decreased blinking, decreased frequency of swallowing, and drooling. A stooped, flexed posture with bending at the elbows, knees, and hips. Note: Similar symptoms may be seen due to aging and/or some other reasons. Only a neurologist can diagnose, detect, and confirm Parkinson’s Diseases.

Know more about Parkinson’s dementia: Parkinson’s dementia is a complication of PD. It causes people to develop difficulties with reasoning, thinking, and problem-solving. 50% to 80 % of people with Parkinson’s will experience some degree of dementia. Symptoms of Parkinson’s disease dementia include: depression sleep disturbances delusions confusion hallucinations mood swings slurred speech Changes in appetite Changes in energy level Certain people are more likely to develop Parkinson’s disease dementia. Risk factors for the condition include: Men are more likely to develop it. The risk increases as you get older. Existing cognitive impairment. If you had memory and mood issues before a Parkinson’s diagnosis, your risk of dementia may be higher for dementia. Severe Parkinson’s symptoms. You may be more at risk for Parkinson’s disease dementia if you have severe motor impairment, such as rigid muscles and difficulty walking.

Causes of PD: Substantial Nigra (SN) is a part of the Basal Ganglia in the base of the brain. Nerve cells (Neurons) in the SN produce a chemical called Dopamine. In normal health conditions, Dopamine remains available at an exact balance level with other neurotransmitters. Dopamine at a balanced level helps and coordinates with millions of nerve and muscle cells to control movement. When such neurons die or become impaired, they produce less dopamine, and a low level of dopamine causes movement problems. It is called Parkinson’s Disease [PD]. The reason for neuron problems is still not clear. Nerve endings are also found lost in PD cases. Nerve endings produce Norepinephrine which is the main chemical messenger of the sympathetic nervous system. It controls many functions like blood pressure, heart rate, etc. It is assumed that a lack of Norepinephrine produces fatigue, irregular blood pressure, and slow movement of food through the digestive tract. It may also be responsible for the sudden drop in blood pressure when a person with PD stands up from a sitting or lying position. Many brain cells of the person with PD contain Lewy bodies (unusual clumps of alpha-synuclein protein). Researchers are trying to find out the relationship between Lewy bodies and PD. The exact cause of PD is still unknown, however, some of the possibilities are listed below: It may be inherited, but not always. Environmental components and viruses may also be responsible for PD. People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease. Exposure to certain toxins and pesticides may increase the risk of Parkinson’s disease. People who experience head injuries may be more likely to develop Parkinson’s disease. It may be due to a specific alteration in genes. Experts confirm the genetic reason. Other reasons are not confirmed by experts; therefore, reasons other than genetics are called Idiopathic. The term Idiopathic comes from the Greek word for unknown reasons. Causes based classifications of Parkinson's disease [PD]: It can be classified as below: Familial Parkinson’s disease: PD can have a familial cause. It can be inherited from one or both of the parents. Around 10% of PD cases are estimated to fall under this category. It is found that at least 7 different genes are linked with PD.  Idiopathic Parkinson’s disease: It is believed that the abnormal shape of a protein called alpha-synuclein is responsible for PD. When some proteins do not have the correct shape (called misfolding), such proteins cannot be broken and cannot be used by our bodies. Such unbroken and unused proteins build up. The tangles or clumps of such proteins are called Lewy bodies and cause toxic effects and cell damage.  Induced Parkinsonism: Some diseases have similar symptoms to Parkinson's Disease [PD]. Such diseases are called Induced Parkinsonism ( not true Parkinson's Disease). The causes for such induced parkinsonism are listed below: Specific Medications- Several medications (like psychiatric medicines) can cause Induced  Parkinsonism. If you stop taking such medications within a short period, symptoms of Induced Parkinsonism will go away. Encephalitis-  It is the inflammation in the brain and may cause Induced Parkinsonism. Exposure to Toxins and poisons- Several substances like Manganese dust, Carbon monoxide, welding fumes, and certain pesticides may cause Parkinsonism. Head injury - High impact and repeated head injury due to various reasons like boxing, football, and hockey may cause brain damage, which will lead to induced parkinsonism. Specifically, it is called Post-traumatic parkinsonism.

Diseases similar to PD: Many diseases/disorders show symptoms similar to PD. They are also called Parkinson's - plus syndrome or Atypical Parkinsonism because they have the symptoms of PD plus some additional symptoms. Some of them are listed below: Multiple system atrophy. Lewy body dementia. Progressive supranuclear palsy. Corticobasal degeneration. The big difference is that such disorders do not respond to Levodopa treatment like PD does.

Which genes are linked to Parkinson’s Disease [PD]? Researchers have found that the following genes are linked with PD: SNCA This gene, which makes the protein alpha-synuclein, was the first gene identified to be linked with Parkinson's disease. It has been established that the Lewy bodies seen in all cases of PD contain clumps of abnormal alpha-synuclein. This discovery revealed the link between hereditary and sporadic forms of the disease.   LRRK2: LRRK2 codes for a complex protein called Dardarin that plays a role in many cellular functions. It has been established that LRRK2 mutations affect how cells metabolize alpha-synuclein. These changes may lead to the formation of Lewy bodies. The activity of this protein may increase in sporadic PD.   DJ-1: This gene helps protect cells from oxidative stress. Mutations in this gene can cause rare, early-onset forms of PD.   PRKN (Parkin): The Parkin gene makes a protein that helps cells break down and recycle proteins. Mutations in this gene can cause early-onset PD.   PINK1: PINK1 codes for a protein active in mitochondria. Mutations in this gene appear to increase susceptibility to cellular stress. This gene is also linked to early-onset forms of PD.   GBA (Glucocererosidase-beta): Mutations in GBA cause Gaucher disease, a type of lipid storage disorder. Different changes in this gene are linked with an increased risk for Parkinson's disease and faster progression of symptoms in people who have PD.

Diagnosis of Parkinson’s Disease (PD): A neurologist (a healthcare expert) can diagnose PD  or rule out other conditions with the help of some examinations, procedures, and biological marker tests before the motor symptoms. It includes: Medical history Physical examination Review of Symptoms Neurological examination Blood and lab tests Imaging tests SPECT scan ( DAT scan) Genetic testing Medication Alpha-synuclein test Follow-up appointments Now, we will describe the diagnosis:  Physical and Neurological examination along with medical history: Thinking, mental abilities, senses, coordination, and reflexes are tested with the help of medical history and physical and neurological examination. Blood and lab tests: These tests are conducted to rule out other diseases showing similar symptoms. Such tests do not help diagnose Parkinson’s Disease (PD). Imaging tests: Imaging tests like MRI, brain Ultrasound, and PET (Position Emission Tomography)  scan are conducted to rule out other conditions.  Such tests do not help diagnose Parkinson’s Disease (PD). SPECT scan ( DAT scan): A specific Single Photon Emission Computerized Tomography (SPECT) scan is also called a Dopamine Transporter (DAT) scan. It identifies the different types of tremors and is helpful to confirm the doubt that you have Parkinson's disease.  It confirms the symptoms, and along with the result of the neurological exam, a diagnosis of Parkinson's disease can be determined. However, it cannot differentiate the diagnosis of PD from Parkinson’s syndrome.  Genetic testing: Samples of blood, saliva, skin, tissue, or amniotic acid are taken to analyze changes in genes (DNA) and correlate with any family history of Parkinson’s disease and/or with your ongoing symptoms. Medications: Certain medicines for Parkinson’s disease are given to the patient. If medicine improves the condition, it helps to diagnose the disease correctly. Alpha-synuclein test: Abnormal clumps of protein accumulate in the brain and cause Lewy Body Dementia (LBD), a progressive disease that affects thinking, mood, behavior, and movement. Alpha-synuclein is found in the Lewy Bodies. It forms clumps that the body can not break down. The clumps spread and damage the brain cells. The alpha-synuclein test (SYNTap)  is also called an alpha-synuclein Seed Amplification Assay (aSyn-SAA). It detects misfolded or clumped alpha-synuclein proteins in the cerebrospinal fluid. Misfolded aggregates of this protein in the brain are a hallmark of Parkinson’s disease. It detects Parkinson's disease before symptoms begin. The sample for the alpha-synuclein test is taken from spine fluid (also called spinal tap or lumbar puncture). The aSyn-SAA test has a 93% accuracy and has been validated through the Parkinson's Progressive Markers Initiative (PPMI) in the USA. The aSyn-SAA test was approved by the US FDA IN 2019.  Scientists are trying to find a way to conduct this test with blood or saliva samples instead of spinal fluid. SynONE test: Another diagnostic test is a skin biopsy test (Syn-One) that looks for abnormal alpha-synuclein. It may be 93% accurate in detecting Parkinson’s Disease.  Since it is classified as a laboratory-developed test, therefore,  Syn-One does not require FDA approval. It can be used by clinicians. Follow-up appointments: Follow-up appointments with a neurologist are necessary to confirm the diagnosis, adjust the medications, and provide the most suitable treatment.

Stages of Parkinson’s Disease [PD]: It may be classified into four parts based on the Movement Disorder Society - Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). It examines the symptoms and describes the impact of PD on different parts of the body. Part 1 (Nonmotor aspects of experiences of daily living): It deals with symptoms like dementia, depression, anxiety, mental ability, mental health-related issues, pain, constipation, urine incontinence, fatigue, etc. Part 2 (Motor aspects of experiences of daily living) It deals with movement-related problems like the ability to speak, chew, eat, swallow, etc. It also deals with the ability to self-dress and bathe in case of having tremors, etc.  Part 3 (Motor examination): It is used to determine the movement-related effects of Parkinson’s Disease. It measures the effects based on speech, facial expression, stiffness, rigidity, walking gait and speed, balance, movement speed, tremors, etc. Part 4 (Motor complications): It determines how much the impact of PD’s symptoms affects the life of the people with PD. It measures the time of certain symptoms that you have each day. It also measures the impact on daily life.

Treatment of Parkinson’s Disease (PD): PD can not be cured, but by medications, its symptoms can be controlled. Treatment of PD by medicines is done by two methods: Direct treatment of PD and Symptom treatment. Direct treatment means medicine to control PD. Symptom treatment means medicines to control only some specific symptoms of PD. Such symptoms are listed below: Erectile and sexual dysfunction. Fatigue or sleepiness. Constipation. Sleep problems. Depression. Dementia. Anxiety. Hallucinations and other psychosis symptoms. Some of the medications are listed below: Dopamine: People suffering from Parkinson's Disease [PD] have a low level of dopamine in the brain.  People cannot simply take dopamine pills because dopamine does not easily cross the blood-brain barrier, a protective lining of cells inside blood vessels that regulate the transport of oxygen, glucose, medications, and other substances in the brain. There are Dopamine precursors like Levodopa, which can cross the blood-brain barrier and then convert into Dopamine.  Medicines like Levodopa increase the level of dopamine. Levodopa is also called L-dopa. People with PD are given levodopa combined with another substance called carbidopa. When added to levodopa, carbidopa prevents the conversion of levodopa into dopamine before entering the brain. This stops or diminishes the side effects of excess dopamine in the bloodstream, such as nausea. Carbidopa-levodopa is often very successful at reducing or eliminating the tremors and other motor symptoms of PD during the early stages of the disease. Levodopa is almost always effective. If it is not effective, it means the disease is not PD; it may be another disease like Parkinsonism. However, continuous and long-term use of Levodopa leads to side effects, and in turn, it may be less effective in treating PD. A healthcare provider can prescribe Levodopa with other medications to stop the processing of Levodopa before it enters the brain.  This combination helps avoid other side effects of dopamine, especially nausea, vomiting, and low blood pressure when you stand up (orthostatic hypotension). Levodopa can reduce the movement-related symptoms of PD, but it does not replace lost nerve cells or stop its progression. Nerve cells can use levodopa to make dopamine and replenish the brain's reduced supply. People may need to increase their dose of levodopa gradually for maximum benefit. Dopamine Simulators (Dopamine Agonists): Dopamine is a neurotransmitter. The cells act in a certain way when molecules of Dopamine latch on them.   Dopamine Agonists can latch onto cells and activate them in the same way (mimic) as Dopamine does. Mostly, it is given to younger patients to delay the starting of Levodopa. Dopamine Metabolism Blockers: Our body naturally breaks down dopamine. In PD patients, Dopamine falls below the required level. Dopamine metabolism blockers block the breakdown of dopamine, and our body maintains the required level of dopamine. Such medicines are given to younger patients and also given with Levodopa at later stages of PD. Levodopa metabolism inhibitors: Such medicines slow down the breakdown process of levodopa in our body. Therefore, dopamine remains last longer in our bodies. These inhibitors are given with care because they have toxic side effects and may damage the liver. So, such medicines are given when levodopa is less effective. Adenosine blockers: Adenosine is a molecule used in various ways throughout our body. Adenosine blockers block the actions of adenosine on certain cells and have a supportive effect when used with levodopa. Medicines may also be given to impact other brain chemicals like neurotransmitters which transfer the information between the brain cells. Some medicines may be given to control the non-movement symptoms. Some of the medications available in the market are described below:

Medicines:

Carbidopa-levodopa [Rytary, Sinemet, etc.]: Levodopa is the most effective Parkinson's Disease medicine.  It is a natural chemical that passes into the brain and becomes dopamine.  Levodopa is combined with carbidopa to help levodopa reach the brain and to prevent or lessen side effects such as nausea. A reformulated, potentially longer-acting levodopa/carbidopa pill (Crexont) has been approved by the US FDA. The medication contains both immediate-release granules and extended-release pellets. In the United States, carbidopa-levodopa is called Sinemet, which is available as a tablet taken by mouth or a tablet that dissolves on the tongue. Carbidopa-levodopa is available in three different immediate-release dose combinations: 10/100, 25/100, and 25/250 (the first number is the carbidopa dose in milligrams, and the second number is the levodopa dose in milligrams). Three slow-release formulations are available, i.e., controlled-release carbidopa-levodopa tablets (brand name: CR Sinemet) and two separate extended-release carbidopa-levodopa capsules (brand names: Rytary and Crexont). In Canada and Europe, levodopa is combined with benserazide (brand names: Madopar or Prolopa). Dosage: Treatment is usually started with a small dose of the immediate-release tablet two to three times per day with a meal or snack (to minimize nausea, the most common early side effect). The dose is then slowly increased over several days, depending on the person's tolerance, to the lowest dose that controls symptoms. Once levodopa is tolerated, it can be taken on an empty stomach (since protein from food can decrease the absorption of levodopa). Carbidopa-levodopa is usually best taken on an empty stomach if you have advanced Parkinson's disease. However, a doctor (healthcare provider, pulmonologist, etc.) can guide you correctly as per individual health conditions. Don't stop the use of levodopa without the consultation of a neurologist; otherwise, sudden stoppage of levodopa medicines may have serious side effects such as inability to move or breathing difficulties. Side effects:  The most common side effects of levodopa are nausea, restlessness, vomiting, dry mouth, sleepiness, dizziness, and headache. More serious side effects can include confusion, hallucinations, delusions, agitation, and psychosis; these are more common in older people. Side effects can usually be avoided or minimized by starting with a low dose and increasing gradually. Motor complications In many cases, higher and/or long-term (5 to 10 years, but often even longer) use of levodopa is associated with complications called motor fluctuations and dyskinesia. Higher doses or long-term use of levodopa may cause involuntary movements (twisting and writhing), known as dyskinesia, hallucinations, or psychosis.  If this happens, your dose may need to be lessened or adjusted. Motor fluctuations are a group of symptoms that include the "wearing off" effect (when the medication wears off before the next scheduled dose). Dyskinesia consists of abnormal, involuntary movements that cause rapid jerking or slow and extended muscle spasms. At one time, there were concerns that levodopa could potentially speed the breakdown and death of dopamine-producing neurons in the brain. However, current evidence does not support this concern. As a result, most experts continue to recommend levodopa when symptoms compromise the quality of life. Nausea and lightheadedness when you stand up from a lying or sitting position is called orthostatic hypotension (a sudden drop of blood pressure when a PD patient stands up from a lying or sitting position).

Inhaled levodopa (Inbrija): Inhaled levodopa helps to manage the symptoms of PD when oral medicines suddenly stop working during the day.

Dopamine agonists: Unlike Levodopa, Dopamine agonists don't convert into dopamine. Instead, they mimic the dopamine effects in the brain. Dopamine agonists work by directly stimulating dopamine receptors in the brain. It increases the level of dopamine in the brain. Dopamine agonists are effective in controlling the symptoms of Parkinson's disease, however, they are not as effective as Levodopa, but their work lasts longer. Dopamine agonists may be used with Levodopa to increase the duration of effectiveness of Levodopa and reduce the symptoms of PD.  Dopamine agonists may also be used alone or as initial treatment for some people with young-onset Parkinson's disease (symptoms appearing before the age of 50 years). While dopamine agonists may control symptoms in the early stages of the disease, most people with worsening symptoms require levodopa within a few years. Some of the dopamine agonists are listed below: Pramipexole (brand name: Mirapex ER). Ropinirole (brand name: Requip) Bromocriptine. Pergolide. Transdermal  Rotigotine (brand name: Neupro) is given as a patch. Apomorphine is given by injection (brand name: Apokyn). It is a short-acting dopamine agonist shot for quick relief. Dosage:  Oral dopamine agonists (pramipexole, ropinirole) come in immediate-release and extended-release formulations. Immediate-release formulations are generally taken by mouth three times per day, while extended-release formulations are taken by mouth once daily. Apomorphine is available by injection or continuous intravenous infusion. Rotigotine is administered with a once-daily skin patch. Please keep in mind that the dose is always decided by the neurologist or healthcare provider as per the diagnosis, symptoms, and conditions of the patient. Side effects of dopamine agonists:  Such medicines have more side effects than Levodopa; therefore, they are prescribed with care.  In some cases, side effects are so bothersome that the person cannot tolerate them. Starting with a low dose and increasing slowly over several weeks may help to minimize side effects. Such side effects are common at the beginning of the use of medicines. However, they usually resolve over several days. Some more side effects include: Lightheadedness Nausea Sedation Visual hallucinations Confusion Psychosis Sleepiness Nightmares Sudden falling asleep. Drowsiness Vomiting Dry mouth Dizziness A feeling of faintness upon standing. Involuntary movements (Dyskinesia). Low blood pressure after standing up. Edema (swelling, especially in the lower legs and feet, due to excess fluid in body tissues).  Dopamine dysregulation syndrome: A small number of people with Parkinson's disease use excessive amounts of levodopa compulsively. Overuse can lead to mood disorders, such as mania (irrational and elevated mood and energy, unusual thoughts). Impulse control disorders: Treatment with dopamine agonists, even at appropriate doses, increases the risk of impulse control disorders, such as pathologic gambling, compulsive sexual behavior, compulsive shopping, and compulsive eating. Decreasing or discontinuing the dopamine agonist quickly resolves these behaviors in nearly all cases. Lowering the levodopa dose or, if necessary, treatment with antipsychotic medications may also be recommended to control these symptoms. Sleep attacks: The manufacturer of pramipexole has issued a warning that "sleep attacks" can occur suddenly and without warning in people who take the medication, particularly when the dose is greater than 1.5 mg/day. The other dopamine agonists probably carry the same risk. People who drive should be aware of this risk and other factors that can increase drowsiness, such as sleep disorders (insomnia, sleep apnea) and certain other medications (sleeping or anxiety medications).

MAO-B inhibitors: These inhibitors help to block an enzyme called MonoAmine Oxidase-B (MAO-B) that breaks down (inactivates) dopamine in the brain.  MAO-B inhibitors cause dopamine to accumulate in surviving nerve cells and reduce the symptoms of PD. They may also allow dopamine to remain in the brain for a longer period before being broken down. Their benefit is usually small, and some people do not notice any improvement from their use. MAO-B inhibitors can be used to treat "wearing off" in combination with levodopa or other antiparkinson drugs. Selegiline and rasagiline can also be taken alone as initial therapy for patients with mild motor symptoms of Parkinson's disease. Some MAO-B inhibitors are listed below: Selegiline (brand names: Eldepryl, Emsam, Zelapar) - Selegiline (also called deprenyl) can delay the need for levodopa therapy by up to a year or more. When selegiline is given with levodopa, it may keep levodopa from wearing off, which means levodopa will be effective in controlling the symptoms for a long period. It is a well-tolerated medicine. Rasagiline (brand name: Azilect)- It is used to treat the motor symptoms of PD (with or without levodopa). Safinamide (brand name: Xadago). Dosage : Selegiline is usually taken by mouth twice per day (in the morning and at noon to avoid insomnia). Zelapar is a form of selegiline that dissolves on the tongue. Rasagiline and safinamide are taken by mouth once per day. Always keep in mind that the dose is decided by the neurologist or health expert as per the needs of the individual. Side effects: Some of the side effects are listed below: Headaches Heartburn Dry mouth Orthostatic hypotension Dizziness Nausea Nightmares Insomnia/difficulty in falling asleep. Confusion When MAO-B inhibitors are added to carbidopa-levodopa, it increases the risk of hallucinations. Always discuss with the Neurologist about taking any medicines in addition to MOA-B inhibitors. They can interact with many drugs, including Antidepressants, painkillers, Ciprofloxacin, St. John’s wort, and some narcotics. A rare but serious reaction may happen. In older adults with Parkinson's disease, selegiline often causes confusion, which may preclude its use in this group. People who take antidepressants and MAO-B inhibitors at the same time can sometimes develop a condition called serotonin syndrome, which includes severe high blood pressure, fast heart rate, fever, and muscle rigidity, among other symptoms, but fortunately, this complication is extremely rare. Certain nonspecific MAO inhibitors are sometimes used to treat depression and must not be taken with foods that contain tyramine, such as aged cheeses and red wine. However, selegiline, rasagiline, and safinamide are specific MAO inhibitors, which means that they do not require dietary changes or restrictions.

COMT inhibitors: Catechol O Methyl Transferase (COMT) inhibitors help levodopa therapy last longer by blocking an enzyme that breaks down dopamine.  COMT Inhibitors may be used to prolong and enhance the effect of levodopa. They also help to treat the fluctuation in the effect of Levodopa The treatment is primarily used for people with motor fluctuations who have "wearing off" periods at the end of their dose of levodopa.  These medications have no beneficial effect when taken alone. Some of the COMT inhibitors are listed below: Entacapone (brand name: Comtan) Opicapone (brand name: Ongentys) Tolcapone (brand name: Tasmar) Stalevo is a drug that combines entacapone and carbidopa-levodopa in one pill. Dosage: Tolcapone is usually taken by mouth three times per day.  Entacapone is taken with each dose of levodopa, up to eight times per day.  Opicapone is taken once daily. Always keep in mind that the dose is decided by the neurologist or health expert as per the needs of the individual. Side effects: Some of the side effects are listed below: Increased risk of involuntary movements [Dyskinesias] Diarrhea Nausea  Vomiting Dizziness Orange discoloration of urine. Abdominal pain Low blood pressure after standing up. Sleep disturbances Hallucinations Confusion. Tolcapone (Tasmar) is rarely prescribed because, in some cases, it risks serious liver damage and liver failure. However, it is useful for people who do not respond to other therapies. Contrary to this, Entacapone does not cause liver damage.

Anticholinergics: When dopamine levels drop in the brain, Acetylcholine becomes more pronounced. Such medicines block a chemical (neurotransmitter) in the brain named Acetylcholine. An anticholinergic medication may be recommended to reduce symptoms of bothersome tremors in people with Parkinson's disease under age 70 who do not have significant slowness or difficulty walking. Anticholinergics may be given alone or with levodopa or dopamine agonists. Anticholinergics may help control the severe tremor and muscle rigidity in PD, as well as in Parkinsonism. Nowadays, Anticholinergics are not often used due to their modest benefits and risk of various side effects. Generally, such medicines are not recommended for old people due to their severe side effects. Some of the Anticholinergics are listed below: Benztropine mesylate (Cogenitin) Trihexyphenidyl Biperiden HCL Procyclidine Ethopropazine, Orphenadrine These medications are believed to be equally effective, but trihexyphenidyl and benztropine are the most commonly used. Dosage:  Trihexyphenidyl and benztropine are usually taken by mouth two or three times per day. Always keep in mind that the dose and particular medications are always decided by the neurologist or health expert as per the needs of the individual. Side effects: Some of the side effects are listed below: Nausea Rapid heart rate Blurred vision Dry mouth Constipation Difficulty emptying the bladder (Urinary problems) Impaired sweating Delirium Hallucination Memory loss Confusion Sedation

Amantadine (Symmetrel, and Gocovri): Amantadine is an antiviral drug that was originally developed to prevent influenza but was found to improve mild symptoms (tremor, slowness, rigidity) in people with Parkinson's disease. It is available in an immediate-release formulation (brand name: Symmetrel) and an extended-release formulation (brand name: Gocovri). Normally, it is prescribed at the early stages of PD. It may be taken alone for short-term relief of mild and early-stage PD symptoms. However, it is also used with Carbidopa-Levodopa at the advanced stage of Parkinson's disease to help control dyskinesia (involuntary muscle movements or jerky motions). Sometimes, it is also used with Anticholinergic medications. After several months, amantadine's effectiveness wears off in up to half of the people taking it. However, the extended-release formulation (Gocovri) can also improve "wearing off." Dosage: Immediate-release amantadine is usually taken by mouth two to three times per day, while the extended-release is taken once daily. Always keep in mind that the dose and particular medications are always decided by the neurologist or health expert as per the needs of the individual. Side effects: Some of the side effects are listed below: Mottled skin (Livedo Raticuleries) - Abnormal skin changes:  blotchy, purple-colored areas of skin ( usually found on the wrists and legs). Edema - Swelling due to excess fluid retention in the body tissues, it may be in any part of the body, but is usually found on legs, ankles, and feet. Abnormality in thinking and memory. Lack of concentration. Visual hallucinations. Confusion Agitation. Insomnia. Nightmares.

Adenosine receptor antagonists (Adenosine 2A antagonists): It is also called an A2A receptor antagonist.  The Adenosine 2A antagonist Istradefylline (brand name: Nourianz) blocks a transmitter called Adenosine, which boosts dopamine signaling in the brain. It is used as an add-on therapy for patients who have "wearing off" periods.  This medication does not improve Parkinson's disease symptoms when taken alone. It helps prevent the wearing off of dopamine and allows more dopamine to be released. Scientists are trying to find out the benefits of it to treat other symptoms of PD. Dose: Istradefylline is taken orally once daily. Always keep in mind that the dose is always decided by the neurologist or health expert as per the needs of the individual. Side effects : The most common side effects of Istradefylline include dyskinesia, constipation, nausea, hallucinations, insomnia, dizziness, and impulse control disorders. Istradefylline should not be used in patients with severe liver problems.

Treatment by Surgery: When medications are no longer effective in controlling the symptoms of PD, the neurosurgeon may recommend surgery. The following types of surgery may be performed to treat the symptoms of PD: Stereotactic surgery in the thalamus, globus pallidus, and subthalamic nucleus part of the brain: Pallidotomy (lesion surgery) - In this procedure, a specific portion of the brain called the globus pallidus is destroyed.  It is performed by inserting a wire probe into the globus pallidus – a very small region of the brain, measuring about a quarter inch, involved in the control of movement. It can improve tremor, rigidity, and bradykinesia symptoms, possibly by interrupting the connections between the globus pallidus and the striatum or thalamus. It can also improve gait and balance and reduce the amount of levodopa people require, thus reducing drug-induced dyskinesias. Thalamotomy: It uses radiofrequency energy currents to destroy a small but specific portion of the thalamus. Thalamotomy is used mostly for greater benefit in patients with essential tremors rather than Parkinson’s. Because these procedures cause permanent destruction of small amounts of brain tissue, they have largely been replaced by Deep Brain Stimulation (DBS), which is one type of surgery used to treat Parkinson's Disease [PD]. Additionally, a method that uses focused ultrasound from outside the head can now create brain lesions without surgery. Deep Brain Stimulation (DBS): In this type of surgery, Electrodes are surgically implanted within the brain, in the subthalamic nucleus or the globus pallidus. These electrodes are connected to a pacemaker-like small electrical device (pulse generator - battery-packed)  implanted in the chest near the collarbone. When it is turned on, this pulse generator sends painless, controlled electrical pulses to the brain via a wire placed under the skin. It stimulates the brain and blocks the signals that cause many of the motor symptoms of PD. It has a long-term effect to suppress the symptoms of PD. DBS does not stop the progression of PD. However, it may reduce the dyskinesia symptoms (tremors, slow and involuntary movements, and rigid muscles) of Parkinson’s disease [PD]. It usually does not help with speech problems, “freezing,” posture, balance, anxiety, depression, or dementia. DBS is generally useful for people whose PD responds to levodopa and who have developed dyskinesias or other symptoms despite drug therapy.  DBS surgery is approved by the US FDA. Follow-up appointments with the surgeon are needed to adjust the settings and/or replace some parts of the device for the best results. Side effects: Some of the side effects of DBS are listed below: Some people may face complications due to stimulation. It does not keep Parkinson's disease from getting worse. Injury or death of tissue Bleeding in the brain Infection Skin breakage Muscle twitches Depression Speech or vision problems. Pump-delivered therapy: Carbidopa-levodopa infusion (Duopa): The US Food and Drug Administration ( US FDA) approved a pump-delivered therapy called Duopa. The pump delivers a combination of levodopa and carbidopa. To use the pump, your doctor will have to perform a surgical procedure to place the pump near the small intestine. A feeding tube is placed, and this medicine is infused through this tube in a gel form and goes directly into the small intestine.  It is useful in the advanced stages of PD when oral medicines still work, but it is necessary to have a constant level of levodopa. It helps to control motor difficulties and other symptoms like anxiety and depression. Side effects: Some risk is involved in placing the feeding tube. It may come out or cause an infection at the infusion site.

Advanced treatment of Parkinson’s Disease [PD]: MRI-guided Focussed UltraSound (MRgFUS) is a minimally invasive treatment that is used to control the tremors related to Parkinson’s disease. In this procedure, an MRI is guided by ultrasound waves to the brain areas where the tremors start. The ultrasound waves with very high temperatures burn these areas. Side effects: Abnormality in walking and speaking. New involuntary muscle movements (Dyskinesia).

Treatment in the experimental stage: Some of the following treatments are  in the experimental stage and may be available in the future: Stem cell transplant: Dopamine-using neurons will be transplanted into the brain to take over the work of damaged neurons. Neuron-repair treatments: The damaged neurons will be repaired and attempt to form new neurons. Gene therapies and gene-targeted treatments: In this treatment, mutations of genes causing Parkinson’s Disease will be targeted. In another procedure, the effectiveness of levodopa and other treatments will be increased. The following infusion formulations are also under trial: Supernus’s continuous apomorphine infusion (SPN-830) is similar to an insulin pump under the skin. NeuroDerm’s ND0612 provides continuous levodopa/carbidopa infusion through an insulin pump device.  Under the skin, continuous levodopa/carbidopa infusion is given through a pump patch that attaches to the skin. Abbvie’s Foslevodopa/Foscarbidopa (ABBV-951, Produoopa, and Vyalev) for severe motor fluctuations with advanced Parkinson’s disease.  Continuous infusion formulations such as these aim to reduce fluctuations in the levels of dopamine that can occur in people with Parkinson's when the effects of oral medicine wear off and movement becomes stiffer. Note: A vaccine meant to train the body to recognize abnormal forms of the alpha-synuclein protein is under study as well.

Treatment for non-motor symptoms in PD: Always keep in mind that the particular medications and their dosages are always decided by the neurologist or health expert as per the needs of the individual. It varies from one person to another. However, a piece of general information is given here: Depression: Depression is one of the most common mental health problems experienced by people with Parkinson's disease. While the medications used to treat motor symptoms of Parkinson's disease do not help depression, effective medications are needed to treat depression. Although the best medication depends upon the individual's situation, a class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs) is commonly used. Although less often used, tricyclic antidepressants such as nortriptyline are also effective. Sleep disorders: Daytime sleepiness and fatigue are frequent problems in people with Parkinson's disease and are often a result of nighttime sleeping problems such as frequent awakening. Treatment options include improving sleep habits and recognizing and treating problems that disrupt sleep at night (such as difficulty turning or changing position in bed, pain, and frequent urination). The use of a stimulant (such as caffeine or modafinil) to decrease sleepiness during the day may sometimes be helpful. Dementia Difficulties with memory and thinking (dementia) are a common problem for people with Parkinson's disease, especially as the disease progresses and the person ages. A class of medications known as the cholinesterase inhibitors, which were originally developed to treat Alzheimer's disease, may help to improve these symptoms. Examples include Rivastigmine (brand name: Exelon), Donepezil (brand name: Aricept), Galantamine (brand name: Razadyne), and Memantine (brand name: Namenda).  Psychosis and hallucinations The treatment of psychosis and hallucinations in people with Parkinson's disease often includes stopping or decreasing the dose of one or more of the medications used to treat motor symptoms of Parkinson's disease. It is sometimes possible to decrease these doses slightly and thereby improve the symptoms of psychosis and hallucinations with little to no worsening of tremors and other movement problems of Parkinson's disease. If adjusting medications does not improve symptoms adequately, an antipsychotic medication such as Quetiapine (brand name: Seroquel), Clozapine (brand name: Clozaril), or Pimavanserin (brand name: Nuplazid) may be used. However, people who take Clozapine must have frequent blood counts (once per week) due to a rare but potentially serious risk of a decrease in the number of white blood cells. Pimavanserin (Nuplazid): It is used to treat the hallucinations and delusions that can occur due to Parkinson's disease.

Lifestyle changes and home remedies to manage the symptoms of Parkinson’s Disease [PD]: We can not say that lifestyle and home remedies can cure PD. It is yet to be established whether caffeine, antioxidants, and other dietary factors may be beneficial for preventing or treating PD. However, with the help of lifestyle changes and home remedies, symptoms of PD may be managed to some extent.    Some of the lifestyle changes and home remedies are listed below: Healthy eating for PD patients: Parkinson’s Disease is the result of decreased dopamine levels in the brain. With a healthy diet, the level of the hormones may be increased naturally and it may have a significant impact on PD.  Likewise, a nutrient-rich, balanced diet that focuses on specific nutrients may be able to help reduce some symptoms and prevent the progression of the disease. These foods include: A diet with high-fiber food and plenty of liquid is helpful to avoid constipation. Eat a balanced diet rich in nutrients and omega-3 fatty acids.  Antioxidants: Foods high in these substances may help prevent oxidative stress and damage to the brain. Antioxidant-rich foods include nuts, berries, and nightshade vegetables. Fava beans: These lime green beans contain levodopa, the same ingredient used in some Parkinson’s medications. Omega-3s: These heart and brain-healthy fats in salmon, oyster, flaxseed, and some beans may help protect your brain from damage. Avoid dairy products and a high-intake protein-rich diet: Avoid dairy and saturated fat. These food groups may increase your risk for Parkinson’s Disease or speed up its progression. A very high intake of a rich diet may reduce the absorption of Levodopa, which is a main medicine for PD.  Physical activities and exercise: With the consultation of a health care provider, physiotherapist,  and/or neurologist, suitable exercise and physical activities can improve mobility, muscle strength, walking, flexibility, and balance in the body. It may reduce anxiety and depression. Walking, swimming, gardening, yoga, cycling, dancing, water aerobics, and stretching may be helpful. However, taking the recommendation of a healthcare provider and/or physiotherapist is better. It is yet to be established whether high-intensity exercise can slow the progression of PD. If needed and recommended, take the help of a Physical, Occupational, and Speech therapist for gait, tremors, rigidity, mental abnormality, dressing, walking,  cooking, swallowing, and speech problems. Vocal exercises may help improve speech and swallowing. Adequate rest is also good for PD patients.

Complementary and Supportive Therapies: Such therapies with medications help to manage the symptoms like fatigue, depression, and pain. They also improve the quality of life. Some of the such therapies are listed below: Massage: It can reduce muscle tension and provide relaxation. Tai chi: It is traditionally used in China. In this type of exercise, muscle strength, flexibility, and balance are improved with the help of slow and flowing motion techniques. Yoga: In this type of physical activity, gentle stretching of the body is carried in various forms for different body parts. It helps to improve the flexibility and balance of the body. Alexander technique: The main focus of this technique is concentrated on muscle posture, balance, and movement It helps reduce pain and muscle tension. Meditation:  In this method, we remain calm and quiet. We try to focus our minds on an idea or image. By meditation, stress and pain can be reduced.  Relaxation Technique:   It helps to manage blood pressure and heart rate. It improves muscle tone also. Self-hypnosis: It helps us learn to relax through our phrases and suggestions.  Relaxation, breathing, visualization, and suggestions are some of the techniques. Acupuncture: Traditionally used in China. It uses a hypodermic needle to insert the fluid through the skin into acupoints. Along with medications, it is mostly used to treat pain and stress. Coping and support: A person suffering from a chronic disease may feel depressed, angry, and discouraged at times. It may be hard to cope with such problems. PD is also a frustrating disease due to walking, talking, and even eating problems. Depression, hopelessness, and sadness are common problems with PD. If a person is unable to cope with them, meditation is needed as per the guidance of a health care provider. Family and friends' support is also needed to reduce such problems. Social groups, especially for PD  sufferers, help provide relief. Consultation with a psychologist may also be helpful to cope with the stress, etc. Some self-improvement techniques are also helpful: Try to continue your routine work as much as possible. Be positive and focus on the present. Precautions for PD patients: Exercises: Very simple exercises and stretches may help you move around and walk more safely. However, some precautions needed to be taken, including: Walk carefully. Pace yourself — try not to move too quickly. Let your heel hit the floor first. Check your posture and stand up straight. This will help you shuffle less. Precautions to avoid falling: Do not walk backward. Try to not carry things while walking. Try to avoid leaning and reaching. To turn around, make a U-turn. Do not pivot on your feet. Remove all tripping hazards in your house, such as loose rugs. Precautions while getting dressed: Allow yourself plenty of time to get ready. Avoid rushing. Select clothes that are easy to put on and take off. Try using items with Velcro instead of buttons. Try wearing pants and skirts with elastic waistbands. These may be easier than buttons and zippers. The following tips help improve balance and gait: Do not move too quickly. When walking, put down your heel first. During the walk, don't put your head down; look forward. The following tips help prevent falls: Do not rush to work. At a time do one work, not many. Use a handrail if available. Sleep with the night light on. Avoid any path that may disturb your balance. For movement, use a walker or cane if recommended. If you start shuffling, stop and take help. Try to stand straight.

What is the wearing-on and wearing-off condition of PD? The “On” period means the period after taking the medication. During the ‘on’ period, a patient may move with relative ease, reduced tremor, and reduced stiffness.  The benefit from levodopa may lessen over time. It also may wax and wane. These episodes are called ‘wearing off’, and such uncontrolled writhing movements are called Dyskinesias. The ‘Off’ period occurs just before taking the next dose of medication. During the ‘off’ period, the patient has more difficulties in controlling their movements. In the long run, the PD patient may notice more pronounced symptoms before their first dose of medication in the morning and between doses as the period of effectiveness after each dose begins to shorten. People may experience sudden, unpredictable “off periods” where the medications do not seem to be working. Taking levodopa more often and in smaller amounts can help with this.

Is there a cure for Parkinson’s? There’s currently no cure for Parkinson’s disease. It is chronic and worsens over time.

Parkinson’s prognosis: Complications from PD can greatly reduce the quality of life and prognosis. Individuals with PD can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal. Proper treatment improves your prognosis and increases life expectancy. It may not be possible to slow the progression of Parkinson’s, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.

What is the life expectancy of PD patients: Parkinson’s disease is not fatal. However, in some cases, Parkinson ’s-related complications can shorten the lifespan of people diagnosed with the disease. The difference in the life expectancy of  PD-affected people and people without PD may be negligible.

Summary of the blog:

General Summary: PD  is not curable and is a permanent, lifelong, and degenerative brain condition. Parkinson’s is a progressive disease, which means symptoms of the condition typically worsen over time. However, this condition usually takes a long time to get worse. Parkinson’s disease isn’t contagious, and you can’t contract it from another person. It is not fatal also.

Causes Summary: Why it happens is still unknown, but in some cases, it is inherited. Though this disease is usually age-related, it can rarely happen in adults of age 20 due to heredity or a family history of PD.  Environmental Exposure to pesticides is considered a risk factor for PD. In rare cases,  exposure to toxic substances like manganese metal during welding work and MMTP (an illicit drug) are also considered risk factors for Parkinsonian symptoms. Most people with PD have lost 60% to 80% or more of their dopamine-producing cells. We can say that when the level of dopamine in the brain is reduced by 60 to 80%, the symptoms of PD can start to appear. PD causes major changes in brain chemistry. Basal Ganglia, a specific part of the brain, deteriorates in the PD.

Symptoms summary: Tremors (trembling in the hands, arms, legs, and jaw), rigidity (stiffness of the limbs),  slowed movement, and impaired balance and coordination are the main symptoms of PD. It mainly affects muscle control, balance, movement, senses, thinking ability, and mental health. Over time, more severe symptoms can appear. PD affects different people in different ways. The rate of progression and the particular symptoms differ among individuals. PD symptoms typically begin on one side of the body. However, the disease eventually affects both sides, although symptoms are often less severe on one side than on the other. Its symptoms develop gradually and worsen over time. As the PD progresses, people have difficulty walking and talking. In extreme conditions, people may not be able to talk and eat. PD increases a person’s risk for potentially life-threatening complications, including falls, blood clots, lung infections, and blockages in the lungs. These complications can cause severe health issues. They can even be fatal.

Diagnosis summary: Diagnosis is made based on health history, a physical and neurological exam, as well as a review of signs and symptoms. Imaging tests, such as a CAT scan or MRI, may be used to rule out other conditions. A Dopamine Transporter (DAT) scan may also be used. These tests do not confirm PD, but they can help rule out other conditions and support the doctor’s diagnosis. An alpha-synuclein test can confirm the presence of PD. A neurologist (a healthcare expert) can diagnose PD  or rule out other conditions with the help of some examinations, procedures, and biological marker tests before the motor symptoms.

Treatment summary: In most cases, medication for Parkinson's disease is recommended once the symptoms are severe enough to interfere with the quality of life. All decisions regarding the use of antiparkinson medications should be made jointly by the patient, caregivers, family, and healthcare provider. Currently, no treatment has been proven to slow, stop, or change the progression of Parkinson's disease. However, medications for Parkinson's disease are usually effective in controlling the symptoms of the disease. In almost all cases, medication will be required to control the various physical and mental health symptoms linked with PD. Different treatment options are available to control the symptoms of PD. Medications or surgery can manage the symptoms of Parkinson’s Disease [PD]. Levodopa, dopamine agonists, or monoamine oxidase type B (MAO-B) inhibitors can be used initially for patients who require treatment for symptoms of Parkinson's disease. Among these agents, levodopa is the most effective for motor symptoms. The decision of initial treatment should be individualized based on symptoms, diagnosis, health conditions, and recommendation of a neurologist. Levodopa is the first-line medication for Parkinson’s disease. It is absorbed by the brain’s nerve cells and converted to dopamine. The drug transmits messages that control movement and helps patients manage difficulties with walking, movement, and tremors. Levodopa is the main effective treatment of PD.  However, a healthcare provider can prescribe it with other medications to enhance the effectiveness of Levodopa and reduce the symptoms and side effects of treatment. There are several formulations of levodopa. In all forms, it is combined in various concentrations with another compound (carbidopa or benserazide) to improve the efficacy of levodopa and reduce side effects such as nausea. Carbidopa alone has no benefit for Parkinson's disease symptoms. About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa. Carbidopa delays the breakdown of levodopa before it enters the brain and increases the level of dopamine. Levodopa is usually taken three times per day, and the dose may be slowly increased over time, depending upon the patient's response.  Dopamine agonists can imitate the action of dopamine in the brain. They’re less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective. Dopamine agonist medications include pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), rotigotine (brand name: Neupro), and apomorphine (brand name: Apokyn). Other Parkinson's disease medications may be taken together with a dopamine agonist, if necessary.  MAO-B inhibitors inhibit the enzyme monoamine oxidase B. This enzyme breaks down dopamine in the brain. Selegiline (brand names: Eldepryl, Emsam, Zelapar) and rasagiline (brand name: Azilect) are MAO-B inhibitors that may help to relieve mild symptoms of Parkinson's disease in some people with early Parkinson's disease.   Catechol O-methyltransferase (COMT) inhibitors prolong the effect of levodopa. The catechol-O-methyl transferase (COMT) inhibitors tolcapone (brand name: Tasmar), entacapone (brand name: Comtan), and opicapone (brand name- Ongentys) plus the MAO-B inhibitors selegiline (brand names -Eldepryl, Emsam, Zelapar), rasagiline (brand name- Azilect), and safinamide (brand name- Nourianz), and extended-release amantadine (brand name: Gocovri) can all be used to relieve symptoms of "wearing off" in Parkinson disease. Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity. Anticholinergic drugs are usually reserved for younger patients in whom tremor is the predominant problem. Amantadine (Symmetrel) can be used along with carbidopa-levodopa. It’s a glutamate-blocking drug (NMDA). It offers short-term relief for the involuntary movements (dyskinesia) that can be a side effect of levodopa. Amantadine or extended-release amantadine (brand name: Gocovri) may be used to reduce dyskinesia in people with Parkinson's disease.  Effective medications are available to treat specific non-motor symptoms seen in people with Parkinson's disease.  Most of the time, medicines work very well and control the symptoms When oral medicines do not work suddenly during the day, Inhaled Levodopa or Dopamine Agonist (Apomorphine (Apokyn) shot may be recommended for quick relief. Over time, Parkinson’s medications can be less effective. By late-stage PD, the side effects of some medications may outweigh the benefits. However, they may still provide adequate management of symptoms. When medicines are no longer helpful, a neurologist may recommend surgery. Treatment by Surgical interventions is an option for people who do not respond to medication, therapy, and lifestyle changes. In Deep Brain Stimulation (DBS), Electrodes are surgically implanted in specific parts of the brain. A generator connected to the electrodes sends out pulses to the electrodes connected with wire under the skin to help reduce symptoms. DBS (Deep Brain Stimulation) surgery is safer than Pallidotomy and Thalamotomy. Ultrasound therapy is used when Deep Brain Stimulation  (DBS) surgery doesn’t work. Currently, there’s no treatment for Parkinson’s disease dementia. Instead, a doctor will focus on treating other symptoms. Sometimes, medications used for other types of dementia can be helpful. A neurologist or a healthcare provider may also recommend aerobic exercise, physical therapy for balancing and stretching, and speech therapy. Yoga uses targeted muscle movement to build muscle, increase mobility, and improve flexibility. People with Parkinson’s may notice that yoga even helps manage tremors in some affected limbs. More research is needed to improve the positive effects of medications and DBS to suppress the symptoms of PD.

Treatment under trial to slow the progression of Parkinson’s Disease (PD): The researchers are trying to find a treatment that could help slow the progression of Parkinson's disease. These are called neuroprotective or disease-modifying therapies. The idea is based upon the concept that dopamine-producing neurons could be protected from early death and depletion of dopamine. However, so far, no treatment has been proven to be neuroprotective. Many treatments have been studied, including monoamine oxidase type B (MAO-B) inhibitors, dopamine agonists, coenzyme Q10, and vitamin E. However, there is not enough evidence to indicate that these treatments are effective, and they are not currently recommended to slow the progression of Parkinson's disease. Clinical trials are still going on to find out the remedy.

An overdose of Levodopa may be toxic and lead to severe side effects. Medications used to treat PD may cause the development of the sleeping disorder, Obsessive-Compulsive Disorder [OCD], Hallucinations, or Delusions in some people.

PD  is not fatal on its own. But it can lead to other conditions that are sometimes fatal. Most people normally have a normal life span with proper treatment. Generally, PD doesn’t affect our life expectancy. It may be very few years less or on par with people without PD.

General data summary: PD generally starts after 50 years of age or around 60 years. It may occur before 40 years of age in around 4% of cases. White people are more prone to PD than black or Asian people. Geographical regions may be one reason for higher risk.   Only 15 percent of people with Parkinson’s Disease have a family history of PD. Genetic forms of Parkinson’s disease are rare, accounting for about 10% to 15% of cases. More than 90 gene variants associated with Parkinson’s Disease have been identified so far. Some studies suggest that PD affects more men than women, though the reason is not yet clear. It is the most common motor (movement-related) brain disease and ranks second among age-related degenerative brain diseases. It is estimated that PD affects at least 1% of people over age 60 worldwide.

USA data for PD: It is estimated that around 1 million people in the US have Parkinson’s disease. Moreover, around 90,000 new diagnoses for PD are made each year. It may be even more since Parkinson’s Disease is often misdiagnosed.  Around 90% of people with PD in the US are insured by Medicare; however, around 40% have not seen a neurologist, and only around 9% have visited movement disorder specialists, as per 2019 data.

Disclaimer: The best efforts are made to provide authentic and updated basic information on Parkinson's Disease. This blog is prepared from the data compiled from various websites including those mentioned in the blog. The information given in this blog is only for educational purposes, it is not intended to serve as medical advice and can not replace the medical advice in any form. Anyone seeking specific neurosurgical advice, medication, or assistance should consult a health care provider, neurosurgeon, or neurologist. Always keep in mind that the particular medications and their dosages are always decided by the neurologist or health expert as per the needs of the individual. It varies from one person to another. I am not a health professional, and this blog is not AI-generated, instead, it is manually written. Therefore  I do not take any responsibility (legal or otherwise) for its typographical error, correctness, completeness, consequences, etc. Before following anything from this blog, it is strongly requested to consult a specialist, doctor, neurologist, or healthcare provider. https://www.mayoclinic.org https://www.nia.nih.gov https://my.clevelandclinic.org https://www.aans.org https://www.healthdirect.gov.au https://www.nhs.uk https://www.ninds.nih.gov https://www.healthline.com https://www.medcentral.com https://www.michaeljfox.org https://www.uptodate.com

Parkinson’s disease is not curable and not fatal. It is possible to manage, control, and delay the progress and more severe symptoms of the disease. We may live life in a better way with the help of treatment. == Best of luck== ==The end==