Parkinson’s disease is a degenerative disease of the brain manifested by resting tremor, rigidity, slowness of movement, and postural instability. The disease usually begins in middle age although it can begin in younger people and also in the elderly. It usually begins as a problem controlling one hand or one side, sometimes associated with resting tremor. The diagnosis can only be made by physical examination and by history since there is no "test" for Parkinson’s disease.
When studies are done for Parkinson’s disease, they are done to exclude other conditions that might mimic Parkinson’s disease. This would include such things as strokes, tumors, or effects of certain medications such as Reglan or Manganese.
Once the diagnosis is made, treatment is usually with medications. The mainstay of treating Parkinson’s disease is Sinemet which is a combination of L-Dopa and an enzyme (dopa decarboxylase). L-Dopa replaces dopamine, the missing chemical in the brain. There are other medications that work in combination with L-Dopa to increase the effectiveness of it. Of these, dopamine agonists such as Eldepryl, Parlodel, Requip, and Mirapex are most commonly used. Also, other medications which sometimes are beneficial include Comtan and Tasmar. Some of the older medications such as Artane and Cogentin are now used primarily for the treatment of tremor.
There is some disagreement as to which medication should be used first. Some studies suggest that Eldepryl might be beneficial when used first. However, many neurologists, including me, feel that L-Dopa is the primary medication in the treatment of Parkinson’s disease and should be used when treatment is necessary. There are surgical treatments of Parkinson’s disease including fetal cell transplantation and various ablation procedures (freezing of specific brain tissue) and also some stimulators. These surgical procedures are of benefit to a very select group of patients.
The prognosis in Parkinson’s disease varies widely. Many patients respond quite well to treatment and live long and active lives. There are a number of conditions that can be associated with Parkinson’s disease, so called "Parkinson’s Plus syndrome" which include orthostatic hypotension (drop in blood pressure when a person stands), dementia, and many other associated abnormalities involving the nervous system. These Parkinson’s Plus syndromes tend to be more progressive, more severe, and less responsive to treatment.
As mentioned earlier, the diagnosis of Parkinson’s disease can only be made by a physician after doing a history and neurological examination. There is no specific "test" for this. There are many conditions that may look similar to Parkinson’s disease, most notably a heredofamilial or essential tremor. Medical examination is necessary to differentiate these conditions from Parkinson’s disease.
