Parkinson’s disease is a chronic, progressive neurodegenerative disorder characterized by tremors, rigidity, bradykinesia, and postural instability, caused by the loss of dopamine-producing neurons in the substantia nigra.
Mnemonic: "P.A.R.K. = Progressive Akinesia, Rigidity, Kinetic
Tremor"
CAUSES & RISK FACTORS
- Idiopathic (Unknown Cause – Most Common).
- Genetic (HLA-DR2, HLA-DR3 – Rare, Except in Early-Onset Cases).
- Environmental Toxins (Pesticides, MPTP – Drug-Induced Parkinsonism).
- Head Trauma (Repeated Concussions – Seen in Boxers).
- Age > 60 Years (Strongest Risk Factor).
- Less Common in Smokers & Coffee Drinkers.
Mnemonic: "I.G.E.H.A. = Idiopathic, Genetic, Environmental,
Head Trauma, Age"
PATHOLOGY OF PARKINSON’S DISEASE
- Loss of Dopaminergic Neurons in Substantia Nigra.
- Presence of Lewy Bodies (Abnormal Protein Aggregates in Neurons).
- Decreased Dopamine Levels in Basal Ganglia.
- Increased Activity of Subthalamic Nucleus (Leads to Bradykinesia).
Mnemonic: "L.L.D.S. = Lewy Bodies, Loss of Dopamine,
Subthalamic Hyperactivity"
SYMPTOMS OF PARKINSON’S DISEASE
(TRAP)
- Tremor (Resting Tremor – "Pill-Rolling")
- Rigidity (Lead-Pipe & Cogwheel Stiffness)
- Akinesia/Bradykinesia (Slow Movements, Masked Face, Micrographia – Small Handwriting)
- Postural Instability (Frequent Falls, Stooped Posture, Shuffling Gait)
Mnemonic: "T.R.A.P. = Tremor, Rigidity, Akinesia, Postural
Instability"
OTHER CLINICAL FEATURES
- Facial Symptoms → Masked Face (Hypomimia), Reduced Blinking.
- Speech Issues → Soft, Monotonous Speech (Dysarthria).
- Autonomic Dysfunction → Constipation, Orthostatic Hypotension, Sweating.
- Neuropsychiatric Symptoms → Depression, Dementia (Late-Stage).
- Glabellar Tap Sign → Persistent Blinking with Forehead Tapping.
Mnemonic: "F.S.A.N.G. = Face, Speech, Autonomic, Neuro,
Glabellar Tap"
DIAGNOSIS OF PARKINSON’S DISEASE
- Clinical Diagnosis (No Specific Test).
- MRI/CT Brain (To Exclude Other Causes – Stroke, Tumors).
- Dopamine Transporter Scan (DaTSCAN) – Confirms Dopamine Deficiency.
- Response to Levodopa (Good Response Suggests PD).
Mnemonic: "C.M.D.R. = Clinical, MRI, DaTSCAN, Response to
Levodopa"
TREATMENT OF PARKINSON’S DISEASE
1. MEDICAL MANAGEMENT
- Levodopa + Carbidopa (Most Effective – Converts to Dopamine in Brain).
- Dopamine Agonists (Bromocriptine, Pramipexole – Mimics Dopamine Action).
- MAO-B Inhibitors (Selegiline, Rasagiline – Prevents Dopamine Breakdown).
- COMT Inhibitors (Entacapone – Prolongs Levodopa’s Effect).
- Anticholinergics (Trihexyphenidyl – Controls Tremors in Young Patients).
- Amantadine (For Mild Symptoms, Reduces Dyskinesia).
Mnemonic: "L.D.M.C.A.A. = Levodopa, Dopamine Agonists, MAO-B
Inhibitors, COMT Inhibitors, Anticholinergics, Amantadine"
2. SURGICAL MANAGEMENT
- Deep Brain Stimulation (DBS) – For Advanced PD, Stimulates Subthalamic Nucleus.
- Pallidotomy/Thalamotomy – Rarely Done, Used for Severe Tremors.
Mnemonic: "D.P.T. = Deep Brain Stimulation, Pallidotomy,
Thalamotomy"
3. SUPPORTIVE MANAGEMENT
- Physiotherapy – Improves Balance, Prevents Falls.
- Speech Therapy – Helps with Soft Speech.
- Occupational Therapy – Improves Daily Activities.
Mnemonic: "P.S.O. = Physiotherapy, Speech Therapy,
Occupational Therapy"
HOMOEOPATHIC MANAGEMENT OF
PARKINSON’S DISEASE
For Tremors & Rigidity:
Rhus Tox, Agaricus, Causticum, Zincum Met.
For Bradykinesia & Gait Problems:
Gelsemium, Plumbum Met, Conium.
For Neuropsychiatric Symptoms:
Hyoscyamus, Belladonna, Nux Vomica.
Mnemonic: "R.A.C.Z. = Rhus Tox, Agaricus, Causticum, Zincum
for Tremors"
FINAL REVISION WITH MNEMONICS
- Definition = "P.A.R.K. = Progressive Akinesia, Rigidity, Kinetic Tremor"
- Causes = "I.G.E.H.A." (Idiopathic, Genetic, Environmental, Head Trauma, Age)
- Pathology = "L.L.D.S." (Lewy Bodies, Loss of Dopamine, Subthalamic Hyperactivity)
- Symptoms = "T.R.A.P." (Tremor, Rigidity, Akinesia, Postural Instability)
- Other Features = "F.S.A.N.G." (Face, Speech, Autonomic, Neuro, Glabellar Tap)
- Diagnosis = "C.M.D.R." (Clinical, MRI, DaTSCAN, Response to Levodopa)
- Medical = "L.D.M.C.A.A." (Levodopa, Dopamine Agonists, MAO-B Inhibitors, COMT Inhibitors, Anticholinergics, Amantadine)
- Surgery = "D.P.T." (Deep Brain Stimulation, Pallidotomy, Thalamotomy)
- Supportive = "P.S.O." (Physiotherapy, Speech Therapy, Occupational Therapy)
- Homeopathy = "R.A.C.Z." (Rhus Tox, Agaricus, Causticum, Zincum for Tremors)
Frequently Asked Questions: Parkinson's Disease
1. What is Parkinson's Disease?
Parkinson's Disease is a long-term and worsening condition of the nervous system. It happens because of the loss of nerve cells in a specific part of the brain called the substantia nigra. These cells are responsible for producing a chemical called dopamine, which plays a crucial role in controlling movement. As these cells die, the lack of dopamine leads to the development of Parkinson's symptoms.
2. What are the potential causes of Parkinson's Disease?
Parkinson's Disease can arise from several factors. In most cases (idiopathic or primary Parkinson's), the exact cause is unknown, but it's often linked to the natural degeneration that occurs with age. However, in some instances (secondary or symptomatic Parkinson's), it can be triggered by other conditions such as head injuries, brain inflammation (encephalitis), the use of certain drugs (like antipsychotics), or exposure to toxins (such as MPTP). Although rare, genetic factors and specific gene mutations have also been identified as potential contributors.
3. What are the main motor symptoms associated with Parkinson's Disease?
The primary motor symptoms of Parkinson's Disease are collectively known as TRAP:
- Tremor: This typically presents as a resting tremor, often described as a "pill-rolling" motion of the hands.
- Rigidity: Muscles become stiff and inflexible. This can manifest as either "cogwheel rigidity" (jerky resistance to movement) or "lead-pipe rigidity" (sustained resistance).
- Akinesia/Bradykinesia: This refers to slowness of movement and difficulty initiating movement. Everyday tasks can become time-consuming and challenging.
- Postural Instability: Problems with balance and coordination can lead to an increased risk of falls.
4. Besides movement difficulties, what other symptoms might individuals with Parkinson's experience?
Parkinson's Disease is not solely a motor disorder. Many individuals also experience non-motor symptoms, which can significantly impact their quality of life. These include mood disorders like depression, sleep disturbances, and problems with the autonomic nervous system, such as constipation and orthostatic hypotension (a drop in blood pressure upon standing). In the later stages of the disease, some individuals may also develop cognitive impairment, including dementia.
5. How is Parkinson's Disease typically diagnosed?
Currently, there is no definitive test for Parkinson's Disease. Diagnosis is primarily based on a neurologist's clinical assessment of the individual's symptoms. Doctors will look for the characteristic motor signs like tremor, rigidity, bradykinesia, and postural instability. While not typically used for initial diagnosis, supportive tests such as Magnetic Resonance Imaging (MRI) may be conducted to rule out other neurological conditions. A DaTscan, which measures the level of dopamine transporters in the brain, can also provide supportive evidence.
6. What are the common approaches to managing Parkinson's Disease?
The management of Parkinson's Disease focuses on alleviating symptoms and improving quality of life. This typically involves a combination of strategies. Pharmacological treatment often includes Levodopa-Carbidopa, which is considered the gold standard for replacing dopamine. Other medications like dopamine agonists, MAO-B inhibitors, and COMT inhibitors can also be used. Non-pharmacological therapies, such as physiotherapy, occupational therapy, and speech therapy, play a crucial role in maintaining mobility, independence, and communication skills. In cases where medication is no longer adequately controlling symptoms, surgical interventions like Deep Brain Stimulation (DBS) may be considered.
7. Are there any complementary or alternative approaches mentioned for Parkinson's Disease?
The source briefly mentions a homeopathic approach to Parkinson's Disease, listing remedies such as Agaricus muscarius, Hyoscyamus, Gelsemium, and Causticum. It emphasises the importance of individualised treatment based on the specific symptoms presented by the patient and the principle of symptom similarity in homeopathy.
8. What key aspects of psoriasis are highlighted in the source?
The source also provides a brief overview of psoriasis, defining it as a chronic inflammatory skin condition characterised by well-defined red patches (erythematous plaques) covered with silvery scales. It mentions different types of psoriasis, including plaque, guttate, inverse, pustular, and erythrodermic. Key clinical features noted are the common locations of lesions (scalp, elbows, knees, sacral region), the Auspitz sign (pinpoint bleeding upon scale removal), and the Koebner phenomenon (development of lesions at sites of skin trauma). Management strategies include topical treatments like corticosteroids and Vitamin D analogues, systemic medications such as methotrexate and cyclosporine, and biological therapies like TNF inhibitors. Homeopathic medicines like Arsenic Album, Graphites, and Sulphur are also mentioned in the context of psoriasis management.