Parkinsonian Disease

– The information has been reviewed by Dr. Ma Hon Ming

Parkinsonian disease is a progressive brain disorder caused by the degeneration of nerve cells in an area of the brain known as substantia nigra. This results in insufficient production of dopamine, which affects the ability of the brain to regulate body movement and leads to a loss of muscle control. Symptoms may include tremors in the limbs, slowed movement or impaired balance due to rigid muscles, and poor coordination of facial muscles that causes a loss of facial expression and speech problems. Most cases of Parkinsonian disease are idiopathic and the cause remains unknown, though several factors such as age and family history seem to play a role. While the average age of onset is over 60, around 10% of patients experience early-onset Parkinson’s disease before the age of 40. Other conditions or circumstances may also increase the risk of Parkinsonian disease, such as head injury, long-term use of anti-emetics (medications that combat nausea and vomiting), metal poisoning, tumors, encephalitis and stroke.

Early Treatment of Parkinsonian Disease

The brain is not only responsible for controlling our thoughts, but also for managing body movement. Brain diseases, therefore, should be treated as early as possible so as to prevent deterioration and consequently, major impacts on daily life. As a degenerative condition, Parkinson’s disease is not curable but treatable by medications in order to maintain mobility. There are three main groups of medications, namely levodopa, dopamine agonists and monoamine oxidase-B inhibitors. If symptoms are too severe to be managed by medications, a new form of minimally invasive surgery known as deep-brain stimulation may be considered. During the surgery, the surgeon implants electrodes in targeted areas of the brain through a few small holes made in the skull. These electrodes are connected by wires to a generator implanted in the patient’s shoulder or chest, which creates electrical pulses to stimulate areas of the brain and thereby improve the patients’ mobility. This surgery has been performed overseas for many years and numerous studies have been conducted to prove its effectiveness. However, as it involves the implantation of a device, patients may require some time to recover from the surgery and get used to living with a device in the body. Similar to a pacemaker, the battery of the generator needs to be replaced at regular interval.

Progression of Parkinsonian Disease

Parkinsonian disease is not an acute disease and deteriorates gradually. As it progresses, symptoms may extend from one side of the body to another, which may affect the patients’ ability to walk, and even cause a loss of balance that may trigger a fall. Many patients end up taking smaller steps in order to keep their balance. As the disease deteriorates, patients may experience involuntary movements even if they are taking medications, and may suffer from complete loss of mobility, speech problems and swallowing difficulties when the medications wear off. Depending on the rate of deterioration, Parkinsonian disease can progress from worsening of symptoms to complete loss of mobility over a period of five years in case of rapid progression, or over 10 years or more for slow-progressing cases.

Other Conditions Caused by Symptoms of Parkinsonian Disease

While Parkinsonian disease is not fatal, it weakens the patients’ ability to walk and swallow, which can lead to serious falls or aspiration pneumonia caused by food or other material entering the lungs. To avoid accidents, patients and their families should remain attentive to details regarding daily care and activities.

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