LISTSERV 16.0 - PARKINSN Archives

Health and Age
August 3, 2003
The Complications and Management of Parkinson's Disease

Source: European Federation of Neurological Associations (EFNA)
July 30, 2003

The European Federation of Neurological Associations has published a booklet that is intended to help people who may
have neurological symptoms and conditions, as well as anybody who is interested. Here’s a second extract that discusses
some aspects of living with Parkinson’s disease. Robert Griffith, Medical Editor.

Parkinson's disease - What problems might arise?

Trembling (tremor) is the most common symptom. It may only affect one limb or a part of it. Tremor is present at rest;
it decreases with activity, increases with emotional stress and disappears during sleep.

Stiffness (rigidity) of the limbs. This makes the affected limbs feel heavy and clumsy.

Poor posture and balance. A person with Parkinson's disease tends to stoop forwards with knees and elbows slightly
bent. If the disease affects one side of the body more than the other, the person may lean over, causing loss of
balance. As a result the person may walk with small, rapid, shuffling steps.

Facial muscles may not move as much, resulting in a staring or somber appearance. The frequency of eye blinking is
reduced. Handwriting may become very small (micrographia). The person's voice may gradually become muted and perhaps
hoarser. Speech becomes fainter and may be unintelligible. In the later stages, swallowing may be affected. There may
be considerable tiredness, and people with Parkinson's disease often become depressed. Depression responds to
medication. Most people have normal intellectual function, though there may be minor memory problems after several
years of treatment.

What is the outlook?

Parkinson's disease is not itself fatal. Most people with this condition can expect to be independent or moderately
independent for many years after diagnosis. Much depends on the individual's response to medication and the experience
of their doctor in treating Parkinson's disease.

Parkinson's disease is unpredictable. There may be 'good days and bad days', and, later on, minutes or hours when the
response to medication is 'on' or 'off'. 'Freezing' is a term applied to sudden inability to move; this is only
temporary, and there are various measures that can be taken to counteract it. Dementia develops in up to 20% of people
in the later stages of the disease.

What treatment / therapy is available?

Many drugs are available to treat Parkinson's disease and new ones are constantly being introduced. Drugs are given
that replace or mimic the action of the nerve signal transmitting substance (dopamine) that is lacking in Parkinson's
disease. Some of these drugs have side-effects, notably hallucinations and involuntary movements (dyskinesia), and it
may take some time to find the best combination of medication for each individual. As the disease progresses, some
drugs become less effective and are then replaced or supplemented by others.

Physiotherapy and daily physical exercise, such as sports and yoga, play an extremely important role in maintaining
mobility and correcting posture. A speech therapist can suggest techniques to overcome problems in communicating.

Surgical techniques have also been used to treat people with Parkinson's disease whose symptoms do not respond well to
medication and who are judged suitable for surgery. Severe tremor or rigidity that does not respond to medication may
be improved by surgery to particular areas of the brain; electrical stimulation of these areas has also been found
beneficial in some cases.

Transplantation of tissue from early human embryos into the diseased part of the brain has been performed in some
specialised institutions. This technique is ethically controversial and its effects have not been fully evaluated.
Efforts are being made to use animal-derived tissue or substances (trophic factors) to regenerate the cells that
produce dopamine.

Source
European Federation of Neurological Associations (EFNA).
Common Neurological Symptoms and Conditions: a guide for non-professionals.
Published by The DARE Foundation, 23 Vine Street, Brighton BN1 4 AG, UK.
Pdf version available at:
http://www.efna.net/docs/pdf/common_text.pdf