Beyond the Tremor: A Deep Dive into Parkinson's Disease

by Dr. Sreekanta Swamy, Lead Senior Consultant - Neurology, Aster RV Hospital

One of the most prevalent neurodegenerative diseases worldwide is still referred to as 'Parkinson's disease'. The condition is named after James Parkinson who, in 1817, described the shaking palsy (paralysis agitans). According to a 2019 burden of disease study, India has an estimated 7,71,000 Parkinson's patients with an annual fatality of 45,300. The disease is marked by symptoms like tremors of hands, difficulties in maintaining body balance and movement, along with sleep disorder, pain and other mental health issues. Nearly 10 million people are living with Parkinson’s disease in the world. It is expected to increase many fold by 2040 as the number of elderly population increases. It is seen commonly around the age of 60 yrs, even though small percentage of patients are diagnosed in young age, as the age advances the number of affected people also increase till around 85 years of age.

Every year on April 11 world Parkinson’s day is observed to create awareness, and educate people about this disorder. It is important to educate people because this is the second most rapidly increasing neurodegenerative, progressive brain disease all over the world. It results in progressive disability in the affected person and puts a huge economic burden on the family and society.

Parkinson disease is a brain disorder, seen in elderly population. It is grouped under the umbrella of neurological disorders called movement disorder, because it mainly affects the nerve cells in the brain which produces hormone called dopamine that controls the movements of our body.

Age is the single most risk factor to develop Parkinson’s disease; many other factors like exposure to pesticides and other chemicals, environmental pollution are also implicated. Males are affected twice than females. Small percentage can be hereditary.

The disease may go unnoticed for a few years before the actual diagnosis can be done, as it usually evolves slowly and progresses slowly. Usually, the symptoms occur when nearly more than 50% of dopamine secretion is reduced. Sometimes few symptoms start many years before the actual symptoms of Parkinson’s disease starts; example-patient may have chronic constipation, disorder of smell and sleep abnormalities.

Parkinson's disease manifests in various symptoms, often beginning with tremors in the hands, particularly at rest, although tremors in the lips and toes may also occur. Rigidity or stiffness in the body is common, making movement challenging and requiring extra effort. Bradykinesia, or slowness of movement, is another hallmark symptom, affecting not only physical actions but sometimes also cognitive processes and response times, which can mistakenly be attributed to aging. Additionally, individuals with Parkinson's may experience difficulty maintaining balance or postural instability, leading to problems with walking and an increased risk of falls. These symptoms collectively contribute to the progressive nature of Parkinson's disease, highlighting the importance of early detection and intervention in managing the condition effectively.

All these symptoms slowly progress, many other symptoms may add up over time, like forgetfulness, low volume speech, difficulty speaking, behavioral changes, abnormal sleep pattern; change is the walking style, stooped posture etc.

Diagnosis is mainly by clinical examination of patient, Sometimes DAT scan, MRI scan may help. Many other disorders of the brain can mimic like Parkinson’s disease which needs to be identified.

As far as the treatment is concerned, even though this disease is described more than 200 years ago, so far there is no permanent cure. Whatever treatments are available will help to control the symptoms and try to give quality life to the patient. Both drug treatment and surgical treatments are available. The main drug is Levodopa; there are many other drugs available. In the initial few years drugs work well, with less side effects, but over years there benefit becomes less and less and side effects may limit their usage,

Surgical management in the form of Deep Brain Stimulation (DBS) is available for patients who don’t get significant benefit by drugs or develops abnormal movements called dyskinesia and other side effects will benefit from surgical management

Other modalities of management include regular physical exercises, balanced diet, lifestyle management many help along with medications. Family support care giver’s role is most important managing patient’s daily activities. Many self-help groups are available to help the patient and the family