Parkinsonism is an umbrella term that refers to brain conditions that cause slowed movements, rigidity (stiffness) and tremors. These conditions can happen for many reasons, including genetic mutations, reactions to medications and infections.
SYMPTOMS OF PARKINSONISM: -
The key symptoms of parkinsonism are:
- Slowed movements (bradykinesia).
- Stiffness or rigidity.
- This symptom always happens with parkinsonism.
- Other possible symptoms include:
- Unstable posture or walking gait.
- Flexed, hunched or stooped posture.
- Freezing (being unable to move when trying to walk).
- Condition-specific parkinsonian symptoms
Certain symptoms are more likely with a few conditions involving parkinsonism. Those conditions and the symptoms include:
Parkinson’s disease: In addition to motor (movement-related) symptoms, this condition tends to involve several non-motor symptoms also. Many of these affect the unconscious processes of your body. Examples of this include constipation, loss of sense of smell and sleep problems.
Vascular parkinsonism: This condition tends to cause early balance and walking problems. It can also cause trouble speaking (dysarthria) and swallowing (dysphagia). People with this also tend to have an unusual reflex when the bottom of their foot is touched a certain way (known as Babinski’s sign, this causes their toes to extend and fan out rather than curl).
Drug-induced parkinsonism: People with this tend to have parkinsonism-type symptoms equally on both sides of their body. With Parkinson’s disease, the effects usually are worse on one side.
Toxin-induced parkinsonism: People with this have more severe "cogwheel rigidity," which is a jerky pattern to their movements (similar to the second hand of a clock). Their muscles also are tense, causing slowed movements and trouble walking backward.
Juvenile parkinsonism: Experts usually suspect this type of parkinsonism once they rule out other causes because it is rare for this condition to happen to those under age 45.
CAUSES OF THE CONDITION: -
The causes of parkinsonism depend on the specific subtype of the condition.
PARKINSON’S DISEASE: -
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells (neurons) communicate with each other. When you have Parkinson’s disease, you don’t have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements. The neurons that fine-tune your movements need dopamine. Without it, they can't do their job correctly. That’s why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson's disease.
With lack of dopamine, the basal ganglia (a key area of your brain) start to deteriorate. As they do, you lose the abilities they once controlled. As Parkinson's disease gets worse, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
GENETIC PARKINSON’S DISEASE: -
The only confirmed causes of Parkinson's disease are genetic mutations that you inherit from your parents. Genetic Parkinson's disease accounts for about 10% of all cases.
IDIOPATHIC PARKINSON’S DISEASE: -
When Parkinson’s disease isn’t genetic, experts classify it as “idiopathic” (this term comes from Greek and means “a disease of its own”). That means they don’t know exactly why it happens.
Experts suspect Parkinson’s disease happens because of a problem with how your body uses a certain protein, α-synuclein (alpha sy-nu-clee-in). Proteins are chemical molecules that have a very specific shape. When some proteins don’t have the correct shape — a problem known as protein misfolding — your body can’t use them and can't break them down.
With nowhere to go, the proteins build up in various places or in certain cells, like the dopamine-using cells that control movement. Tangles of these proteins are visible when looking at these cells under a microscope.
Secondary parkinsonism: - Secondary parkinsonism means this condition is happening because of another medical condition. Examples of secondary parkinsonism include:
Vascular parkinsonism: This form of parkinsonism happens when you don’t have enough blood flow to certain areas of the brain. That causes damage to the affected parts of your brain, leading to parkinsonian symptoms.
Post-traumatic parkinsonism: This kind of parkinsonism happens because of brain damage from repeated head injuries. It’s especially common in high-contact sports like boxing, football and hockey.
Drug-induced parkinsonism: These kinds of parkinsonism can happen when a drug (either prescription or recreational) interferes with how your body creates or uses dopamine.
Toxin-induced parkinsonism: This happens because toxic substances can destroy very specific types of brain cells. When those specific brain cells are dopamine-sensitive neurons in the basal ganglia, it can lead to parkinsonism symptoms.
Normal-pressure hydrocephalus: Normal-pressure hydrocephalus (NPH) is when you have too much cerebrospinal fluid (CSF) inside your skull, which puts pressure on parts of your brain areas responsible for walking and controlling your bladder. It can happen because of injuries, bleeding in your brain, tumors, and many other reasons. The condition is named NPH because when you have this, a spinal tap (lumbar puncture) will show normal pressure levels even though imaging tests may show large pockets of spinal fluid in your brain.
Postencephalitic parkinsonism: Encephalitis is an inflammation of your brain that can happen when you have an infection. It can happen after you have an infection that causes encephalitis. This kind of parkinsonism is less common in developed countries.
Atypical parkinsonism : These are unusual or rare conditions that cause parkinsonism. These include:
- Progressive supranuclear palsy.
- Corticobasal degeneration.
- Multiple system atrophy.
Other types of dementia or inherited conditions
Other kinds of degenerative brain diseases and genetic conditions can also cause parkinsonism. Some examples include:
- Alzheimer’s disease.
- Huntington’s disease.
- Wilson’s disease.
Parkinsonism isn't contagious. Some of the things that because it is genetic, so you can inherit them from your parents or pass them to your children.
SYMPTOMS IN GENERAL: -
A person with Parkinsonism usually starts developing symptoms at anywhere from age 50 to 80, according to the University of Texas Southwestern Medical Center.
Parkinson’s disease can cause varying and progressive symptoms throughout its course. Some of the most common symptoms associated with the disease include:
Difficulty showing facial expressions.
slowed, affected movements
tremor, especially of one hand
A person with Parkinsonism may have some, but not all, of the symptoms listed above. This is because they also have an additional disorder that affects the brain’s functioning.
For example, people with Parkinsonism often do not have the hand tremor that affects many people with Parkinson’s disease.
Other symptoms associated with Parkinsonism include:
Dementia issues with the autonomic nervous system, such as problems with controlled movements or spasms early problems with balance rapid onset and progression of symptoms.
Each underlying cause of Parkinsonism, such as dementia with Lewy bodies, also has its own unique set of symptoms.
RISK FACTORS: -
Risk factors for Parkinson's disease include:
Age: - Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. If a young person does have Parkinson's disease, genetic counseling might be helpful in making family planning decisions. Work, social situations and medication side effects are also different from those of an older person with Parkinson's disease and require special considerations.
Heredity: - Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
Sex: - Men are more likely to develop Parkinson's disease than women. Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson's disease.
Parkinson's disease is often accompanied by these additional problems, which may be treatable:
Thinking difficulties: You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't usually helped by medications.
Depression and emotional changes: You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease.
You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Health care providers may give you medication to treat these symptoms.
Swallowing problems: You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.
Chewing and eating problems: Late-stage Parkinson's disease affects the muscles in the mouth, making chewing difficult. This can lead to choking and poor nutrition.
Sleep problems and sleep disorders: People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.
People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may improve your sleep.
Bladder problems: Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty in urinating.
Constipation: Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract.
YOU MAY ALSO EXPERIENCE:
Blood pressure changes: You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension).
Smell dysfunction: You may experience problems with your sense of smell. You may have difficulty identifying certain odors or the difference between odors.
Fatigue: Many people with Parkinson's disease lose energy and experience fatigue, especially later in the day. The cause isn't always known.
Pain: Some people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies.
Sexual dysfunction: Some people with Parkinson's disease notice a decrease in sexual desire or performance.
Because the cause of Parkinson's is unknown, there are no proven ways to prevent the disease.
Some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease.
Some other research has shown that people who consume caffeine — which is found in coffee, tea and cola — get Parkinson's disease less often than those who don't drink it. Green tea is also related to a reduced risk of developing Parkinson's disease. However, it is still not known whether caffeine protects against getting Parkinson's or is related in some other way. Currently there is not enough evidence to suggest that drinking caffeinated beverages protects against Parkinson's.
Parkinson's disease is a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves. Symptoms start slowly. The first symptom may be a barely noticeable tremor in just one hand. Tremors are common, but the disorder may also cause stiffness or slowing of movement.
In the early stages of Parkinson's disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson's disease symptoms worsen as your condition progresses over time.
Although Parkinson's disease can't be cured, medications might significantly improve your symptoms. Occasionally, your health care provider may suggest surgery to regulate certain regions of your brain and improve your symptoms.
TYPES OF PARKINSONISM: -
There are 3 main forms of parkinsonism, as well as other related conditions.
Most people with parkinsonism have idiopathic Parkinson’s, also known as Parkinson’s. Idiopathic means the cause is unknown. The most common symptoms of idiopathic Parkinson’s are tremor, rigidity and slowness of movement.
Vascular parkinsonism (also known as arteriosclerotic parkinsonism) affects people with restricted blood supply to the brain. Sometimes people who have had a mild stroke may develop this form of parkinsonism. Common symptoms include problems with memory, sleep, mood and movement. Drug-induced parkinsonismSome drugs can cause parkinsonism. Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders), which block the action of the chemical dopamine in the brain, are thought to be the biggest cause of drug-induced parkinsonism. The symptoms of drug-induced parkinsonism tend to stay the same – only in rare cases do they progress in the way that Parkinson’s symptoms do.Drug-induced parkinsonism only affects a small number of people, and most will recover within months – and often within days or weeks – of stopping the drug that’s causing it.
NEUROPATHOLOGY OF PARKINSON’S DISEASE: -
Macroscopically, the brain in idiopathic PD is often unremarkable with mild atrophy of the frontal cortex and ventricular dilation in some cases. The main distinctive morphological change in the PD brain is observed in transverse sections of the brainstem, where almost all cases present with loss of the darkly pigmented area in the substantia nigra pars compacta (SNpc) and locus coeruleus. This pigmentation loss directly correlates with the death of dopaminergic (DA) neuromelanin-containing neurons in the SNpc and noradrenergic neurons in the locus coeruleus. Cell death in the SNpc is mostly restricted to a specific group of neuromelanin-containing dopaminergic neurons, namely the A9 neurons, while other neuronal and glial cell types are largely spared.
Quantitative morphometric studies in postmortem PD brains have calculated approximately 30% loss of DA neurons in the SNpc by motor symptom onset, adjusting for age. After the motor symptoms appear, nigral DA neuron loss increases up to 60% or higher and strongly correlates with the severity of motor features and disease duration. The result of this remarkable cell loss is the denervation of the nigrostriatal pathway, leading to diminished dopamine levels in the striatum. The reduction of dopaminergic signaling is considered responsible for the appearance of the cardinal motor symptoms in PD. Recent work has shown that nerve cell death in the SNpc is preceded by the loss of axon terminals projecting to the striatum. Mechanistically, the early neuron and axon terminal loss observed in PD suggests a substantial preclinical stage that predates the onset of symptoms by several years.
Apart from the SNpc, widespread cell loss can be found in several subcortical nuclei, including the locus coereleus, the nucleus basalis of Meynert, the dorsal motor nucleus of the vagus nerve, the pedunculopontine nucleus, the raphe nuclei, and also the hypothalamus and the olfactory bulb. Multiple non-dopaminergic neurotransmitter systems are affected, such as the cholinergic, adenosinergic, glutamatergic, GABAergic, noradrenergic, serotonergic, and histaminergic. Degeneration in those systems is thought to account for some of the non-motor symptoms of PD that do not respond well to dopamine replacement therapies. However, the precise pathological mechanisms underlying the non-motor symptoms in PD are still relatively unclear.
LEWY BODY PATHOLOGY: -
Microscopically, the pathological hallmark of PD is the presence of abnormal cytoplasmic deposits within neuronal cell bodies which are immunoreactive for the protein α-synuclein. These pathological protein aggregates are called Lewy bodies (LBs) and are often accompanied by dystrophic neurites (Lewy neurites), which are mostly axonal.
Diagnosing parkinsonism relies heavily on a doctor examining your symptoms, asking you questions and reviewing your medical history.
TESTS FOR PARKINSON'S: -
When healthcare providers suspect a condition that falls under parkinsonism, various imaging and diagnostic tests are possible. These include:
- Blood tests (these can help look for other forms of parkinsonism).
- Computerized tomography (CT) scan.
- Genetic testing.
- Magnetic resonance imaging (MRI).
- Positron emission tomography (PET) scan.
PARKINSONISM AND ITS HOMOEOPATHIC ASPECTS: -
Definition: - The syndrome characterized by tremor, poverty of movement, slurring speech and akinesia due to damage of Substantia Nigra/Basal Ganglia.
- Idiopathic : Paralytic Agitans.
- Genetic disorders : Huntington's chorea.
- Infections: Viral exposure.
- Drugs: Neurotoxic drugs.
CLINICAL FEATURES: -
- Age group -Elderly/old.
- Patients initially presents with tremors.
- Gradually fine tremors changes to coarse tremors.
- There's profuse sweating due to Hypercatacholamine release.
- There is slurring of speech,Low voluaemic,ill distinct speech.
- Poverty of movement finally with akinesia.
- The disease clinically presents mostly at the time of sitting or leaving the chair or getting out of bed.
- There may be relaxation of sphincteric activity and is presenting with sphincter atonicity like seminal emissions, urination, Involuntary defaecation.
- Rattling of writing.
- Pin rolling movement.
- Walking as if patient is finding his own centre of gravity.
- Fastinate gait.
- Correction of fluid/electrolyte balance to control different ions.
- High calorie diet.
- Counselling for calmness and quiet mental state.
- Direct supply of Dopamine.
- Indicated Homoeopathic remedy is the best clinical recovery.
HOMOEOPATHIC REMEDIES FOR TACKLING PARKINSONISM: -
1) Argentum nitricum:- For ataxia(loss of muscle co-ordination), trembling, awkwardness.
2) Causticum:- For the restless legs.
3) Cuprum:- For muscle cramps.
4) Merc.vivus:- For easing Parkinsons that is worse at night and for the panic attacks.
5) Zinc.met:- For restlessness and depression.