World Parkinson’s Day is observed on 11th April every year. Parkinsonism is a neurodegenerative disease mainly affecting the motor system. This spectrum includes Parkinson’s disease (PD), Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Dementia of Lewy body and Corticobasal Degeneration (CBD). Parkinson’s Disease is common and affects more than seven million patients worldwide. It is mainly seen in elderly individuals, after 60 years.

“The exact cause of Parkinson’s disease is not known but exposure to toxins, infections, certain drugs, metabolic derangements and brain lesions can lead to this disease. There is an abnormal and excessive accumulation of alpha-synuclein protein in the substantia nigra pars compacta of basal ganglion. This leads to disruption of the major motor and oculomotor circuits of the brain,” says Dr Rima Khanna, Consultant, Neurology, Fortis Shalimar Bagh.

The features of PD is bradykinesia (slowness in activities of daily living), rigidity, tremors and postural instability. As the disease progresses, the typical motor symptoms become a concern. Dr Rima gives some inputs on the condition.

Early Signs of Parkinson’s Disease 
• Chronic constipation. Reduced gastric motility
• Shoulder pain and frozen shoulder
• Anosmia (reduction in the power of smell)
• Sleep dysfunction (insomnia, patients enact the dreams and may injure the bed partners)
• Psychomotor Slowing (increased response time, reduced attentiveness, forgetting things)
• Change in handwriting (smaller letter size)
• Mood Changes (anxiety, depression)
• Change in voice (low and soft voice)
• Reduction in associated movements (while walking the arm swing decreases)
• Hypomimia (expressionless face, reduced blink rate, drooling of saliva)
• Tremors (rest tremors are typical of PD)

Diagnosis  of Parkinson’s Disease
PD is diagnosed by detailed medical history and thorough neurological examination. Neuroimaging preferably MRI brain is required for evaluation. DaTSCAN which detects the metabolic activity of dopamine transmitters in basal ganglion is used to assist in the evaluation of Parkinsonism.

How to reduce the risk of Parkinson’s Disease
Regular exercise, consumption of caffeinated drink, antioxidants and anti-inflammatory drugs may have some protective effect against this disease. But there is no conclusive evidence for the same.

Management of Parkinson’s Disease
It is a neurodegenerative disease thus no cure is available but with drugs and surgery, the disabling motor symptoms can be ameliorated leading to better quality of life. The basket of drugs available includes MAO inhibitors, COMT inhibitors, dopamine agonist and levodopa. As the disease progresses, the oral medication becomes less effective and the patient may require surgery (deep brain stimulation), continuous apomorphine infusion and enteral dopa pumps to control symptoms.