Parkinson’s Disease – Pharmaceutical and Physical Therapies

Neuroscience and Neurology CategoryMuscle control, movement, and balance of the body and mind are affected by a progressive disorder of the central nervous system, Parkinson’s disease. The result of this imbalance is a lack of harmony and fine-tuning of movement and contractions of inflexible muscles and joints. In Parkinson’s, the substantia-nigra cells, responsible for dopamine release, are destroyed or malfunction. This roots a large loss in the amount of available dopamine to keep balance with the acetylcholine. The results are symptoms of tremor, stiff muscles and joints, posture instability, slowed movements, depression, vertigo, sleeping disorder, sexual inability, difficulty in swallowing, and speech pathologies. Though there is no method to entirely stop the loss of these nerve cells, there are interventions that attempt to manage a slow decline of these cells as a treatment option, commonly medication and physical therapy.

Symptoms of Disease

Developed Parkinson’s has typical symptoms and signs that are displayed in most patients. However, it is difficult to diagnose Parkinson’s at its initial stages because the symptoms are considered insignificant. Neuroimaging tests (e.g. MR) may be done to confirm such a diagnosis.

Perceptible symptoms:

  • Tremors: shaking in hands especially when they are at rest
  • Slow movement: trouble to start any heavy muscular work
  • Inflexible limbs: stiffness, weakness, aching, muscle tenseness
  • Deprived stability and coordination: difficulty with walking
  • Urinary problems and constipation
  • Difficulty in sleeping
  • Problems of too oily or too dry skin
  • Giddiness and problems with speech

While medical professionals do not have an accurate blood or imaging test/scan approved by the FDA to diagnose Parkinson’s disease, Parkinson’s specialist performs diagnosis based on an evaluation of prominent symptoms usually presented in a progressed stage. The development of the disease varies in individuals; therefore their symptoms can vary significantly according to their particulars of sleep and the daily stress-levels. After diagnosis, therapies can help manage symptoms, improve function, and sustain a higher quality of life.

Pharmaceutical Interventions

Sinemet (carbidopa/levodopa) is the only medicine that controls the symptoms of Parkinson’s by replacing dopamine. Most patients can use it to control their disease for several years. Doctors prefer to initially prescribe a low dosage because the body eventually reacts less to the treatment and high-doses have severe side-effects. It is absorbed in your blood and transported to your brain. Foods rich in protein often include substances that compete with Sinemet for entry in the brain. Doctors suggest maintaining body weight and having appropriate level of protein in your diet with your medication.

Permax acts as a substitute for the action of dopamine and reduces the likelihood for dyskinesias, or impairment of voluntary movements resulting in fragmented or jerky motions.

Symmetrel (amantadine hydrochloride), Artane (trihexyphenidyl HCl), and Cogentin (benztropine mesylate) promotes nerve cells to released stored dopamine and is useful in cases of earlier stages of Parkinson’s disease.

Physical Therapies

It is important in the treatment of Parkinson’s disease to continue normal muscle tone. To maximize the benefits of medication, daily exercises and activities are often optimal therapies.

Basic exercises:

  • Bring the toes up with every step.
  • While walking or turning, widen your legs by 10 inches to prevent falling.
  • Practice walking and turning daily at least for 15 minutes.
  • Practice quick side tracks of the body to ensure good body balance.
  • While walking, swing the arms freely to reduce the fatigue.
  • Carry a bag with weight to decrease the bend having on one side.
  • Practice a difficult work repeatedly every day and it will be easier after some days.
  • Raise your arms and stretch as possible as you can towards the sky.
  • Practice singing, reading and making faces in front of mirror.
  • Practice chewing hard and move the food around the mouth.

Proper sleep (quality, duration, and patterns) can also be helpful to diminish the symptoms of Parkinson’s. Tremors in Parkinson’s disease readily disappear after sleep.

The accurate and early diagnosis of Parkinson’s disease is essential for proper management, however, misdiagnosis is a very common problem faced by most patients. Though the biomedical community has not mapped the neuropathogenesis of Parkinson’s to specific pathways, research is in progress and additional therapies are being investigates. The progression of Parkinson’s disease presents intra-patient discrepancies; therefore, treatment must be individualized. In all, basic physical therapies and educational and support resources aid patients and augment the positive effects of anti-Parkinson’s medication.

By: Rakhi Garg
Editor: Shaheen Lakhan

Shaheen E Lakhan, MD, PhD, MEd, MS, FAAN

Shaheen E Lakhan, MD, PhD, MEd, MS, FAAN, is a board-certified neurologist and pain specialist, medical educator, and scientist. He is the executive director of the Global Neuroscience Initiative Foundation (GNIF). He is a published scholar in biomarkers, biotechnology, education technology, and neurology. He serves on the editorial board of several scholarly publications and has been honored by the U.S. President and Congress.
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