PD is a movement disorder where dopamine-producing brain cells die off in a particular area of the brain. Dopamine is responsible for the fluidity of movements. Typical symptoms of PD are resting tremors, gait disturbances where the patient has a classic shuffling gait, stooped forward, decreased arm swing, decreased turning, slowness (where they are having difficulty turning in bed, getting out of bed, getting out of a chair), and masked faces (where the patient lose the normal expression that people have using their faces). The symptoms are very slowly progressing, occurring over years.
The diagnosis of PD is based on the clinical symptoms and physical examination; there is no specific test to confirm it. However, some testing is done such as MRI and metabolic work up to rule out other disorders that can mimic PD.
It is also important to differentiate PD from Parkinson plus syndromes. These syndromes can in addition to the typical PD symptoms present with other symptoms such as dementia as in Lewy Body Dementia or autonomic dysfunction (dizziness or orthostatic hypotension) as in multisystem atrophy. Other rare Parkinson plus syndromes also exist.
The treatment of PD is not a cure; however, there are medications, which can help improve the symptoms, function and the quality of life. These medications include dopamine agonists (Mirapex and Requip), carbidopa-levedopa (Sinemet) and also Azilect. These medications typically improve the symptoms and the functionality of the patient; however, it is a delicate balance because certain medications have significant side effects that can be worse than the disease itself.
Other modalities include physical and occupational therapy that improve the patient’s quality of life and activity of daily living. We identify and treat sleep disorders (common in patients with PD). Patient’s family education, is essential in copping with the disease. If symptoms become very severe or patients become resistant to medication, deep brain stimulation implant, done by a local neurosurgeon is considered too. We provide the programing and follow-up for those patients.