Parkinsons Disease

About Parkinsons Disease

Parkinsons disease is a progressive neurodegenerative disorder primarily affecting dopamine producing neurons in the substantia nigra. It affects millions of people worldwide, with WHO estimating more than 8.5 million in 2019, and incidence increases with age. Dr James Parkinson first described the disease in his 1817 Essay on the Shaking Palsy. The cardinal motor symptoms are resting tremor typically 4 to 6 Hz, asymmetric onset, bradykinesia slowness of movement, rigidity stiffness, and postural instability later in the disease course. Non motor symptoms are equally debilitating and include loss of smell anosmia often preceding motor symptoms by years, constipation, REM sleep behavior disorder, depression, anxiety, cognitive impairment progressing to dementia in late stages, and autonomic dysfunction orthostatic hypotension, urinary urgency. Diagnosis is clinical, based on history and neurological examination. Response to levodopa supports the diagnosis. Treatment focuses on symptom management. Levodopa combined with carbidopa Sinemet remains the most effective medication. Other medications include dopamine agonists pramipexole, ropinirole, MAO B inhibitors selegiline, rasagiline, and COMT inhibitors entacapone. Deep brain stimulation DBS of the subthalamic nucleus or globus pallidus helps selected patients with motor fluctuations. No treatment has been proven to slow disease progression.