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Shaking Palsy

more about Shaking Palsy

Parkinson's disease or Paralysis Agitans

  • Parkinson's diseases (PD) are a slow progressive condition that affects a group of cells in an area of the brain called the substania nigra.  These cells produce a brain chemical known as dopamine that, along with another brain chemical known as acetylcholine, control and regulate normal muscle movements and coordination.  As PD progresses and dopamine levels decrease, symptoms develop.

  • Mask-like face with no expression.
  • Decreased blinking
  • Tremors -- involuntary trembling affecting any part of the body, i.e., neck, hands, fingers, arms, etc.  Tremors are often on one side of the body, they improve with sleep and activity, and can be stopped if the patient concentrates. Tremors may get worse with stressors, such as anger.
  • Limb stiffness (rigidity) -- the arms and legs may be difficult to move or bend, as though in a lead pipe or a cogwheel.
  • Slowed movements (bradykinesia)
  • Small, cramped handwriting (micrographia)
  • Freezing sensation
  • Dragging the foot
  • Gait is affected -- small steps taken, and the legs are wide apart.
  • Balance problems develop
  • Posture -- often leaning forward
  • Difficulty getting up from chair
  • Difficulty turning
  • Constipation
  • Weight loss
  • Speech is often low-volume and clipped.
  • Swallowing difficulty
  • Dandruff or oily skin
  • Depression -- two out of three patients are depressed
  • Anxiety
  • Memory problems and Dementia

  • Idiopathic (unknown)
  • Virus infections or genetic causes are being investigated.
  • Medications such as Reglan or Haldol, and some pesticides can decrease dopamine levels and mimic the symptoms of PD but do not cause it.

  • Males slightly higher than females
  • Age >60 but can occur as early as 20-30

  • There is no special blood test or scan for diagnosis of PD while the patient is alive.
  • The brain of a patient after death can be examined and may show lesions called Lewy bodies.
  • History and clinical exam
  • Doctor may consult with a neurologist (brain and nerve specialist)
  • A neurological and medical exam can rule out other diseases and is the first step in diagnosis.
  • CAT scan, MRI, and PET scans are all special brain scans that can be of help in ruling out other causes.

  • Supportive care:
    1. Understanding the disease and its limitations.
    2. Make home comfortable for the patient-special devices such as chairs, eating utensils and toilet seats, and railings in bathtubs can help.
    3. Assistants and caregivers can aid in eating, dressing, shopping, driving, etc.
    4. Caregivers can also be stressed and overworked.
    5. Physical therapy, occupational therapy, and speech therapist may be recommended by the doctor.
    6. There may be a need for dietary evaluation to make sure the patient is drinking or eating adequately.
    7. If there is weight loss, supplements or tube feeding (tube placed in the stomach) can be considered.
    8. Medications can reduce symptoms and improve function.
    9. Medications either replace dopamine, prevent its destruction, stimulate its release, or offset the effects of the acetylcholine system.
  • Medications can be taken in combination or alone and include:
    1. Selegiline or Eldepryl
    2. Sinemet
    3. Tolcapone
    4. Cogentin
    5. Artane
    6. Numerous others
    7. Some recommend Vitamin E and other antioxidants (need further studies).
    8. Nicotine and caffeine may have beneficial effects.  Further research is needed.
  • Neuro-surgery, brain surgery:
    1. Used in severe cases
    2. Associated with great risk
    3. Adrenal medullary transplantation of fetal tissue (from fetus) and genetically- engineered cells are still experimental.
    4. Pallidotomy and thalamotomy can be used to improve movements.
    5. Deep brain stimulation acts as a pacemaker for the brain and helps control abnormal movements in PD.

  • Be hopeful -- great advances have been made in last several years.  Work with your doctor and neurologist.  Be patient with yourself and your caregivers.

more about Shaking Palsy

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