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Hypokinetic Movement Disorders

 

Parkinson's Disease

Parkinson’s disease (PD) affects about 1 percent of people over the age of 60, and over 1 million people in the United States. Parkinson's disease usually begins above the age of 40, but younger patients can be affected. PD generally presents slowly, and progresses slowly over years. Patients often have one or several of the following signs:

Diagnosis of Parkinson’s Disease

PD can only be diagnosed by the information the patient provides and the findings on physical examination. There is no test available that can diagnose PD, although your physician may recommend tests to rule out disorders that might look like PD. Because there are many different symptoms that can be associated with PD, not everyone with this condition suffers from the same problems.

Early PD is often very difficult to diagnose and is best managed by a movement disorder specialist in order to treat the symptoms that are most important to the person with PD. Many signs and symptoms remain mild and treatable for many years.

Treatment of Parkinson’s Disease

Although there is no cure for Parkinson's disease at present, there are medications that can provide relief from many of the symptoms. PD results from a lack of the neurotransmitter dopamine in the brain. Most medications used to treat the disease either mimic the effect of dopamine, increase dopamine levels, or extend the action of dopamine in the brain.

Over time, it can become difficult to control PD symptoms due to disease progression and medication side effects. Common problem symptoms include dyskinesias (involuntary movements) and variability in responsiveness to medication over the day. For some of these patients, who are in otherwise good health, deep brain stimulation or other surgical therapies may be considered.

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Parkinsonism/Parkinson-Plus Syndromes

Parkinsonism is a description that is used when a patient has any combination of the following features:

There are many causes of Parkinsonism, but Parkinson’s disease is the most common cause. Other “mimickers” of Parkinson’s disease are described below. In general, these syndromes are less responsive to PD medications:

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Cortical Basal Ganglionic Degeneration (CBGD)

CBGD is a rare parkinsonian disorder. Patients may have stiffness or rigidity on one side of the body, as well as dystonia. In addition, patients may have speech problems due to apraxia. Some patients complain of an arm or leg that seems to move of its own volition. This is known as an “alien limb” phenomenon.

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Drug-induced Parkinsonism

Drug-induced Parkinsonism may look exactly like PD, except that patients are usually on a medication that causes the PD-like symptoms. Antipsychotic drugs and drugs commonly used to treat nausea are the most frequent causes. In general, the Parkinsonian symptoms improve after discontinuation of the offending medication.

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Lewy Body Disease or Dementia with Lewy Bodies (DLB)

After Alzheimer’s disease, dementia with lewy bodies is the second most common cause of neurodegenerative dementia. Most commonly, patients have visual hallucinations, fluctuating cognition and Parkinsonism. Other symptoms include repeated falls, fainting spells, delusions, sleep disorders and depression. While many patients with PD can eventually develop dementia, we diagnose DLB clinically when dementia occurs at the same time -- or before -- the development of Parkinsonian signs. When patients have PD for a long time and then develop dementia, they are classified as having Parkinson’s disease dementia (PDD).

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Multiple System Atrophy (MSA)

Multiple System Atrophy (MSA) is a progressive disorder affecting multiple structures within the nervous system, causing symptoms of Parkinsonism, ataxia (incoordination, speech changes, spasticity, weakness) and/or autonomic problems (erectile dysfunction, urinary problems, dizziness when standing up). MSA is an umbrella term that includes the following disorders:

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Progressive Supranuclear Palsy (PSP)

Progressive supranuclear palsy (PSP) is a degenerative disorder with motor symptoms similar to PD, but patients generally have difficulty walking and frequent falls early in the course of the disease. The hallmark of the disease is an inability to move the eyes down and up. Speech and swallowing problems are common, and some people with PSP may also think slowly and have trouble keeping their eyelids open. PSP is also known as Steele-Richardson-Olszewski syndrome.There is no cure for PSP, and there is no known way to stop the progression of the disorder. The goal of treatment is to minimize the complications associated with disease progression and improve the patient’s overall quality of life.

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