Parkinson’s disease or paralysis agitans is a chronic, degenerative neurological disorder that affects one in 100 people over age 60. The motor symptoms of this disease result from the death of dopaminergic neurons in the substantia nigra, located in a region called the mesencephalon or the midbrain.

The cause of this cell death is not well understood. Research points to genetic and environmental factors. This cell death causes the levels of dopamine to drop. Dopamine is a neurotransmitter responsible for sending chemical messages in the brain. The early and the most obvious symptoms are movement-related. These signs/symptoms include resting tremors, stooped posture, rigidity, slowness of movement and difficulty walking as well as impaired balance and coordination. As the disease progresses, disturbance of thought, speech, difficulty swallowing and behavioral problems may arise.

Dementia is commonly seen in the advanced stages of the disease. Depression is the most common psychiatric symptom. Typically, symptoms begin on one side of the body and migrate over time to the other side. The presence of Lewy bodies is the hallmark of Parkinson’s disease.

Do I have Parkinson’s disease?

This is a question best answered by a neurologist preferably with experience with movement disorders. The most important step you can take is to see a neurologist who will perform a thorough medical history and neurological examination. CT and MRI of patients with Parkinson’s disease usually appear normal. There are no definitive tests for Parkinson’s disease.

Dopaminergic function in the basal ganglia can be measured with a PET scan using Ioflupane (DaTSCAN).

There are multiple drugs used to treat Parkinson’s disease. They include the dopamine replacement therapies such as Levodopa/Carbidopa (Sinemet). This drug is highly effective for the treatment of the motor symptoms of the disease however it does not slow the progression of the disease.

Other medications utilized include the dopamine agonists (Pramipexole, Ropinerole, and Bromocriptine). These medications mimic the effect of dopamine on the brain. Dopamine agonists can be used alone or in combination with Levodopa/Carbidopa. These medications have not been shown to slow the progression of the disease.

MAO-inhibitors (Selegiline and Rasagilene). MAO- inhibitors inhibit an enzyme that breaks down Levodopa. These drugs may be used alone or in combination with Levodopa/Carbidopa.

COMT-inhibitors (Entacapone, Tolcapone). Catechol O-methyltransferase (COMT) inhibitors allow a larger amount of Levodopa to reach the brain. This raises the dopamine levels. These medications can be used in conjunction with Levodopa/Carbidopa.

Exercise can also be helpful to those who suffer from Parkinson’s disease. Exercise has been shown to maintain and improve mobility, flexibility, strength, and improve gait. This in turn can improve the quality of life for those who have this disease. For instance, riding a stationary bike. A study was performed at the Cleveland Clinic by Dr. Jay Alberts. It demonstrated “Aerobic fitness can be improved in PD patients following both voluntary and forced interventions. However, only forced exercise results in significant improvements in motor function and bimanual dexterity.” Another non-pharmacological approach is Tai-Chi.

There is plenty of support available for this disease. There are many famous people who are afflicted with this disease. Michael J. Fox (actor), Muhammad Ali (former boxer), and Janet Reno (former Attorney General of the US). Please visit,, and

Please remember, the key to success in treatment is early diagnosis.

If you suspect you or a loved one has this disease, please visit your doctor as soon as possible.

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