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About Parkinson's Disease
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The following is a list of questions to ask your doctor About Parkinson's Disease  as well as tips for preparing for these conversations.

What is Parkinson's disease?

Parkinson's disease (PD) is a degenerative brain disorder caused by a steady decline in the cells that produce the brain chemical dopamine. This loss of dopamine leads to poor communication between nerve cells that control movement. Symptoms include tremors with varying degrees of muscle rigidity and sluggish or involuntary movements. Symptoms usually appear in the 60s or 70s, but can affect younger adults as well. Although the exact cause is unknown, PD is thought to be due to a combination of genetic and environmental factors, including toxins, drugs and brain trauma.

How you can prepare for this discussion

  • Gather all medical records, including hospitalizations, surgical procedures and laboratory test results
  • List all current and past medical conditions
  • List current and past prescriptions, over-the-counter medications and dietary supplements
  • List all illicit drug use
  • Note any history of head trauma
  • Ask family members about their health history, specifically neurologic diseases

What are the symptoms of Parkinson's disease?

There is a wide range of symptoms that can fluctuate daily or worsen over time. Early in the disease there may be trembling or shaking of the hands or feet while at rest, but as the number of dopamine-producing cells diminish, symptoms worsen, causing uncontrolled muscle contractions, shuffling gait when walking, and stooped posture. People can also experience problems with thinking and speech, intestinal and urinary disturbances, pain, fatigue and depression.

How you can prepare for this discussion

  • Ask friends and family if they have noticed any changes in physical and mental behaviors
  • Gather past medical records
  • Keep a diary of all symptoms, the time of day they occur, their frequency, and what brings them on

How is Parkinson's disease treated?

Although there is no cure and it is not possible to stop the progression of this disease, there are many medications that can be given alone, or in combination, to slow the progression of the symptoms. The goal of medical therapy is to replace lost dopamine in the brain using a similar chemical, levodopa, and to help the body use it more effectively. The timing of treatment is controversial, however, because dopamine-replacing medications may lose their effectiveness over time. Some people with early symptoms may decide to forgo treatment with levodopa until more advanced symptoms appear. Still, once symptoms appear, more than 50 percent of dopamine-producing cells have been destroyed, interfering with many activities of daily living, so many physicians recommend early treatment.

How you can prepare for this discussion

  • Note any drug allergies, or if you have had trouble taking medications in the past
  • List any side effects you have had with current or past medications
  • List all the prescriptions, over-the-counter medications and dietary supplements you are taking

What can be done when medications wear off?

As more and more dopamine-producing cells are lost, the brain is less able to use levodopa effectively, and people may experience the reappearance of symptoms because the medication doesn’t last as long during the day. Increasing the dose of levodopa is counter-productive as it causes an increase in involuntary movements (dyskinesias). So doctors are now using lower doses, timed-released formulations, divided doses, or combination medications to help keep the levels of dopamine steady.

How you can prepare for this discussion

  • Keep a symptom diary that includes the characteristics of your symptoms and the time of day they occur
  • Rate your symptoms using a scale of 1 to 10
  • Note any side effects from current or past medications

Are there any surgical options?

Certain surgical procedures (thalamotomy, pallidotomy) can destroy parts of the movement centers in the brain to help restore the balance that normal movement requires. Another procedure involves implanting a device in the brain similar to a pacemaker in the heart. The electrical brain stimulation device (deep brain stimulation) blocks the signals that cause tremors. Surgical options are usually reserved for people who have poor symptom control with medications, or who are experiencing dyskinesia as a result of their medication.

How you can prepare for this discussion

  • Think about your particular concerns regarding the risk and benefits of a surgical procedure
  • List any injuries or surgical procedures performed in the past
 
 
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