Question: What is Parkinson's disease?
Dr. Bill Simpson: Well, it's called a movement disorder, and one of the most common movement disorders. It's manifested by usually the beginning a tremor, called a pill-rolling tremor, which is just a very short fast movement of the fingers, the thumb and the first forefinger like you are rolling a pill on your fingers, three per second, four per second, very fast.
Usually, it begins on one side of the body and gradually progresses to involve both sides and sometimes to involve larger portions of the body. That's the sort of the first sign, although it may be preceded by what's called bradykinesia, which is slow movement, slowing of the movements and stiffness, they call it lead-pipe rigidity, meaning it feel sort a like bending a lead-pipe when you ask a person to, and you try to bend the person's arm, that's Parkinson's disease, so, the rigidity and the bending the bone, the difficulty moving through an arc.
Then they often times also have what they call a masked face or a poker face. The face; it loses some of its expression. They look depressed almost even though very frequently they aren't depressed, but they just have very little movement of their facial muscles. When they walk, they have a very difficult gait sometimes, starts off normal, then gradually it becomes more and more shuffling with quick short steps and difficulty on making turns and things like that. Then difficulty on keeping going forward sometimes, sometimes a sort of freeze in the middle of movement and can't get going again until they are touched or moved somehow and often times, tend to fall backwards as they are walking. They have difficulty with balance.
So it's multiple things beginning with a tremor and progressing to difficulty with movements of all kinds. Nobody really understands it's one of those with unknown as to what's listed as the cause. There are a few back in the 70s I guess it was, there was a designer drug which was used in California primarily which produced Parkinson's disease. The Parkinson's disease happens because we don't have enough dopamine produced in our brains and that particular drug targeted at the dopamine producing cells in the brain and it produced a drug-induced Parkinsonism. In general, the persons who develop Parkinson's' disease in late life have abnormalities in the parts of the brain, the putamen that produce dopamine. If you don't have enough dopamine, you don't move normally.
Treatment for Parkinson' disease:
Dr. Bill Simpson: Moving is good. Keeping moving is good in Parkinson's disease. So, giving them physical therapy to help them, keep moving and develop their -- keep their balance working well, all those things help the Parkinson's patients. We also have medicines that increase the level of dopamine in the brain. That's what all of our treatments in general have been to either increase the level or decrease the breaking down of dopamine, so that we give people back some of the dopamine that allows them to move more normally.
Tremors not associated with Parkinson's disease:
Dr. Bill Simpson: Most common one is called a benign essential tremor. That tends to be a rest tremor and tends to be slightly higher frequency, faster than the Parkinson's tremor. It can involve not just the hand but it can involve the head and have a bobbing motion of the head like I am doing now or a bobbing motion of several different parts of the body. Usually, this occurs at rest, it can occur during movement also. So it can make it difficult for patients to get a coffee cup to their mouth or something like that. That sometimes happens in a benign essential tremor and it's just that. It's only a tremor and it doesn't have the other associated symptoms with it, it's just a movement problem, just a tremor.
Even the benign tremor can be treated too. Treatments for benign tremors can involve propranolol or beta-blocker can decrease tremor. Some of the mild or anticonvulsants can also be used for that to -- medicines usually for seizures can also be helpful for the benign tremor. So any time a tremor is bothers you, if it keeps you from doing something that you want do, if you are embarrassed about it, if you don't like to go out in public because of it, if any kind of symptoms like that happens, then that's a good time to go to see your doctor.
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