Parkinson's Clinic

Parkinson disease is a progressive neurodegenerative disease.People affected by Parkinson disease may develop various symptoms including tremor, stiffness or rigidity in their legs and arms, slowness of movements and /or imbalance.In the early stages there may be a slight shaking of hands or walking difficulty that is barely noticeable. Over time the symptoms may become more pronounced resulting in unclear speech and varied physical disability.

Parkinson usually develops in people over the age of 60 years. The risk of developing Parkinson increases with age. It affects both men and women.

Rarely Parkinson disease develops in people at 40 years or so – called young onset Parkinson disease.

Parkinson disease is a Movement Disorder.It results from loss of brain cells (neurons) in an area of brain called the substantia nigra that modulates movements. The cells of substantia nigra involved in Parkinson disease produce a chemical called dopamine.Deficiency of dopamine is believed to be responsible for most of the symptoms of Parkinson disease.

• Shaking (tremor) of hand or leg
• Loss of facial expressions or poker face
• Fatigue
• Muscle ache
• Decreased speed in walking
• Difficulty in getting in and out of a car
• Difficulty in turning while walking
• Leg getting ‘stuck’
• Fear of falls while walking or unprovoked falls
• Slowness of daily activities, for instance, dressing, bating, eating

Diagnosis of Parkinson disease is based on a through neurological examination and is best done by a neurologist who is a Movement Disorder Specialist. Many diseases may mimic symptoms of Parkinson disease and it is essential to exclude these through clinical examination and appropriate tests (blood tests, brain imaging).

Various diseases can mimic Parkinson disease. Treatment of these diseases is different from Parkinson’s Disease. Consultation with a Movement Disorder Specialist is essential for early diagnosis and prompt treatment.

Some of the diseases that may resemble Parkinson’s Disease are:

• Essential tremor
• Dystonic tremor
• Neuroleptic drug use
• SWEEDS
• Diffuse Lewy Body Disease
• Multiple System Atrophy
• Parkinson disease dementia
• Progressive Supranuclear Palsy
• Strokes
• Brain infections
• Huntington disease
• Metal deposition disorders: Neurodegeneration from Brain Iron Accumulation (NBIA), Wilson Disease (WD)

There is effective medical treatment available to alleviate symptoms of Parkinson disease.

With treatment people with Parkinson disease can lead a normal and active life. They can be independent and continue to work throughout their natural lives.

There a number of medications available to treat Parkisnon disease.

• The principal basis of treatment of Parkinson disease is to replenish dopamine deficiency in the brain.For instance, levodopa gets converted to dopamine in brain, while drugs like carbidopa and entacapone prevent dopamine destruction, and thereby, increase the amount of dopamine available.
• Various other drugs modify brain chemicals other than dopamine and help control various symptoms of Parkinson disease.
• Treatment is tailored as per an individual patient’s problems.

Parkinson disease is a progressive disease and symptoms worsen over time. However, there is effective medical treatment available that can be modified over time to keep pace with the disease progression.

Generally medications used to treat Parkinson produce a steady response that is sustained throughout the day.

• However, in a few patients after many years of Parkison disease the response to medications becomes short lived.These people experience an ‘ON’ or drug effect after taking their medication.A few hours later the response wears off and they experience an ‘OFF’
• During an ‘ON’ phase patients are normal, though some may have involuntary or excessive movements called dyskinesias.
• The ‘OFFs’ are characterised by slowness of movements and in some cases ‘freezing’.

Motor fluctuations are best treated by modifying the doses and timing of various drugs. These are best done by a neurologist who is a Movement Disorder Specialist.

There is an effective surgical treatment for Parkinson disease. Surgery is indicated for patients who have symptoms despite best medical treatment. With surgery even people with disabling motor fluctuations can resume normal lives and return to work.

• Deep Brain Stimulation of the Subthalamic Nucleus (DBS STN) is an FDA approved standard of care treatment for Parkinson disease.
• There are other surgical modalities under research but these are experimental and not approved by FDA as of now
• Stem Cell Therapy for Parkinson is under research and has not yet been scientifically tried in human being.Stem Cell Transplantation is not a scientific treatment option for Parkinson disease available as of now anywhere in the world.

People affected with Parkinson disease may experience pain in muscles, constipation, problems related to urine control, sleep, vivid dreaming, enacting dreams, impairment in smell, giddiness, weight loss, impulse control disorders, confusion or hallucinations.There is effective treatment available for these non- motor symptoms.

Kokilaben Hospital offers the opportunity to consult world class experts and avail of the state of the art in technology to diagnose, treat and rehabilitate people with Parkinson and Movement Disorders.

This is a specialist clinic for people with neurological problems resulting in Movement Disorders. The clinic offers a comprehensive screening and care program for Parkinson and other Movement Disorders including neurology consultation, physical and cognitive rehabilitation and, psychotherapy.
The mission of the Clinic is to provide state of the art multidisciplinary care to patients with Parkinson disease and their families.

Alzheimer is associated with deposition of abnormal proteins in the brain, brain cell death and brain shrinkage. The exact causes and risk factors of Alzheimer are subject of active research.