Parkinson’s disease is a degenerative disorder of the central nervous system. The motor symptoms of Parkinson’s disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain.

Early in the course of the disease, the most obvious symptoms are movement-related; these include shaking, rigidity and slowness of movement. It starts slowly and progresses gradually. Therefore, it is difficult to know the exact onset of the disease. Here, we will look at the early symptoms of the disease to offer solutions when early Parkinson’s disease is suspected.

The three major symptoms of Parkinson’s disease are tremors, rigidity and bradykinesia. Before these major movements are significant enough to be obvious, many patients feel more vague symptoms. These vague symptoms include olfactory dysfunction, gastrointestinal dysfunction and constipation, sleep disorder, chronic fatigue and decreased energy. Other symptoms that can be present include depression, urinary dysfunction and sleep disorders. 

Bradykinesia

Bradykinesia is a slowing of the body movement. These Bradykinesia symptoms are the most common symptoms of discomfort. Therefore, a patient’s sports functionality declines with age but it often progresses slowly. This means that the patient or the ones that look after them may not even notice it.

Bradykinesia can also occur in the face, which becomes expressionless or “mask-like” as the patient’s face does not show any expression or emotions.

Tremors

Tremors in Parkinson’s disease arise when the patient is resting, and tends to become less pronounced when the patient is moving. The resting tremor, which is a characteristic of Parkinson’s disease, is often called “pill-rolling” tremor, where the patient may look like they are “rolling pills” or “counting coins.”

Rigidity

Rigidity refers to the muscles becoming stiff. When the rigidity progress, the body becomes more rigid and movement reduces. The classic rigidity in Parkinson’s disease feels like cogwheels turning when the patient is bending his or her arm, and hence termed “cogwheel rigidity.”

Other mobility-related symptoms

Gait problems are common in Parkinson’s disease patients. Characteristically in these patients, their arms swing less when they walk, their feet do not move far from the ground and they often drag their feet.

If the patient’s disease has spread, they may feel like their feet are stuck to the ground and that it is difficult to start moving. On the other hand, when they try to stop moving, they find it difficult to stop their feet and can fall down.

As the disease progresses, patients develop balance problems and experience instability of posture so that they tend to fall down. These symptoms, along with gait problems, are significant problems that affect the patient’s lifestyle as well as increasing the risk of fractures from accidents.

The patients can also develop speech problems, where their voice becomes quiet, and the patient often whispers or mumbles. The tone and rhythm of speech can also become monotonous, in severe cases; it becomes very difficult to understand what the patient says.

Moreover, if the Parkinson’s disease progress for long term, the patient can develop dystonia or dyskinesia. It helps to take the correct prescribed medication to control the symptoms.

Treatment

There are a variety of treatments for Parkinson’s disease. One thing to keep in mind is the importance of the course. We sometimes see patients who present very severe symptoms, that consume foods or herbal medicines that they believe to be healthy, or use alternative or home remedies without being seen by a specialist or doctors.

There is no such thing as the best treatment for everyone. It is important to find the most appropriate treatment for each patient, and continue with this treatment.

Can Parkinson’s disease be treated?

The treatment of a disease can mean two things. One is the treatment of the cause of the disease, such as the treatment of tuberculosis using anti-tuberculosis medication to remove the cause. Another method of treatment is the symptomatic treatment, such as the use of antihypertensive medication to control blood pressure to modify the symptoms.

The treatment of Parkinson’s disease belongs to the latter. Parkinson’s disease cannot be cured. However, its symptoms can be removed or reduced.

Unfortunately, Parkinson’s disease is a progressive disease, which means that the patient will need to continue medication adjustment throughout his or her life. Therefore, there is active research in Korea into the development of a treatment to prevent the progression of Parkinson’s disease. It will take a long time, there is also research into the use of genetic treatment of Parkinson’s disease. 

By Cho Jin-whan

The author is a doctor at Department of Neurology at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ―Ed.