World Parkinson’s Day: how to understand tremors for a good diagnosis

What causes Parkinson’s disease (PD)?

Parkinson’s disease is caused by the degeneration of nerve cells in the brain, causing a deficiency of dopamine. Dopamine is responsible for several bodily functions such as movement, memory, reward, and motivation. “Loss of dopaminergic neurons in the brain leads to dopamine deficiency in the basal ganglia. This impairment causes a range of motor symptoms, including tremors, rigidity and bradykinesia (slowness of movement), as well as non-motor symptoms such as cognitive impairment, depression and autonomic dysfunction,” says Dr. Singh.

“It may be familial, when it runs in families. These patients usually have a younger age at onset and a more severe manifestation of the disease. The majority of cases are sporadic, which means doctors don’t cannot predict whether or not a person will develop Parkinson’s disease in the future Poor lifestyle factors such as lack of physical activity, poor eating habits, exposure to toxins and certain medications can accelerate the development of the disease and its aggravation,” explains Dr. Goyal.

Parkinson’s disease progresses slowly over the years. “However, the rate of progression varies from patient to patient. It can sometimes worsen very slowly, leaving the patient independent for most of their life, while in other cases it weakens patients within a few years of its onset. In such patients, a high dose of medication may be required, which in turn produces unavoidable side effects. In such cases, surgical modalities can be investigated in selected patients,” adds Dr. Goyal.

What are the symptoms ?

The easily identifiable warning signs of Parkinson’s disease are:

· Shaking or jerking in the hands, arms, legs or face.

· Stiffness or rigidity in the arms, legs or trunk.

· Slowness of movement.

· Impaired balance and coordination.

· Changes in speech and writing.

· Depression or anxiety.

· Sleep disturbances.

· Memory and cognitive problems.

Are all involuntary hand movements a sign of Parkinson’s disease?

“In neurology practice, we frequently encounter patients presenting with hand tremors. But each time, a hand tremor cannot be attributed to Parkinson’s disease. It’s a combination of rigidity, tremors, bradykinesia and postural imbalance. Tremors or rigidity are predominant but tremors alone are rarely a symptom. There are various other causes of tremors like essential tremors, physiological tremors, drug induced diseases and other degenerative diseases like spinocerebellar ataxias to name a few. Tremors due to Parkinson’s disease usually affect one hand first and spread to the others. The tremors while holding cups and pouring tea may not be due to Parkinson’s disease,” says Dr. Goyal.

How to diagnose Parkinson’s disease?

Although there is no specific test to diagnose Parkinson’s disease, neurologists look at the specific symptoms associated with the disease. Early diagnosis and treatment can help manage symptoms and improve the quality of life for people who have it.

What are the treatment options?

Discussing treatment options, Dr Singh says, “There are several treatment options available for Parkinson’s disease, including medications, physiotherapy and deep brain stimulation. Treatment focuses on managing symptoms and improving quality of life. The mainstay of treatment is drug therapy, with drugs aimed at increasing dopamine levels in the brain. Levodopa, a precursor of dopamine, is the most effective drug for the treatment of Parkinson’s disease. Other medications, such as dopamine agonists, monoamine oxidase inhibitors (MAOIs), and anticholinergics may also be used. In addition to pharmacotherapy, non-pharmacological interventions, such as physical therapy and deep brain stimulation (DBS), can be used to improve motor symptoms. It also calls for “raising awareness so we can help ensure people living with this condition get the care and support they need.” “

How to prevent the onset of Parkinson’s disease?

Studies suggest that certain toxic chemicals in the form of free radicals accumulate in the brain with aging and exposure to environmental toxins. “This “oxidative stress” can lead to neuronal death. Regular aerobic exercise, reducing exposure to toxins like pesticides, tobacco exposure, stress management, getting enough sleep, and healthy eating habits can help prevent this free radical injury. Regular exercise not only helps strengthen muscles, maintain balance, endurance and coordination, but also ensures an adequate supply of blood and oxygen to the brain, mitigating any form of oxidative damage. Following a healthy diet is an equally important aspect of preventing Parkinson’s disease. The Mediterranean diet has always been recognized as a model of balanced eating, building up adequate antioxidants in the form of fruits and berries, as well as healthy fats like omega-3 and omega-6 fatty acids. These fatty acids appear to provide neuroprotection, thereby slowing the disease process,” says Dr. Goyal.