Parkinson’s Disease & Movement Disorder

Parkinson's disease is the 2 nd most common neurodegenerative disorder after Alzheimer's disease. A recent study showed that Parkinson's disease occurs as commonly as in the West. Three out of every thousand individuals, aged 50 years and above, have this disease.

As population continues to age, the number of people with Parkinson's disease and movement disorders, such as essential tremor, dystonia, chorea and myoclonus will rise. As with many other medical conditions, these diseases currently do not have a cure. However, there are effective treatments available to control symptoms and improve daily function. Minimally invasive surgery is also available to treat patients with advanced disease.

The Parkinson's disease and Movement Disorders Programme emphasises the provision of comprehensive clinical services coupled with strong research initiatives. A multi-disciplinary team of neurologists, neurosurgeons and therapists work together to provide the care that is currently accepted widely as most effective.

What Is Parkinson's Disease?

The symptoms of Parkinson's disease are caused by degeneration of a structure of the brain called the substantial nigra. This causes a lack of a neurotransmitter called dopamine.

Parkinson's Disease

The major symptoms of Parkinson's disease include:

• Shaking of arms or legs when at rest
• Stiffness of arms, legs or body
• Slowness of movement and walking
• Stability problems when walking or standing

Other common signs include an expressionless face (masked faces), softer voice, smaller handwriting, drooling of saliva, difficulty swallowing and walking difficulties. There is no simple laboratory test to diagnose Parkinson's disease and doctors make the diagnosis based on a set of symptoms and signs.

Treatment For Parkinson's Disease

Parkinson's disease is a slowly progressive disorder. There is currently no cure. However, there are effective medications that can improve the symptoms of the disease. Your doctor will be able to recommend the most appropriate medications depending on your symptoms, age and other medical conditions. Treatment has to be individualised and medications that are suitable for one patient may not be ideal for another. For patients with more advanced disease, limited neurosurgery called deep brain stimulation may further improve symptoms. This involves the implantation of a wire into the brain to electrically stimulate that area.

What Are Movement Disorders?

Movement disorders refer to a group of neurological conditions that result in disorders of normal body movements. This may refer to conditions that slow down body movements such as Parkinson's disease or conditions that are associated with abnormal or increased body movements.

The disorders we often see in our movement disorders clinics include:

• Ataxia

Impaired ability to coordinate voluntary movements that may result in problems with walking and balancing.

• Chorea

Jerky, irregular, relatively rapid, involuntary movements that can affect the face or limbs.

• Dystonia

Slow, twisting, involuntary movements associated with forceful muscle contractions or spasms. This may affect the eyes (blepharospasm), muscles of the face, jaws, neck, upper limbs and/or lower limbs. At times these spasms occur on performing a specific task such as writing (writer's cramps).

• Hemifacial spasms

Involuntary twitching or spasms that affect one half of the face, including the eye muscles, resulting in uncontrollable eye closure.

• Myoclonus

Brief, involuntary, jerk-like twitching or contractions of muscles.

• Myokymia

Fine persistent quivering or rippling of muscles.

• Tremors

Rhythmic, involuntary, to-and-fro shaking movements that often affect the arms, hands or head

• Tics

Repetitive, purposeless muscle movements (motor tics) or vocalisations (vocal tics) that arise from an irresistible urge that is temporarily relieved following the execution of the movement or vocalisation.

These abnormal movements may arise from a variety of diseases and careful evaluation is necessary to determine the underlying cause.

Treatment For Movement Disorders

After the type of abnormal movement has been classified the cause established, the next step is to reduce the frequency or severity of these movements so as to improve function or reduce discomfort. Oral medications are the main type of treatment used to control these movements. For some of these disorders such as facial spasms or dystonia, botulium toxin injections may be useful to relieve the symptoms.

Research

Research is a major emphasis of this Programme at the National Neuroscience Institute. Areas of research include:

• clinical drug trials on new medications to treat Parkinson's disease
• genetic studies of patients with Parkinson’s disease or other
• movement disorders
• epidemiological studies on the occurrence of these disorders ]
• and the risk factors for these conditions
• clinical studies to better characterize and understand these
• disorders radiological studies (neuro imaging) of movement disorders
• laboratory research on animal and cell models of movement
• disorders

Bother patient-based and laboratory- based research are conducted at the Institute under strict ethical guidelines. Doctors and scientists work together closely to understand the causes and find better means to treat patients with Parkinson's disease and other movement disorders. patients who are interested to participate in these research initiatives are encouraged to approach their treating doctors.