Parkinsonism Treatment Hospital in Mumbai, India

Parkinson’s is a chronic progressive degenerative disorder affecting mainly people above the age of 60. Males are more prone than females. Worldwide prevalence is 0.3 – 1 %. If we talk about India alone, Parkinson’s disease is the second leading chronic degenerative disorder after Alzheimer's, with a prevalence that is directly proportional to age. Between the age of 70-79 years, it could be as high as 280 for a Hundred thousand people.

Parkinson’s disease is a disorder that impacts the brain and leads to difficulty with balancing, coordination and walking. Along with this, the patient also experiences shaking and stiffness.

Ataxia:

It is a neurological problem marked by the gradual loss of muscle control and coordination making it difficult to perform normal day to day activities. The disorder affects the cerebellum, which is responsible for controlling movement, as a result of which the patient is likely to face difficulty with coordination and speech along with an unsteady gait. Ataxia is usually diagnosed by physical examination, neuroimaging and detailed evaluation of the patient’s health.

Causes - Ataxia can be a result of severe head trauma, stroke, cerebral palsy, autoimmune diseases (like sclerosis and celiac disease) and infections.

Symptoms - The major symptoms associated with Ataxia include problems with speech, inability to perform motor tasks, nystagmus (involuntary movement of the eyes), difficulty with swallowing food and inability to walk steadily.

Pre-Detection Tests - Ataxia is usually diagnosed by a thorough neurological examination that includes physical examinations, imaging tests (like CT scan and MRI scan), genetic testing and spinal tap.

Treatment - Ataxia cannot be completely treated, however, the problem can be easily managed by simple medication and therapies (physical, speech and occupational) that aim at improving the quality of the patient’s life.

Cervical Dystonia

Commonly known as spasmodic torticollis, it is a neurological condition marked by persistent or intermittent spasms of the neck muscle due to which the neck starts bending towards the sides involuntarily. Although the condition is quite rare, it can affect people of any age group and gender. Initially, the patient experiences very mild symptoms which worsen gradually. The condition cannot be cured, however, proper treatment can help to relieve the symptoms thereby improving the quality of the patient’s life.  

Symptoms - As far as the symptoms are concerned, these involve the involuntary bending of the neck towards the back, front and sideways i.e.

• Chin toward shoulder
• Ear toward shoulder
• Chin straight up
• Chin straight down

Causes - As such, there is no known cause of cervical dystonia however it is believed that this might be triggered by genetic mutations or severe head, shoulder and neck injuries.

Diagnosis - Cervical dystonia is diagnosed by physical examination, however, simple blood tests and MRI scans may be suggested in some cases.

Treatment - In the initial stages, cervical dystonia is usually managed by medication and therapies. Botulinum toxin is directly injected into the neck muscles. Other drugs that may be used for the treatment include Dysport, Xeomin and Myobloc. If these fail to work, surgery may be recommended. Surgical treatments for cervical dystonia include deep brain stimulation and cutting of nerves.

Chorea

It is a neurological disorder marked by abrupt and uncontrolled body movements which may range from acute to chronic. Over time, the patient may also start to experience problems with speech, gait and posture. The condition is very likely to affect people with a history of rheumatic fever.

Symptoms - Various symptoms associated with chorea include dystonia, abnormal eye movements, speech difficulty, impaired gait and loss of balance.

Causes - The condition may also be triggered by the following:

• AIDS
• Unhealthy genetic mutations
• Metabolic and endocrine disorders
• Side effects of certain medication
• Chronic infections

Diagnosis - The diagnosis of chorea requires thorough medical history to determine the underlying cause. Doctors may also suggest MRI scans and blood tests for parathyroid hormones or spiky erythrocytes.

Treatment - Doctors initially resort to medication and therapies to help with the symptoms. Deep brain stimulation is recommended for patients who do not respond well to other forms of treatment.

Parkinson’s disease is classified into five stages. This includes:

Stage 1: Certain changes such as tremor, change in facial expressions, posture, and walking. These changes are mild and therefore do not hamper the patient’s routine.

Stage 2: The above symptoms affect both sides of the patient’s body. This makes them face difficulty in performing routine activities.

Stage 3: Patient experiences loss of balance and reduced movements along with a tendency to fall on the ground.

Stage 4: The patient needs support or walker to move from one place to another.

Stage 5: This is the most complicated stage and involves stiffness in the legs, delusions, and hallucinations.

The main symptoms are tremor, rigidity, stiffness, slowing and imbalance however there are other-motor symptoms like apathy, anxiety, depression, dementia, sexual disturbances and sleep disturbances. It also affects the gastric system leading to lack of appetite, indigestion, constipation and the Genito-urinary system producing a frequency of micturition and incontinence of urine.

It is triggered by the deficiency of chemical neurotransmitters, like dopamine and norepinephrine, in the substantia nigra, which is the part of the brain responsible for controlling mobility.

The possible complications linked with Parkinson’s disease include:

- Emotional changes that lead to depression in severe cases

- Increased thinking difficulties

- Sleep disorders

- Chewing problems

- Constipation

- Pneumonia and sudden fall (often lead to death)

The treatment in the early Parkinson’s symptoms is very amenable to medical therapy mainly dopamine replacement therapy with L-dopa and carbidopa however as the disease advances and age advances there is less response to the standard medication and one needs to increase the frequency of medication and there are side effects of medications.

The non-motor symptoms also advance in the late Parkinson’s after 8-10 years of the disease and will require very complex treatment to continue dopaminergic stimulation.

Some of the preventive measures linked with Parkinson’s disease include a healthy and balanced diet. Engaging in routine physical activity will also help to prevent Parkinson’s disease.

The average life expectancy of patients with Parkinson’s disease is usually similar to those without the disease. If the patient suffers from sudden falls, choking or pneumonia, then it can lead to death.

In Parkinson’s there is no test to detect Parkinson's; it is mainly a clinical examination to confirm the onset and the stage of the disease. An isotope scan can be carried out to confirm the disease however, it is available in very few centres. The diseases relentlessly progress inspire by medicines as there is no curative treatment but these medications improve quality of life and patients can live a normal life with proper adjustment of treatment for a very long time.

This brain disorder is linked with the eventual loss of the substantia nigra part of the brain. This impacts dopamine production which also affects the coordinating activities handled by the brain.