Parkinson's Disease

Maintaining Motor Control: Medical Treatments for Parkinson's

Many people associate Parkinson's disease with the celebrities who visibly suffer from it, from Michael J. Fox to Pope John Paul II. One reason we can often identify people with Parkinson's disease is because they have the signature symptom: a noticeable tremor. As a motor system disorder, Parkinson's disease also causes muscle rigidity, shuffling gait, and impaired balance and coordination.

It's difficult to know who is at risk for Parkinson's disease, though age appears to be the strongest predictor. Other risk factors include a first-degree relative with the disease; exposure to certain pesticides and herbicides; and the overuse of certain mediation such as the anti-psychotic Haldol.

Medications for Parkinson's disease can control symptoms by stimulating or replacing the brain chemical dopamine. But the most effective medications, called levodopa-containing compounds, tend to "wear off," so each dose does not last as long as it once did. Doctors sometimes hold off on starting these medications in an effort to delay the wearing-off effect. And new combination therapies help provide relief from symptoms for a longer period of time. Below, William Koller, MD, PhD, founder of the University of Kansas Parkinson Disease and Movement Disorder Center in Kansas City, discusses the most common treatments for Parkinson's disease.

What is Parkinson's disease?
Parkinson's disease involves symptoms including slowness of movement, stiffness of the muscles, difficultly walking, tremor (which some people refer to as shakiness) and sometimes difficulty with balance.

What causes Parkinson's disease?
We have a fairly good knowledge of what happens in the brain in Parkinson's disease. We know that a small group of cells die in a very small part of the brain. When those cells die, there's a loss of dopamine, which is a brain chemical or what we call a neurotransmitter. So the chemical basis of Parkinson's is loss of this dopamine chemical in the brain.

The part of the brain that's involved in Parkinson's is called the basal ganglia, and it helps control our movements and how we coordinate them. So when the basal ganglia doesn't work, we end up with slowness, stiffness and tremor.

How common is Parkinson's disease?
Parkinson's disease can affect all individuals and may be slightly more prominent in men. It's estimated that, at least in the United States, there's probably one million people affected with Parkinson's disease. Once you get over age 65, 1 percent (that is, 1 in 10) of people are at risk for Parkinson's disease. About 10 percent of cases occur before age 50, which we call young-onset Parkinson's disease, and of course, Michael J. Fox would be an example of someone with young-onset Parkinson's disease.

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