Book Now

Parkinsonism

Overview

Parkinsonism refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinson's disease (PD). It includes both idiopathic Parkinson's disease and other disorders (like multiple system atrophy, progressive supranuclear palsy, and drug-induced parkinsonism). The core features include bradykinesia (slowness of movement), rigidity, resting tremor, and postural instability.

Goals of Therapy

  • Relieve symptoms.
  • Improve quality of life.
  • Preserve functional independence.
  • Delay disease progression (as much as possible).

Types of Therapy for Parkinsonism

Pharmacological Therapy

Levodopa-Based Therapy :

  • Levodopa + Carbidopa (e.g., Sinemet).
  • Most effective for core motor symptoms (bradykinesia, rigidity).

Dopamine Agonists :

  • Examples: Pramipexole, Ropinirole, Rotigotine.
  • Used in early disease or adjunct to Levodopa.

MAO-B Inhibitors :

  • Examples : Selegiline, Rasagiline, Safinamide.
  • Mild symptomatic relief, may have neuroprotective effects.

COMT Inhibitors :

  • Examples: Entacapone, Opicapone.
  • Extend duration of Levodopa effect, reduce "off" time.

Amantadine :

  • Helps with tremors and Levodopa-induced dyskinesia.

Anticholinergic Agents :

  • Examples : Trihexyphenidyl, Benztropine.
  • Effective mainly for tremor (used cautiously, especially in elderly).
Non-Pharmacological Therapy

Physical Therapy :

  • Enhances mobility, strength, and balance.
  • Reduces risk of falls.

Occupational Therapy :

  • Helps maintain independence in daily tasks (e.g., dressing, cooking).

Speech and Language Therapy :

  • Addresses speech difficulties (dysarthria).
  • Manages swallowing issues (dysphagia).
  • Uses techniques like LSVT LOUD.

Nutritional Therapy :

  • Manages constipation and weight loss.
  • Adjusts protein intake to improve Levodopa .

Psychosocial Support :

  • Treatment of depression, anxiety, apathy.
  • Support groups, psychotherapy, counseling.
Surgical Therapy

Deep Brain Stimulation (DBS):

  • Implanted electrodes stimulate areas like STN or GPi.
  • Used in advanced Parkinsonism with drug-related complications.

Lesioning Procedures :

  • Examples: Thalamotomy, Pallidotomy.
  • Less common now due to DBS.
Emerging & Advanced Therapies

Device-Assisted Therapies :

  • Levodopa-Carbidopa intestinal gel infusion (LCIG).
  • Apomorphine infusion pumps.

Focused Ultrasound Therapy :

  • Non-invasive lesioning of thalamus for tremor control.

Gene Therapy (Experimental) :

  • Aims to modify disease at molecular level.

Stem Cell Therapy (Experimental) :

  • Potential to replace lost dopaminergic neurons.
Supportive & Palliative Care
  • For advanced Parkinsonism or Parkinson-plus syndromes.
  • Symptom control, caregiver support, end-of-life planning.

MONITORING & SIDE EFFECTS

  • Watch for motor complications (on-off, dyskinesias).
  • Monitor for neuropsychiatric side effects (hallucinations, delusions).
  • Orthostatic hypotension, constipation, urinary issues.
  • Drug interactions (especially with MAO inhibitors).

KEY POINTS

  • Parkinsonism is chronic and progressive.
  • Therapy must be individualized.
  • Multidisciplinary care is essential.
  • Treatment targets both motor and non-motor symptoms.