Tremors—always a sign of Parkinson’s?
Not necessarily. As in Parkinson’s, essential tremor—one of the most common forms of tremor—affects the hands, arms and head and may also affect the voice. But while Parkinson’s is known for its “resting tremors” (shaking that occurs during the absence of movement), in essential tremor, movement—lifting a cup, say—makes the shaking more pronounced. Essential tremor is not serious and often requires no medication; however, those with the condition should avoid caffeine and stress, both of which aggravate the tremors.
Who is at risk?
Parkinson’s has been known to science since first being chronicled in 1817 by British physician James Parkinson. He called the malady “the shaking palsy.” Yet it remains an unpredictable affliction that seemingly strikes at random:
- Parkinson’s is a worldwide disease, although some evidence suggests the nonwhite population is at less risk of developing it.
- Men are just as likely as women to develop Parkinson’s.
- Age is a definite factor: 90 percent of cases are diagnosed after age 50.
- There is no correlation between Parkinson’s and social factors, like education, income or occupation.
A final note: Only a neurologist’s exam can confirm Parkinson’s disease. There is no blood test or other screening currently available. Seek a prompt medical evaluation if you notice early warning signs like forgetfulness; difficulty getting to your feet; moodiness; or tremors in your limbs, trunk or face.
What you can do
Here are steps people with Parkinson’s disease can take to sustain their quality of life:
- Exercise. Exercise can help maintain and improve mobility, flexibility, balance and range of motion.
- Join a support group. Support groups can play an important role in a patient’s and his or her family’s emotional well-being.
- Pay attention to diet. Many patients benefit from a low-protein diet. A dietitian familiar with Parkinson’s disease can offer the proper nutritional guidance.
- Consider communication therapy. A speech therapist can teach sufferers ways to compensate for Parkinson’s disease symptoms.
- Commit to an active life. Parkinson’s disease seems to advance more slowly in people who remain involved.
Michael J. Fox, Katherine Hepburn, Muhammed Ali. What do all of these public figures have in common? All are or were sufferers of Parkinson’s disease, a malady that affects at least 500,000 Americans, with another 50,000 patients diagnosed each year, according to the National Institute of Neurological Disorders and Stroke (NINDS). In fact, NINDS acknowledges that these figures may be low since many people with the disease have not yet been diagnosed. The National Parkinson Foundation, for instance, estimates that 1.5 million Americans suffer from Parkinson’s.
In Parkinson’s, cells in a small part of the brain called the substantia nigra slowly die off. This degeneration disrupts the levels of dopamine, a brain chemical necessary for normal movement. The disease, which belongs to a group of conditions known as motor system disorders, tends to strike those older than 50. The earliest symptoms are subtle and easy to dismiss. They include fatigue, depression and difficulty with routine tasks. Sometimes, family and friends are the first to observe that something is wrong. They may notice an absence of facial expression or realize that the person is becoming stiff and unsteady.
Often, tremors on one or both sides of the body finally prompt patients to seek help. Indeed, advanced Parkinson’s is recognized by four symptoms:
- tremors affecting the hands, limbs, jaw and face
- stiffness of the limbs and torso that leads to a stooped posture
- slowness of movement
- loss of balance and coordination
No two people with Parkinson’s are affected in exactly the same way. Some are able to lead near-normal lives for many years, while others are plagued by quickly progressing symptoms.
In the early stages, eating well and exercising (walking is ideal) are often enough to maintain good health without medication. Equally important is surrounding oneself with a strong support network.
No cure exists for Parkinson’s, but medications can help ease its symptoms. Most commonly, doctors prescribe drugs containing levodopa (L-dopa), a substance produced in the body, to treat the disease. L-dopa helps replenish dopamine, but drugs can produce unwanted side effects like nausea and involuntary movement. L-dopa is often given in combination with carbidopa to enhance effectiveness or reduce side effects.
Other drug therapies, such as dopamine agonists, amantadine, anticholinergics and selegiline, may be used alone or with L-dopa, depending on the disease’s stage or symptoms. Researchers continue to study other drugs they hope will slow Parkinson’s progression.
In cases when symptoms do not or no longer respond to drug therapy, surgery may be used. Deep-brain stimulation, when electrodes are implanted into the brain and an electrical device that controls the electrodes, called a pulse generator, is placed in the chest, has been shown to help relieve tremors and other symptoms.