Parkinsonism (patient information)

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 * Associate Editor(s)-In-Patient: Jinhui Wu, M.D.

Overview
Parkinsonism refers to any condition that causes Parkinson's-type abnormal movements. Such conditions include encephalitis, meningitis, stroke, brain tumor, brain degenerative disorders and some toxins or overdose of medications. Signs and symptoms are similar to Parkinson's disease, including tremor, muscle stiffness, decrease in facial expressions and bradykinesia. There is not specific test for parkinsonism. The goal of the tests is to confirm or rule out other diseases that can cause similar symptoms. Treatment of Parkinsonism is similar to Parkinson's disease. Prognosis varies from person to person, depending on the underlying cause of Parkinsonism.

What are the symptoms of Parkinsonism?
Parkinsonism refers to any condition that causes Parkinson's-type abnormal movements. Symptoms caused by Parkinsonism are the same as Parkinson's disease.
 * Tremor: Tremor is one of the most common signs. It often affects in a hand, arm, or leg. It occurs when the person is awake and sitting or standing still, and subsides when the person moves the affected body part.
 * Rigidity: Muscle stiffness often occurs in the limbs and neck. Later, the patient can not move an arm or leg normally and feel pain in the limb.
 * Decrease in facial expressions: This appearance is cause by loss of movement in the muscles in the face. Patients with Parkinsonism may feel it difficult to speak and swallow.
 * Bradykinesia: Slowness of movement and impaired balance occur in the later in the patients with Parkinsonism. They are likely to take small steps and shuffle with the feet close together. They also have trouble in turning around and keeping balance. These abnormities may result in frequent falls.
 * Some types of paralysis
 * Dementia: Patients may appear progressively memory loss, losing interest in things they previously enjoyed, difficulty communicating, reading or writing, difficulty with performing tasks. With time goes on, more signs such as withdrawing from social contact, personality changes and inappropriate behavior may be observed.

Who is at highest risk?

 * Infections such as encephalitis, meningitis
 * Stroke
 * Brain tumor
 * Degenerative disorders: Corticobasal degeneration, dementia, diffuse Lewy body disease, multiple system atrophy, progressive supranuclear palsy
 * Toxins: Manganese, carbon monoxide, and methanol
 * Medications: Antipsychotics, metoclopramide, phenothiazine, overdose of anesthesia drugs

How to know you have Parkinsonism?
Tests are not usually specific for parkinsonism. However, the goal of the tests is to confirm or rule out other diseases that can cause similar symptoms.
 * Meidcal history, physical examination and neurological evaluation
 * Blood tests: These tests include the check of thyroid function, liver function, kidney function, glucose levels, even the presence of any toxins.
 * Imaging studies such as head CT (computerized axial tomography), MRI (magnetic resonance imaging), and positron emission computerized tomography (PET): These images can also be used to help doctors confirm or exclude the brain disease causing Parkinsonism.

When to seek urgent medical care?
Call your health care provider if symptoms of Parkinsonism develop.

Diagnosis
The health care provider may be able to diagnose Parkinson's disease based on your symptoms and a physical examination. However, the symptoms can be difficult to assess, particularly in the elderly. The signs (tremor, change in muscle tone, problems walking, unsteady posture) become more clear as the illness progresses.

An examination may show:


 * Difficulty starting or finishing voluntary movements
 * Jerky, stiff movements
 * Muscle atrophy
 * Parkinson's tremors
 * Variation in heart rate

Reflexes should be normal.

Tests may be needed to rule out other disorders that cause similar symptoms.

Treatment options
Treatment of Parkinsonism depends on the underlying cause. The goal is to relieve the symptoms.
 * Treat the underlying causes, such as surgery or radiation therapy for brain tumor, antibiotics for bacterial meningitis, discontinue the overdose medications.
 * Medictions
 * L-dopa: Levodopa can increase the level of dopamine in the brain, helping nerve cells use to make dopamine to replenish the brain's dwindling supply.
 * Dopamine agonists such as bromocriptine, pramipexole, or ropinirole: These drugs may mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. Also, they may delay the onset of levodopa's side effects.
 * Anti-depression drugs: Depression is common in people with Parkinsonism. It is important to recognize and deal with this symptom to improve the life quality.
 * Control dementia: When you show signs such as loss memory, problem on solving, learning, and other mental functions, you need to see your doctor to get some medicines to treat dementia.

Diseases with similar symptoms

 * Parkinson's disease
 * Stroke
 * Essential tremor
 * Dementia
 * Hyperthyroidism

Where to find medical care for Parkinsonism?
Directions to Hospitals Treating Parkinsonism

Prevention of Parkinsonism
Prevention of Parkinsonism depends on the underlying cause.
 * Keep a healthy life-style
 * Avoid to contact with toxins
 * Vaccines to prevent meningitis
 * Avoid of medications overdose: If the patient requires long-term use of medications such as antipsychotics, metoclopramide, or phenothiazine, he/she should be carefully monitored.

What to expect (Outlook/Prognosis)?
Prognosis of Parkinsonism depends on the underlying cause. Outcomes of Parkinsonism caused by brain tumors are poorer than other causes. If the disorder is caused by medications, it may be reversible.

Possible complications

 * Difficulty performing daily activities
 * Difficulty swallowing (eating)
 * Disability (varying degrees)
 * Injuries from falls
 * Side effects of medications

Side effects from loss of strength (debilitation):


 * Aspiration
 * Deep vein thrombosis
 * Malnutrition