Treatment for Parkinson's Disease Using the Gamma Knife

Robert Wood Johnson University Hospital (RWJUH) now offers the Gamma Knife, a noninvasive treatment for Parkinson's disease.

What Is Parkinson's Disease?

Parkinson's disease (PD or, simply, Parkinson's) is the most common form of parkinsonism, a group of motor system disorders. It is a slowly progressing, degenerative disease that is usually associated with the following symptoms, all of which result from the loss of dopamine-producing brain cells:

  • Tremor or trembling of the arms, jaw, legs and face
  • Stiffness or rigidity of the limbs and trunk
  • Bradykinesia (slowness of movement)
  • Postural instability, or impaired balance and coordination

Facts About Parkinson's Disease

It is incorrectly believed that Parkinson's disease disappeared after the introduction of levodopa (L-dopa) in the 1960s. In fact, about 50,000 Americans are newly diagnosed with Parkinson's disease each year, with more than half a million Americans affected at any one time. Further, more people suffer from Parkinson's disease than multiple sclerosis, muscular dystrophy and amyotrophic lateral sclerosis combined.

What Causes Parkinson's Disease (PD)?

The specific cause of PD is unknown, however, medical experts believe symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson's disease is chronic (persists over a long period of time) and progressive (symptoms grow worse over time). Although the disease may appear in younger patients (even teenagers), it usually affects people in late middle age. The disease affects men and women in almost equal numbers. It is not contagious, nor is it likely passed on from generation to generation.

Parkinson's Syndrome, Atypical Parkinson's or Parkinsonism

Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified). In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease.

These disorders may include the following:

  • Tumors in the brain
  • Repeated head trauma
  • Drug-induced parkinsonism - prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset
  • Toxin-induced parkinsonism - manganese and carbon monoxide poisoning
  • Postencephalitic parkinsonism - a viral disease that causes "sleeping sickness"
  • Striatonigral degeneration - the substantia nigra of the brain is only mildly affected, while other areas of the brain show more severe damage
  • Parkinsonism that accompanies other neurological conditions, such as :
    • Shy-Drager syndrome (multiple system atrophy)
    • Progressive supranuclear palsy
    • Wilson's disease
    • Huntington's disease
    • Hallervorden-Spatz syndrome
    • Alzheimer's disease
    • Creutzfeldt-Jakob disease
    • Olivopontocerebellar atrophy
    • Post-traumatic encephalopathy

What Are the Four Primary Symptoms of Parkinson's?

The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Rigidity — Stiffness when the arm, leg or neck is moved back and forth.
  • Resting Tremor — Tremor (involuntary movement from contracting muscles) most prominent at rest.
  • Bradykinesia — Slowness in initiating movement.
  • Loss of Postural Reflexes — Poor posture and balance that may cause falls; gait or balance problems.

Other Symptoms of Parkinson's Disease

Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities. These often include the following:

  • Fatigue or general malaise
  • Trembling
  • Difficulty arising from a seated position
  • Lowered voice volume (dysarthria)
  • Small, cramped, spidery handwriting
  • Losing track of a word or thought
  • Irritability or sadness for no apparent reason
  • Lack of expression in the face
  • Lack of animation
  • Remaining in a certain position for a long period of time
  • Unable to normally move arm or leg

What Are the Secondary Symptoms of Parkinson's?

  • Depression
  • Senility
  • Difficulty with speaking
  • Emotional changes (fearful and insecure)
  • Memory loss and slow thinking
  • Difficulty in swallowing and chewing
  • Urinary problems or constipation
  • Skin problems
  • Sleep problems

As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination. The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Treatment for Parkinson's Disease

Specific treatment for Parkinson's disease will be determined by your physician based on:

  • Your age, overall health and medical history
  • Extent of the condition
  • Type of condition
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

With today's medicine, we have yet to find a cure for Parkinson's disease. However, based upon the severity of the symptoms and medical profile, the physician will establish an appropriate treatment protocol.

Treatment for Parkinson's disease may include the following:

  • Medications
  • Surgery
  • Stereotactic radiosurgery

Robert Wood Johnson University Hospital offers several innovative treatments for Parkinson's, including the Gamma Knife, as well as Deep Brain Stimulation.

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