Parkinson’s disease is a disease that generally begins in adult life. The average age of onset is 55 tp 60 years old. The symptoms of Parkinson’s disease include tremor when the affected limb is at rest, slowness of initiation and carrying-out of movement, rigidity of the neck, arms or legs and impairments in walking and balance. Parkinson''s disease is a slowly progressive disease which usually begins with symptoms in one arm or leg and which over time progressively worsen and lead to difficulties with independent walking. The diagnosis of Parkinson’s disease requires differentiation from other related neurodegenerative disorders such as “Parkinson’s Plus,” progressive supranuclear palsy, Alzheimer’s disease and others.

PD relates to death of a population of brain cells whose important functions include the manufacture and release of the brain chemical messenger dopamine. The reasons for this degeneration are unknown. Current theories suggest that the development of Parkinson''s disease may relate to exposure to environmental toxins in a genetically sensitive individual.

PD treatment is presently divided into “protective” and “symptomatic” therapies. Protective therapies are those that hope to retard the degenerative process in the brain. Symptomatic therapies are those which improve the symptoms of the degenerative process without directly affecting cell degeneration:

Protective therapies: There are no proven drug treatments for the degenerative process of Parkinson’s disease. At Rush, we have participated in research on candidate protective drugs including selegiline, vitamin C, vitamin E, Coenzyme Q10 and lazabemide.  There have been interesting developments regarding the use of trophic factors in PD. Trophic factors are naturally produced chemicals which may prevent or reverse cell degeneration. Human research on trophic factors at Rush is in the very preliminary stages.

Symptomatic therapies: Levodopa (usually taken as the combination drug carbidopa-levodopa -- Sinemet) is the mainstay of symptomatic therapy for Parkinson''s disease. While it dramatically improves the symptoms of Parkinson''s disease, chronic therapy may have its pitfalls including unpredictability, intermittent over medication effects and a number of side effects. Careful adjustment of levodopa and the judicious use of other agents in combination with levodopa can lead to many years of good benefit. 

Dopamine agonists: Dopamine agonists may be used as the sole agent for the treatment of PD, but more often is used in combination with levodopa.  Available dopamine agonists are bromocriptine, pergolide, pramipexole, and ropinirole. 

COMT Inhibitors: COMT inhibitors (tolcapone, Tasmar) enhance the effectiveness of levodopa by inhibiting the degradation of levodopa and dopamine.

Other symptomatic therapies: Other medications used in the treatment of PD include selegiline, trihexyphenidyl, benztropine, amantadine and others.