DIAGNOSIS AND MANAGEMENT
Diagnosis of Parkinson’s in its early stages is sometimes difficult because its symptoms may mimic changes seen with advancing age like slowness, loss of smell, weakness, depression, etc. A diagnosis of Parkinson’s is based on the clinical examination by a neurologist, symptoms reported by the individual and their past medical history.
At times, additional tests like Magnetic Resonance Imaging (MRI) or Computerised Tomography (CT) may be required to rule out other conditions which could cause similar symptoms. There are no standard imaging or pathology tests to diagnose Parkinson’s as yet, however, a clinical diagnosis is usually accurate. In some cases, an accurate diagnosis of the condition may take time. A favourable response to Levodopa (a drug for Parkinson’s) is also considered supportive of the diagnosis.
A neurologist may sometimes ask you to take a DaT Scan when they are unsure of your diagnosis. DaT Scan (Dopamine Transporter scan) is an FDA- approved imaging technique since 2011, which does not diagnose Parkinson’s, but tells the clinician if there is a problem with the dopamine transporter in the brain. DaT scan can be used to differentiate Parkinson’s from Essential Tremor. Research is ongoing worldwide to find better diagnostic methods for an early detection of Parkinson’s like a biomarker for Parkinson’s. Right now, clinical examination plays a crucial role for the diagnosis of Parkinson’s.
A diagnosis of Parkinson’s is often life-changing and can be emotionally difficult to accept. With the help and support from your family, a healthcare team, and the support centre team at the PDMDS, dealing with your diagnosis can be made easier and you can learn to accept and manage Parkinson’s in a better way!
The management of Parkinson’s is multidisciplinary in nature, to cater to the wide range of symptoms seen in it. Although there is no cure, the symptoms of Parkinson’s can usually be effectively controlled using a combination of medications and therapies.
There is no single, optimal treatment method for Parkinson’s because each individual is affected by the condition differently. Help and advice from your healthcare team along with your active involvement in the management of the symptoms will lead to an improved quality of life. As the condition progresses, people with Parkinson’s (PwPs) may need to consult their neurologist to adjust and change the treatments according to their symptoms and current medications.
Following are some of the effective treatment options for the management of Parkinson's
There is a wide range of medications that are used to treat the symptoms of Parkinson’s. However each PwP requires individualized care and treatment.
The main aims of drug treatment for Parkinson’s are to do one of the following-
- Increase the level of dopamine that reaches the brain
- Stimulate the parts of the brain where dopamine works
- Block the action of other chemicals that affect dopamine
A combination of different medications is often required to provide the most effective symptom management. Levodopa, Dopamine agonists, Amantadine, Anticholinergics, Monoamine Oxidase Inhibitors (MAO-B inhibitors), Catechol-O-Methyl Transferase (COMT inhibitors) are the commonly used drugs in the treatment of Parkinson’s.
PwPs are advised to do regular follow ups with their neurologist to review and adjust the medicine dose, frequency and timing depending on their current state of symptoms, side effects, if any, and response to the current drug treatment.
Deep Brain Stimulation (DBS) is a surgical procedure which is a treatment option for advanced Parkinson’s. DBS is usually considered as a treatment option for PwPs whose motor (movement) symptoms no longer respond adequately to medication. It is mainly used to treat disabling symptoms of Parkinson’s such as severe tremor, frequent freezing of gait and dyskinesia (involuntary movement).
In DBS, a neurosurgeon implants in the brain, a medical device called a neuro-stimulator, similar to a cardiac pacemaker, to deliver electrical stimulation to precisely targeted areas on each side of the brain. Stimulation of these areas appears to block the signals that cause the disabling motor symptoms of Parkinson’s. As a result, many PwPs achieve greater control over their body movements post DBS.
Note: DBS can relieve only some specific symptoms and it does not eliminate the use of drugs/medication nor does it result in the reversal of the Parkinson’s symptoms. DBS is NOT a cure for Parkinson’s.
The neurologist will consider all factors such as age and other medical conditions of the PwP before determining if he/ she is a good candidate, and recommends the surgery accordingly. Like with any other surgery, it is best to discuss the risk factors with your neurologist before exploring DBS as a potential surgical option.
SUPPORTIVE REHABILITATION THERAPY
Inspite of optimal medical management, a PwP may still experience the effects of certain symptoms which may interfere with their ability to carry out their daily activities. This can be effectively managed with the help of various rehabilitation therapies. Some of the important therapies used in the supportive rehabilitation for Parkinson’s are physiotherapy, speech therapy, diet and nutrition, counseling, creative therapies like dance therapy and music therapy, occupational therapy, cognitive therapy, etc. There is evidence which indicates the benefits of these therapies to improve symptom management and slow down the progression of Parkinson’s.
These therapies provide exercises and strategies to deal with specific symptoms and helps improve the quality of life of PwPs.
PwPs and their caregivers need to take an active part in the management of Parkinson’s along with the healthcare team. It is also important that people living with Parkinson’s keep themselves active- physically, mentally and socially. The PDMDS support group centre sessions are designed to provide these various rehabilitation therapies for PwPs and their caregivers. Joining a Parkinson’s support group center in your community will provide you with support and motivation to manage your condition better.
Intensive research into finding a cure for Parkinson’s continues worldwide and there is a hope that there will be a cure for Parkinson’s in the near future.
Benefits of Multidisciplinary Management for Parkinson’s
- Improves Physical functioning
- Reduces slowness of movement & stiffness
- Re-education of gait & balance
- Improves flexibility, mobility & activities of daily living
- Helps in becoming physically independent
- Helping to improve speech including clarity of speech, volume,speed, etc
- Improving communication with other people
- Helping in dealing with problems of drooling, dryness of mouth, swallowing.
- Helping to perform activities of daily living (dressing, bathing, writing, etc.) in a better manner
- Suggesting modifications in home and work environment to make these safe and Parkinson’s-friendly
- Fostering independence in daily activities with exercises, tips and strategies
- Educating PwPs on food-medication interaction and tips to maximize the effects of medicines
- Helping with weight regulation (weight loss/gain)
- Providing tips to control the problem of constipation, urinary difficulties with dietary modifications
- Providing a source of happiness and elevated mood
(art, music, dance, craft,drama, etc.)
- Fostering expression through creative mediums
- Improving various motor and non-motor symptoms of Parkinson’s
- Facilitating a better sense of fulfilment and satisfaction
- Providing brain stimulation, keeping the brain active and healthy
- Providing cognitive/brain exercises to improve attention, memory,planning, decision making, visuospatial skills, etc.
- Providing help with psychological difficulties such as depression, anxiety, hallucinations, etc. in Parkinson’s
- Helping PwPs to accept the situation and manage their
mood in a better way
- Providing tips to manage sleep disturbances in Parkinson’s like difficulty falling asleep, nightmares, disturbed sleep, etc.
- Providing education on sleep hygiene
- Allowing caregivers to share their concerns and help them realize the importance of their own health
- Providing tips to manage caregiver stress and burden