Parkinson's Disease

Parkinson Disease is a progressive degenerative (progressive deterioration and loss of function) disease of the brain characterized by tremor, muscular rigidity and slow, imprecise movements.

6.2 million people are affected worldwide, males more often than females – among them Michael J.Fox as famous actor and Muhammad Ali as professional boxer. The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy, in 1817.


A degeneration of substantia nigra (black substance) located at midbrain as part of the basal ganglia, an area of grey matter at the base of the forebrain is causing Parkinson Disease. The trigger factors are unknown but believed to involve genetic and environmental factors as exposure to pesticides and recurrent head injuries. A reduced risk is reported in tobacco smokers and those who drink coffee or tea.


Symptoms develop generally slowly over years including tremor, mainly at rest and described as pill rolling tremor in hands, bradykinesia (slow movements), limb rigidity, gait and balance problems. Thinking and behavioural problems, depression and anxiety, insomnia and dementia in the advanced stages of the disease are observed.


Diagnosis starts by taking an extensive medical history addressing your symptoms, the trigger factors, the duration and the frequency, work environment, social habits, toxic exposure, risk of infectious diseases and family history of neurological disease. Check of vital signs such as blood pressure and pulse, followed by a proper physical examination with focus whether the tremor occurs at rest or action, the location and the appearance, balance, gait, muscle stiffness and speech should give a first differential diagnosis. Additional tests such as laboratory tests, Electromyography (EMG), Nerve Conduction Studies (NCS) and imaging of brain are sometimes recommended investigations for ruling out symptomatic reasons.


Antiparkinson medication, dopamine agonists, apomorphine for subcutaneous injection, MAO-B inhibitors (an enzyme that breaks down dopamine), amantadine and anticholinergics are used. Sometimes surgery as deep brain stimulation can help.

Physical exercise

Regular physical exercise with or without physical therapy can maintain and improve mobility, flexibility, strength, gait speed, and quality of life. Exercises should be performed 45 minutes to one hour after medications when they are at their best. Generalized relaxation techniques such as gentle rocking, slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing and meditation techniques utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and altering environments (surfaces, inputs, open vs. closed) improve the symptoms as well as speech therapy and occupational therapy.

Special diet might be recommended.