Parkinson's disease is an adult-onset neurodegenerative disorder of the extrapyramidal system characterized by a combination of tremor at rest, rigidity, stiffness and bradykinesia. Shuffling gait and en bloc turning are key signs. Postural hypotension and constipation are also common symptoms. The diagnosis requires therapeutic response to levodopa which implies normal striatal neurons. This is the only neurodegenerative disease which is treatable long term.
The specific cause of ParkinsonÕs disease is unknown. There is an increased loss of dopaminergic neurons in the substantia nigra with rate of loss 1% per year in patients with Parkinson's versus 0.5% in normal aging. ParkinsonÕs disease is most likely not genetic. It may be toxic or infectious. Exposure to the toxic substance is MPTP (1-methyl-4 phenyl-1,2,5,6-tetrahydropyridine) is known to cause ParkinsonÕs disease. Pesticide exposure is also implicated. Other non-dopaminergic neurons can also be effected.
Free radical damage has also been implicated as a possible cause of neuronal cell death in Parkinson's disease. It is theorized that an environmental toxin, perhaps in genetically susceptible patients, may cause free radical formation that destroys cells in the substantia nigra.
Tremors can be caused by several mechanisms, including: Creutzfeldt-Jakob Disease (a slow virus), Pheochromocytoma, Magnesium deficiency, Zinc deficiency, Porphyria, Hyperthyroidism, Lithium toxicity, Fructose intolerance, Rescorcinol poisoning (a formaldehyde resin used in glues and rubber), heavy metal toxicity (Manganese, Tin, Mercury, Copper, Lead), Hypoglycemia, Insulinoma, Respiratory acidosis, Shy-Drager syndrome (plasma norepinephrine does not increase on standing), Carbon disylfide poisoning, and Toxaphene poisoning (DDT).
ParkinsonÕs disease is diagnosed by clinical symptoms. As such, there are no specific lab tests. A CT or MRI can eliminate disorders that mimic Parkinson's. A PET scan may also be ordered.
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