PUBLISHED BY: Zahid
CREATED/VALIDATED BY: Janardan Panday
LAST UPDATED ON: Apr 08, 2016

Introduction

Parkinson's disease is a degenerative disorder. This is one of the most common extra-pyramidal crippling disease affecting the older adults. It is a syndrome consisting of classical triad of resting tremor, bradykinesia and rigidity7. This triad does not include the equally important gait and postural stability problems which also constitutes the syndrome. It is a disease of elderly and its prevalence increases from 1% in people over the age of 65 years to 5% in people over the age of 80 years and affects men and women equally8. The disease has insidious onset and is slowly progressive leading to severe morbidity in advanced age. A disease condition 'vepathu' described in Ayurveda may  be correlated with Parkinson's disease. Generalized involuntary movements of all parts of the body or of the head only, is known as vepathu. It is caused by vitiated vata. So 'vatahara' treatment should be given to these patients.

Aetiology

Although aetiology of the disease is not well known but the following factors contribute in the pathogenesis of this disease

1. Genetic factors

2. Accelerated ageing

3. Environmental toxins (methyl-phenyl tetra hydro pyridine- MPTP) and other toxins (manganese, carbon monoxide and methanol)

4. Increased free radical and iron content in the Substantia Nigra

5. Drugs - Reserpine, Ethanol, Lithium, Diltiazem etc.

6. Neurodegenerative disorders such as multi system atrophy, Alzheimer's disease

7. Post infections (viral encephalitis etc.)

8. Brain tumor

9. Repeated head injury (as in boxing)

Pathogenesis

Parkinsonism is caused by degeneration of pigmented neurons (Dopaminergic neuron) in the zona compacta of substantia nigra, resulting decrease of dopamine levels in the brain which leads to motor dysfunctions viz. resting tremor, bradykinesia and rigidity.

Clinical features

1. Resting tremor

2. Bradykinesia

3. Rigidity

4. Stooped posture

5. Masked face

6. Pill rolling movements

7. Lack of postural adjustment

8. Festinating gait

9. Drooping of saliva due to infrequent swallowing movements

10. Monotonous soft voice

11. Absence of arm swing while walking

12. Aches and pain in body

Complications

1. Frequent falls

2. Incapacitation

3. Depressions and dementia

4. Postural hypotension

5. Urinary incontinence

6. Constipation

7. Aspiration

Investigations

There are no confirmatory tests available, diagnosis is commonly made on clinical grounds.The following investigations may help in the diagnosis.

1. CT Scan

2. MRI Scan

3. Positron-Emission Tomography (PET)

4. Levadopa drug challenge test

Differential Diagnosis

1. Drug induced Parkinson

2. Depression

3. Essential tremor

4. Normal pressure hydrocephalous

5. Cerebral hypoxia

6. Carbon monoxide poisoning

Management approaches

a. Preventive

1. Use shali (old rice), godhuma (wheat), citrus fruit, vegetable, nuts, milk and milk products, dadima (pomegranate), nimbu (lemon), mango, orange, guava, apple,peach, garlic, asafoetida, sprout etc.

2. Practice regular aerobic exercises

3. Take balance diet

4. Consume anti-psychotics or any other medication under close supervision of doctor

5. Be as active as possible

6. Avoid yava (barley), peas, puga (areca nut), jambu (jamun), excess protein diet, hot spicy food and incompatible food article.