Parkinsonism: A Disabling Disorder

Parkinsonism is a neuro-degenerative disorder. Its incidence is more common with the advancing age. Prevalence rate of this disease is similar throughout the world and in both sexes.

The origin of Parkinson’s disease is idiopathic (unknown). Even genetic influence is found only in twins. There is notification of effect of certain substance in young drug users which suggests that this idiopathic disease has some environmental influence too.

Clinical Features

In the clinical presentation, initial symptoms are non-specific including tiredness, aching limbs, depression, mental slowness and small handwriting.

The classical symptoms found later include tremors, rigidity and extreme slowness in movement. Rest tremor in upper limb is common, which may also affect legs, mouth and tongue. The symptoms usually appear unilaterally.

Slowness in movement may develop gradually including slowness of gait and difficulty while performing the tasks like shaving, writing and fastening the buttons. Slowness in initiating or repeating movements and impaired fine movements especially of fingers are also found.

Rigidity or increased muscular tone causes stiffness and a flexed posture. Rigidity is mostly in upper limb, which may be cog wheel type or plastic (lead pipe) type.

Physical abnormalities like expressionless face, soft rapid, indistinct speech and impaired postural reflexes are present.

While walking there is slow starting, rapid, small steps, tendency to run, reduced arm swing and shortened stride.

Tremor’s appear first in fingers and may be in the form of flexion or extension of fingers, supination or pronation of forearm. Tremor’s are intermittent, are present at rest and get diminished on action.

Investigations

There are not many diagnostic tests for this disease. Diagnosis is generally made clinically. Imaging like CT scan or MRI of head is advised, when the diagnosis is in doubt or there are features suggestive of some other disease.

Management is done by drug therapy. Surgery is also done but rarely. Physiotherapy and speech therapy are also suggested.

Prognosis

This depends upon the age of onset. If the onset is in middle age then it progresses slowly. After the age of 70 this becomes severe.