Introduction: What is Parkinson's Disease?

Parkinson's Disease (P.D.) is a progressive nervous system brain disorder meaning symptoms continue to worsen over time. It affects the part of the brain which controls the movement of all the body parts. The cause of this disease is still unknown and up until now, there has been no cure for this disease. In layman’s language, the nerve cells ( which control the body movement and relay messages to and from the brain ) start degenerating. The primary motor signs include the following :

• Tremor of hands, arms, and legs while at rest is called resting tremor which occurs when muscles are relaxed such as hands resting on the lap or rigidity of limbs, or both.

• Slowness in movement.

• Postural instability or impaired balance and coordination of the body.

Difference between Parkinson's (Resting) Tremor and Essential Tremor:

Generally, the disease starts with a barely noticeable tremor in one hand. Tremor is a component of both Parkinson's disease and Essential tremor which are both movement disorders. Nonetheless, there is a difference between Parkinson's (Resting) tremor and Essential tremor which is that the tremors are the only symptom of essential tremor which involves shaking in the hands, limbs, trunk, head, or voice of a person. Stress can exacerbate essential tremors. Essential tremor has a strong genetic component and usually starts in early adulthood. For this kind of tremor, one can try one teaspoon of Apple Cider Vinegar, three times a day mixed in lukewarm water. Unlike Essential tremors, symptoms of Parkinson's disease include rigidity, movement problems, and balance difficulties.

As Parkinson's disease progresses, tremors aside there will be more difficulty in standing from a chair or bed, walking, balancing, doing daily work, eating, drinking, and sleeping, and also results in slow speech. Constipation & sleeping problems are most common in all the patients. As time passes the disease creeps slowly but steadily and there is a deterioration of every part of the body which gets worse over time leaving one handicapped and disabled. The symptoms of this progressive disease can be controlled temporarily with drugs but as mentioned before, there is no permanent cure. There are 5 stages of Parkinson's disease which will be discussed later on.

When the disease is confirmed a Neuro Physician will prescribe some basic medicines to control the nervous system. The following are the basic medicines :

1. Sinemet/Syndopa/LCD/Tidomet/ or any equivalent capacity 110, 125 or 250.

2. Amantrel 100

3. Pacitane 2mg /Heksi2

4. Selegiline 5

Dopamine Agonists ( DA ) which act directly on the dopamine receptors are also prescribed before the main medicines. They are given for reducing the risk of developing Levodopa-induced Dyskinesia called (LID)

Some of the Dopamine Agonists are as below :

1. Pramipexole

2. Ropinirole

3. Bromocriptine

4. Rasalect or Rasagiline.

A combination of both main medicines & dopamine agonists is often prescribed so that the main medicines’ side effects are minimized.

The main medicine for Parkinson's disease is Sinemet marketed by Merck & Co. an American Pharmaceutical company. This medicine had been used repeatedly in the treatment of my wife every time in the following three forms till it was available in India. When this medicine, Sinemet, was not available in India then its equivalent Sindopa, Lcd, Tidomat, etc. which are the Indian versions were used.

1. Sinemet 110 (Levodopa 100+ Carbidopa 10)

2. Sinemet 125 SR (Levodopa 100+ Carbidopa 25)

3. Sinemet 250 CR (Levodopa 200+ Carbidopa 50)

There are two components of Sinemet, one is Levodopa which is transmitted to the brain through blood barriers from the small intestine and converted into dopamine (nerve cell) in the brain. The other is Carbidopa which helps levodopa to cross the blood barriers before conversion to dopamine.

Note: I am not a doctor, please consult a Neuro physician for diagnosis and treatment for Parkinson's, here I have narrated the journey of my wife's Parkinson's journey.