Parkinsonism is a neurological condition caused by reduced dopamine levels in the brain—particularly in the substantia nigra. Dopamine is essential for smooth and coordinated muscle movement. When dopamine decreases, patients develop symptoms such as tremors, stiffness, and slow movement. Parkinsonism can be due to Parkinson’s disease, certain medications, toxins, or brain injury. Early diagnosis and proper treatment help improve daily functioning.
1. Causes of Parkinsonism
- Idiopathic Parkinson’s disease: Most common cause. Dopamine-producing neurons gradually degenerate.
- Drug-induced Parkinsonism: Caused by antipsychotics, metoclopramide, reserpine, and other dopamine-blocking drugs.
- Secondary Parkinsonism: Due to head trauma, brain infections, stroke, toxins (MPTP), or tumors.
- Genetic factors: Rare hereditary forms.
2. Symptoms of Parkinsonism
Symptoms usually progress slowly and start on one side of the body.
Core Motor Symptoms (TRAP)
- Tremor: Resting tremor, often described as “pill-rolling.”
- Rigidity: Stiffness of muscles, “lead pipe” or “cogwheel” sensation.
- Akinesia/Bradykinesia: Slow movement and difficulty initiating motion.
- Postural instability: Poor balance, tendency to fall.
Other Symptoms
- Shuffling gait
- Reduced facial expressions (masked face)
- Soft voice (hypophonia)
- Drooling
- Depression and sleep problems
- Constipation
- Cognitive decline in later stages
3. Diagnosis
Diagnosis is clinical and based on symptoms. There is no single lab test to confirm Parkinsonism.
- Physical and neurological examination
- Review of medications (to rule out drug-induced causes)
- MRI or CT scan to exclude stroke or structural problems
- Positive response to levodopa supports diagnosis of Parkinson’s disease
4. Treatment of Parkinsonism
Treatment depends on severity, age, and symptom pattern. Most therapies aim to restore dopamine levels or mimic its action.
1. Levodopa + Carbidopa
- Most effective treatment for reducing symptoms
- Carbidopa prevents breakdown of levodopa before it reaches the brain
- Helps with tremor, rigidity, and bradykinesia
- Side effects: nausea, dyskinesias (involuntary movements), postural hypotension
2. Dopamine Agonists
- Pramipexole
- Ropinirole
- Rotigotine patch
- Less effective than levodopa but useful in early disease or to reduce levodopa dose
3. MAO-B Inhibitors
- Selegiline
- Rasagiline
- Increase dopamine levels by preventing its breakdown
4. COMT Inhibitors
- Entacapone
- Tolcapone
- Prolong the action of levodopa
5. Anticholinergics
- Trihexyphenidyl
- Benztropine
- Mainly used to treat tremor in younger patients
6. Amantadine
- Helps with tremor and levodopa-induced dyskinesias
5. Non-Pharmacological Management
- Physiotherapy to improve balance and movement
- Occupational therapy for daily activities
- Speech therapy for speaking and swallowing issues
- Regular exercise to maintain mobility
- Nutritional counseling
6. Complications
- Dyskinesias (uncontrolled movements) from long-term levodopa
- Motor fluctuations (“on-off” phenomena)
- Depression and anxiety
- Swallowing problems
- Cognitive decline and dementia
- Frequent falls
7. Role of the Pharmacist
- Ensure correct dosing and timing of medications
- Monitor for side effects like dyskinesia and low blood pressure
- Educate patients not to stop medications abruptly
- Identify drug interactions (especially with MAO-B inhibitors)
- Support lifestyle modifications and adherence
- Help differentiate symptoms from medication side effects
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