Parkinson Disease

Parkinson’s disease is a central nervous system disorder characterized by long term progressive degeneration in motor neurons. Health data from the year 2015 found that Parkinson’s disease affected some 6.2 million people with approximately 117,400 deaths across the globe.

The primary pathophysiological process in Parkinson’s disease involves the death of dopamine secreting cells in an area of the brain called the substantia nigra. This has far reaching implications. Circuits affected by the loss of these dopamine secreting cells include the motor, oculo-motor, associative, limbic and orbitofrontal tracts, which coincide with the loss of a variety of motor functions noted in Parkinson’s.

The cause of this cell death is unknown. Researchers have noted the presence of an abnormal collection of protein, called Lewy bodies, in these cells. However, recent studies suggest that these lewy bodies may actually serve a protective rather than causative role.

The four cardinal signs of parkinson’s includes: tremor, postural instability, rigidity and slowness of movement. A characteristic feature often described is the ‘pill rolling’ tremor due the tendency of patients to move their index and thumb in a circular movement.

Parkinson’s is a clinical diagnosis that is based upon the history and neurological examination. It is typically made by a neurologist, outpatient. Imaging is typically not required, but may be performed to rule out other CNS causes that could lead to a similar presentation as Parkinson’s.

1. Parkinson’s disease is a chronic condition that is typically managed in the outpatient setting.

2. There is no cure for parkinson’s. Levodopa is the initial treatment of choice.

3. In the ED setting, ensure good outpatient follow-up. Otherwise, consult neurology to discuss the possibility of inpatient admission for medication initiation of treatment or medication adjustments as necessary.

1. American Academy of Neurology
2. Partners in Parkinson