G20.A2

Clinical Causes: Genetic predisposition: Family history of Parkinson's disease may increase risk. Environmental factors: Exposure to certain toxins or pesticides might contribute. Age: Incidence increases with advancing age, especially after 60. Biological factors: Loss of dopamine-producing cells in the substantia nigra region of the brain. Other risk factors: Head injuries and certain chemical exposures may also play a role.

Key Symptoms: Tremors: Often starting in a limb, particularly at rest. Bradykinesia: Slowness of movement affecting daily activities. Rigidity: Stiffness felt in limbs and body. Postural instability: Impaired balance leading to increased fall risk. Fluctuating symptoms: Periods of 'ON' (better movement) and 'OFF' (worse symptoms), especially during medication cycles. Speech changes: Softer, quieter, or rushed speech. Writing difficulties: Handwriting may become smaller and more difficult. Reduced facial expression: Known as 'masked face,' with less emotional display.

Diagnosis Path: Diagnosis is primarily clinical, based on medical history and neurological examination. Doctors assess the nature of movement symptoms and their progression. They also rule out other conditions with similar symptoms through various tests. Since there is no definitive test for Parkinson's disease, diagnosis often involves observing characteristic signs and response to medication. Imaging tests like DAT scans may support diagnosis, especially in uncertain cases.

Treatment Protocols: Medications: Levodopa combined with carbidopa remains the mainstay, helping replenish dopamine levels. Other drugs include dopamine agonists, MAO-B inhibitors, and COMT inhibitors. Managing fluctuations: Adjusting medication timing and dosing can help reduce 'OFF' episodes. Sometimes, advanced therapies like infusion treatments are considered. Physical therapy: Custom exercises can improve mobility, balance, and flexibility. Speech therapy: To address speech and swallowing difficulties. Occupational therapy: Support for daily activities and adaptive strategies. Surgical options: Deep Brain Stimulation (DBS) may be considered in advanced cases with significant fluctuations and motor symptoms.