Can You Have Parkinson’s Without Shaking

How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

What To Expect From Diagnosis

Theres no single test for Parkinsons, so it can take some time to reach the diagnosis.

Your doctor will likely refer you to a neurologist, who will review your symptoms and perform a physical examination. Tell your doctor about all the medications you take. Some of these symptoms could be side effects of those drugs.

Your doctor will also want to check for other conditions that cause similar symptoms.

Diagnostic testing will be based on your symptoms and neurologic workup and may include:

• blood tests

How Is Essential Tremor Treated

If you have essential tremor, you might find there are things that make it worse, such as stress, caffeine, alcohol and some medicines such as asthma medicines, Ritalin or lithium. Avoiding these triggers can help.

If needed, your doctor might prescribe medicine to decrease the tremor. Possible medicines include:

• beta blockers propranolol is the most commonly prescribed of the beta blockers, which are widely used to lower blood pressure
• anti-epileptic medicines such as primidone and gabapentin
• muscle relaxants such as alprazolam

Your doctor might suggest surgery if you are among the few people who have severe shaking despite avoiding triggers and taking prescribed medicines. Surgery to treat essential tremor may involve stimulation of an area in the brain called the thalamus and this procedure is known as deep brain stimulation.

If you notice that your hands shake and you dont know why, make sure that you talk to your doctor to get the right diagnosis and treatment.

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Assembling Your Care Team

Assembling a team that will provide you with physical and emotional support and adapt to your needs over time is one of the best ways to remain healthy. Parkinsons disease is complex and requires an interdisciplinary approach to care. The care team may include, but is not limited to:

• Movement disorder specialist
• Rehabilitation specialists including physical, occupational, and speech therapists
• Nurse

Parkinsons Is A Condition Which Produces Three Major Symptoms:

• Tremor
• Rigidity
• Akinesia

In addition, because of postural instability, poor balance can be a feature. These symptoms are also associated with disturbance of gait , particularly as Parkinsons progresses.

The symptoms may occur alone or in combination. They usually start on one side of the body and after a period of several years will then involve the other side of the body.

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What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

• Using stem cells to produce new neurons, which would produce dopamine.
• Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
• Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

What Can You Do If You Have Pd

• Work with your doctor to create a plan to stay healthy. This might include the following:
• A referral to a neurologist, a doctor who specializes in the brain
• Care from an occupational therapist, physical therapist or speech therapist
• Meeting with a medical social worker to talk about how Parkinson’s will affect your life

For more information, visit our Treatment page.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

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Gait & Balance Abnormalities

Parkinsons Disease Exam

Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.

Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.

We have three tests for this part of the PD exam:

1) Standing up from a chair

2) Free walking

3) Provoked pull test maneuver for balance

What Is A Parkinsons Tremor

Other health issues can also cause tremors, like multiple sclerosis or essential tremor. But Parkinsonâs tremors are different because theyâre usually:

• Resting. Parkinsonâs tremors happen when your muscles are still. They go away when you move. They also lessen while you sleep. For example, if youâre sitting in a chair with your arm relaxed, you may notice that your fingers twitch. But if youâre using your hand, like when you shake someone elseâs hand, the tremor eases or stops.
• Rhythmic. Parkinsonâs tremors are slow and continuous. They arenât random tics, jerks, or spasms.
• Asymmetric. They tend to start on one side of your body. But they can spread to both sides of the body.

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Other Typical Symptoms Of Parkinson’s

Tremor is an uncontrollable movement that affects a part of the body. A Parkinsons tremor typically starts in the hand before spreading to affect the rest of the arm, or down to the foot on the same side of the body.

There is no cure for a tremor, but there are ways to manage the symptom with support from a specialist or Parkinsons nurse.

Slowness of movement also known as bradykinesia may mean that it takes someone with Parkinson’s longer to do things. For example, they might struggle with coordination, walking may become more like a shuffle or walking speed may slow down.

Everyday tasks, such as paying for items at a check-out or walking to a bus stop, might take longer to do.

Parkinsons causes stiff muscles, inflexibility and cramps. This can make certain tasks such as writing, doing up buttons or tying shoe laces, hard to do. Rigidity can stop muscles from stretching and relaxing. It can be particularly noticeable, for example, if you struggle to turn over or get in and out of bed.

Symptoms and the rate at which they develop will vary from person to person. The most important thing to do if youre worried you have Parkinsons is to speak to your GP.

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

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Types Of Pain In Parkinsons

One review classified the types of PD pain as follows:

• musculoskeletal, in which the pain results from problems with the muscles , bones or joints
• dystonic, which is due to abnormal muscle contractions caused by PD or the medications used to treat it
• radicular pain or nerve pain
• central pain, which is poorly understood and thought to be due to abnormalities in the brain itself

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Parkinsons disease is unpredictable. PD is not a disease you can define other to say that it is ever-changing from one person to another. You may know someone with Parkinsons, yet you will not find another who experiences the disease in the same way. There is nothing certain about the disease. It is not predictable.

Most people do not, and cannot, understand this often misunderstood disease. They focus on the tremors or the dyskinesia . They do not understand it may entail other lesser-known symptoms such as depression, apathy, constipation, and irritable bowel syndrome, drooling, and skin concerns. Other invisible symptoms can include sleep disorders, loss of smell, cognitive issues, moderate to extremely severe pain, dystonia, facial masking, visual and speech issues, mood changes, blood pressure irregularities, tripping, a shuffling gait, restless leg syndrome, and urinary dysfunctions, to name a few more. Yet, these still are not all of the symptoms.

The symptoms of Parkinsons disease are misunderstood because basically, they are not visible and therefore cant be evidenced in most people who have PD.

We often do not believe in something we cant see, diseases included. Many times we choose to believe a person is not struggling or suffering because we cant see below the skin to where the real pain is occurring. Thats because Parkinsons is not just about shaking. Its so much more than that.

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What Looks Like Parkinsons But Isnt

Dr. Fernandez describes two main Parkinsons mimics:

Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.

It most often affects your hands, but can also affect your head and neck, larynx and other areas. In rare cases, it affects your lower body as well.

But one clue can help distinguish essential tremor from Parkinsons.

This is not an absolute rule, but if shaking occurs at rest, it often is Parkinsons. And if shaking occurs in action, such as when youre writing or eating, it is essential tremor, Dr. Fernandez says.

About half of those with essential tremor have a family history of the condition.

Unlike Parkinsons, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.

Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinsons, he says.

Drug-induced Parkinsons. Along with shaking, this condition may cause many symptoms similar to Parkinsons disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.

As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug youre taking, how long you take it and the dosage.

Your doctor likely will treat drug-induced Parkinsons by adjusting your medication.

How Do I Prevent Falls From Common Hazards

• Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
• Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
• Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
• Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
• Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
• Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

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Weakening Sense Of Smell And Taste

This may be due to degeneration of the anterior olfactory nucleus and olfactory bulb, one of the first parts of the brain affected by Parkinsons. This can happen so gradually that youre not even aware of it.

Losing your sense of smell and taste can make you lose interest in food. You may miss out on important nutrients and lose weight.

Painful Symptoms Of Parkinsons Disease

Pain can sometimes be an early symptom of PD. For example, a person may complain of a painful shoulder and be diagnosed with an orthopedic condition such as a frozen shoulder, only to develop a rest tremor on that side at a later point. The painful shoulder was in fact not a frozen shoulder after all, but rather pain due to the rigidity of PD. Now of course, sometimes a frozen shoulder is really just a frozen shoulder, so theres no need to jump to conclusions when you are experiencing pain. Not every ache and pain is a sign of PD, but it is important for you to educate yourself, be aware of the possible connections, and be proactive about seeking medical attention for any notable pain you are experiencing.

If you have PD and develop pain, it is important to first bring this to the attention of your doctor. The pain may be related to your PD, or the pain may be due to a common problem such as arthritis which is exacerbated by your PD. However, in some cases, it may be a symptom of a more serious medical problem. So do not assume that the pain is related to your PD before getting an appropriate medical workup.

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Dementia With Lewy Bodies

• Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
• DLB first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
• While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of their disease.
• There are no specific treatments for DLB. Treatment focuses on symptoms.

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What Causes Parkinsons Disease

Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

Treating Parkinsons With Complementary Medicine

Complementary medicine incorporates many different practices that can be used alongside conventional medicine to try to ease PD symptoms. There is typically not as much rigorous data to support the use of complementary medicine techniques, as compared to conventional medicine, but many patients find them helpful. These include yoga and massage.

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