DEFINITION
FACTS
SIGNS AND SYMPTOMS
rTMS AND PARKINSON'S DISEASE
SEARCH JOURNAL ARTICLES

DEFINITION

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. (National Insitute of Neurological Disorders and Stroke, 2007)

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FACTS

• An estimated 331,000 visits for Parkinson’s disease were made to office-based physicians in 2002. The most consulted physicians were GPs (59%), followed by neurologists (37%).
• Canadian retail pharmacies dispensed an estimated 667,000 prescriptions of Parkinson-indicated medications in 2002 – a 40% increase from the 478,000 prescriptions dispensed in 1998.
• 30% of all Parkinson's patients are under the age of 50
• 20% of all Parkinson's patients are under the age of 40
• Approximately 80,000 to 100,000 Canadians are suffering from Parkinson's disease

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SIGNS AND SYMPTOMS

Primary Symptoms

• Radykinesia: slowness in voluntary movement such as standing up, walking, and sitting down. This happens because of delayed transmission signals from the brain to the muscles.
• Tremors: often occur in the hands, fingers, forearms, foot, mouth, or chin. Typically, tremors take place when the limbs are at rest as opposed to when there is movement.
• Rigidity: otherwise known as stiff muscles, often produce muscle pain that is increased during movement.
• Poor Balance: happens because of the loss of reflexes that help posture. This causes unsteady balance which oftentimes leads to a fall.
• Parkinson's Gait: a common walk of somebody with Parkinson's disease. It includes shuffling, head down, shoulders drooped, lack of arm swing, and leaning backwards or forwards unnaturally. Initiating walking is difficult and freezing mid-stride is common.

Secondary Symptoms

• Constipation
• Difficulty swallowing; saliva and food that get caught in the mouth or in the back of the throat may cause choking, coughing, or drooling
• Excessive salivation
• Excessive sweating
• Loss of bowel and/or bladder control
• Loss of intellectual capacity
• Psychosocial: anxiety, depression, isolation
• Scaling, dry skin on the face or scalp
• Slow response to questions
• Small cramped handwriting
• Soft, whispery voice

As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50. Early symptoms of PD are subtle and occur gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.

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rTMS AND PARKINSON'S DISEASE

• Many patients that undergo rTMS therapy for PD notice that they are able to speak more clearly, increase their walking speeds, and increase repetitive hand movement speeds after rTMS treatment. Many PD patients require ongoing rTMS therapy to maintain these benefits.
• Previous studies have supported rTMS as a viable treatment option for improving speech and motor symptoms for patients with Parkinson’s disease (Khedr et al., 2006, Dias et al., 2006).
• “Previous studies in patients with Parkinson's disease have reported that a single session of repetitive transcranial magnetic stimulation (rTMS) can improve some or all of the motor symptoms for 30 to 60 minutes. A recent study suggested that repeated sessions of rTMS lead to effects that can last for at least 1 month (Khedr et al, 2006)”
• “Observations made using TMS give new pathophysiological insights in functioning of the central motor structures in Parkinson's disease and started new form of TMS - repetitive TMS (rTMS) as a treatment of the Parkinson's disease motor signs” (Derejko M et al, 2005).
• The initial course of rTMS therapy for Parkinson’s involves 10-20 high frequency treatment sessions, over a period of 1-2 consecutive weeks.
• Treatments are administered to three areas over the Motor-Area which is associated with movement.
• Please contact MCC staff members directly to obtain further details.

EXCERPTS FROM PEER-REVIEWED MEDICAL JOURNAL ARTICLES ON RTMS FOR PARKINSON'S DISEASE

• “The SMA [Supplementary Motor Area] stimulation, in contrast to the sham stimulation, engendered significant improvements in total scores and motor scores of the Unified Parkinson's Disease Rating Scale… Results indicate that 5 Hz rTMS over SMA modestly improves motor symptoms in PD patients…” (Hamada et al., 2008)

Search journal articles on Parkinson's Disease

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