Dr. Joon Faii Ong is one of the world’s foremost authorities on essential tremors. He has published more than 100 scientific papers in journals around the world and is well known for his contributions to understanding what causes tremor, how it can be treated, and its impact on quality of life.
In this article, Dr. Ong discusses how tremors affect the quality of life in Parkinson’s patients.
Parkinson’s Disease is a “non,” “familial,” or “sporadic” degenerative disorder of the central nervous system.
It results from a deficiency or loss of nerve cells that produce the neurotransmitter dopamine (DA) in areas of the brain such as the Substantia Nigra. The presence of Lewy bodies and cytoplasmic inclusion in neurons and glial cells is pathognomonic for this disorder.
Parkinson’s manifests itself in four main ways: tremor, rigidity, bradykinesia, and postural instability.
Parkinson’s is a progressive disorder. It begins with a very subtle tremor, which the patient or others around them may not even notice. As the disease progresses, rigidity and bradykinesia become more dominant, coupled with postural instability that often makes patients fall without warning. Eventually, the induced loss of DA leads to depression and dementia.
How Tremors Affect Quality of Life in Parkinson’s Patients
Tremor is the most common motor symptom that occurs in Parkinson’s patients. It can occur at rest or during voluntary movement, but it does not equally affect all Parkinson’s patients. In addition, the severity of tremor in a Parkinson’s patient can vary from barely noticeable to disabling.
An Essential Tremor (ET) is a type of tremor that occurs when one or more body parts move and shake involuntarily and uncontrollably. ET has many different characteristics and degrees (severity). Some individuals exhibit Parkinsonian symptoms such as stiffness, bradykinesia, and a resting tremor.
In Parkinson’s, ET usually develops as the disease progresses. In contrast to Parkinsonian tremor, which occurs at rest and is temporarily relieved by movement, essential tremor persists during movement or maintenance of a posture. The tremors associated with ET can be quite disabling for those who have trouble speaking, walking, eating, and writing.
In Parkinson’s patients with ET, the tremors can cause significant stress on a person’s quality of life. In fact, in one study of Parkinsonian patients with tremors at rest, those who had ET experienced more severe disability scores than those who did not have tremors at rest.
One of the goals of Parkinson’s medication is to reduce tremors. Parkinson’s medications either block the dopamine receptors to increase the amount of dopamine available in the brain or make it more difficult for neurons to release dopamine by other mechanisms. In other words, Parkinson’s medications “replace” the lost neurotransmitter.
In Parkinson’s patients with ET, there are many Parkinson’s medications that can help reduce tremors. However, Parkinson’s medications do not affect ET directly; rather, they act on the tremulous abnormal oscillatory discharge patterns in the brain to exert their effects on movement and tremor. In addition, some Parkinson’s medications also improve rigidity, bradykinesia, and postural instability in some Parkinsonian patients with ET. To read more on topics like this, check out the blog category.
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