The Parkinson’s disease ON-OFF phenomenon is something many patients experience. The phenomenon refers to a change between mobility and immobility that can happen at the flick of a switch. OFF episodes usually occur at the end of a dose when levodopa medication begins to wear off. For patients with Parkinson’s disease, the ON-OFF phenomenon can be life-altering. However, understanding your unique OFF episodes can help you combat the physical and emotional effects. Let’s explore what we know about the Parkinson’s disease ON-OFF phenomenon.

The Parkinson’s Disease ON-OFF Phenomenon

In Parkinson’s disease, the ON-OFF phenomenon occurs when levodopa medication stops working effectively. As Parkinson’s disease progresses, the brain’s levodopa plasma concentration decreases, causing levodopa medications to wear off temporarily and symptoms to return. OFF episodes are most common in patients who have been taking oral levodopa for 3-5 years.

OFF episodes are defined as a returning of Parkinson's symptoms such as tremor, rigidity, slow movement and memory problems. ON periods refer to the times when medicine works and your symptoms are well-controlled, typically just after a dose.

Not all OFF episodes are the same; most people have fluctuating responses to levodopa. What’s more, everyone experiences Parkinsonian symptoms differently due to the bespoke nature of the disease.

The Physical and Emotional Effects of OFF Episodes

The majority of patients experience Parkinson's disease ON/OFF time in the latter stages of the disease. 64% of people with PD reported having 2 hours or more of OFF time per day. Many of those same people feel frustrated and helpless when their medication stops working.

According to OFF Limits PD, there are four types of OFF episodes, each with different physical and emotional effects:

Morning OFF (akinesia)

Morning OFFs occur in roughly 60% of PD patients. They typically appear after a treatment-free night, making it difficult for people with Parkinson’s to get up and on with their day. Symptoms may diminish after you take your first dose of Parkinson’s disease medication, or they may linger throughout the morning. You may have a delayed ON or no ON at all. Morning OFFs can result in depression, lethargy, physical inactivity and pain.

Wearing OFF

Wearing OFF happens when the effectiveness of medication starts to deteriorate toward the end of a dose. Patients may feel frustrated and hopeless as they feel the medicine beginning to wear off and their symptoms returning. Not only does this take an emotional toll, but it can also be physically debilitating. The good news is, your doctor can help you manage your medication to reduce your “wearing OFF” episodes.

Delayed ON, partial ON, no ON

Delayed or partial ONs refer to interruptions in symptom improvement, or no improvement at all, following a medication dose. This can cause anxiety, depression and stress, as well as physical symptoms such as tremor, rigidity or postural “freezing”. If it takes a while for your medication to kick in or your ON periods are becoming less frequent, talk to your doctor about adjusting your dose.

Unpredictable OFF

Unpredictable OFFs can be incredibly frustrating and challenging because you cannot plan your life around them. Affecting 36% of patients, these OFFs aren’t usually related to medication dosage, meaning changing or increasing your dose may not help. Unpredictable OFFs tend to be severe, occurring in a matter of seconds or minutes. They may leave you feeling physically and mentally disabled, which can take its toll on all areas of your life. Talk to your doctor about your treatment options if you experience unpredictable OFFs. You may also benefit from talking to a therapist.

Treatment Options for OFF Episodes

If you show signs of the Parkinson’s disease ON-OFF phenomenon, your doctor may wish to adjust or change your medication. You might be advised to shorten intervals between doses or take your medication on a different schedule. Your doctor may also suggest taking a dopaminergic agent to keep you ON for longer periods.  

Scientists are also working on new treatments to reduce OFF episodes in PD patients.  Inbrija – a new levodopa drug in the form of an inhalation powder – will launch in the first quarter of 2019. This new treatment has been approved by the FDA to treat OFF periods by administering levodopa directly to the bloodstream. It will become available on prescription through a network of specialty pharmacies in the U.S.

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Many people wonder: is Parkinson's disease hereditary? Is there a Parkinson’s disease gene? It's important for patients with Parkinson's disease to understand what caused Parkinson's, especially if they worry about family members inheriting the disease. Others are concerned that they will one day develop Parkinson's, especially if they have seen a parent or grandparent go through it. Although genes are a factor in Parkinson's, the answer to this question is not straightforward. Find out if Parkinson's disease is hereditary and whether or not you should worry.

Is Parkinson’s Disease Hereditary? The Facts

Hereditary diseases are passed from parent to child through genes, but is Parkinson's one of them? Even though Parkinson's can be passed genetically, this is rare. Here are some facts to shed some light on the issue:

• Only 15% of people with Parkinson’s reported having someone in the family with the condition.
• Having a parent with Parkinson’s disease only increases your risk of getting Parkinson’s by 3%.
• Most people with early-onset Parkinson's disease ( diagnosed before the age of 50) are likely to have inherited it.

So is Parkinson’s disease hereditary? Yes, Parkinson’s disease can be genetic. But that’s not to say you will inherit the Parkinson’s disease gene if your parent or grandparent has the condition. Nor does it mean you won’t develop it just because it doesn’t run in your family. Parkinson's can be traced to various gene mutations, but most of the time the cause is unknown.

How Do You Get Parkinson’s Disease?

There is no known cause of Parkinson's disease. Scientists and researchers have found that Parkinson's is caused by a combination of genetics, environmental factors and unknown causes. Patients with Parkinson's disease have been seen to have low dopamine and norepinephrine levels in the brain, as well as Lewy bodies (clumps of protein in the brain) which can occur after exposure to toxic chemicals and aldehydes.

There is no way to avoid getting Parkinson’s, whether or not the disease runs in your family. Some research suggests that avoiding toxic chemicals such as those found in reheated cooking oils and pesticides can reduce your chances of getting Parkinson’s, but this isn’t always possible.  

What to Do If Someone in Your Family Has Parkinson’s Disease

If you spot the signs of Parkinson’s disease in a member of your family, it’s important to consult a doctor straight away. Your doctor can formally diagnose the condition and identify where your loved one is on the Parkinson’s scale. He or she will also suggest ongoing treatment – such as medication and occupational therapy – to help ease their symptoms.  

The Michael J Fox Foundation Center for Parkinson’s Research recommends these tips for caregivers:

• Find a support group for caregivers.
• Stay informed of developments by keeping in close contact with doctors and care staff.
• Stay organized when arranging appointments and physical therapy sessions.
• Expand your medical team to include as many medical professionals as possible.
• Watch for depression and anxiety
• Don’t overlook your own needs

What to Do If You Need Support for Parkinson’s

If you have Parkinson’s disease or you’re caring for someone with the condition, you can contact the National Parkinson’s Foundation Helpline on 1-800-4PD-473-4636 for emotional support and advice.

It can be challenging to see someone you love experience Parkinson’s disease, especially if they require full-time care. However, having someone with Parkinson’s in your family does not mean that you will get it. Parkinson’s disease is not always hereditary.

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Attending Parkinson’s disease support groups can be helpful for many reasons. Whatever stage of Parkinson’s you’re at, the disease can be incredibly isolating, and many people report not feeling connected to others who don’t understand their experience. This is among the many reasons why support groups are helpful for Parkinson's disease patients. Whether you're looking for Parkinson's emotional health support or informative resources, there are many benefits to joining a Parkinson's disease support group.

Why Join a Parkinson’s Disease Support Group?

When you are diagnosed with Parkinson’s disease, it often feels like you a part of a club you didn’t want to join. You may worry that you won’t connect with others with the condition – that they are all older or less active than you. Parkinson’s disease affects people of all ages and abilities, and it presents differently in everyone ("Symptoms of Parkinson’s Listed and Explained"). You may be surprised by how energetic and uplifting Parkinson’s disease support groups can be.

There are various benefits to joining a Parkinson's disease support group, including:

• Regular support
• Education about your condition and ways to manage it
• A chance to learn new coping skills
• Finding comfort in people you can relate to
• Opportunities for empowerment and growth

Misconceptions About Parkinson’s Disease Support Groups

Many people are reluctant to try Parkinson's disease support groups as they fear that talking to or seeing others in later stages of the disease will be difficult or depressing. Others worry that talking about their condition will force them to focus on the negatives. However, the opposite is usually true. Here are some common misconceptions about Parkinson's disease support groups:

Parkinson’s disease support groups are depressing: According to the Michael J. Fox Foundation of Parkinson’s Research, most people are pleasantly surprised by how “normal” a Parkinson’s support group can be. Some groups will involve activities or exercises, while others may focus on fundraising, getting involved in clinical research or simply sharing advice and information with others. It’s important to try a few different support groups to find the right one for you.

Only older people go to Parkinson’s support groups: Parkinson’s disease support groups usually contain a mixture of ages and abilities, and you never know who you’ll meet. That said, there are sometimes specific support groups for people with early-onset Parkinson’s, depending on where you live. Discuss your support options with your care provider.

All you do is talk: Depending on the type of group you attend, you may be encouraged to talk about your experience of Parkinson's disease – but that's not all you'll do. Support groups can be incredibly proactive places where people share tips, exercises and information to help one another. You may meet people with similar interests to you that are entirely unrelated to Parkinson's disease.

Local Support Groups for Parkinson’s Disease

Thanks to the Internet, it’s relatively easy to find local support groups for Parkinson’s disease. You can search “Parkinson’s disease support groups near me” in Google with your Location Services switched on, and you should be directed to meetings in your area. Your doctor will also be able to give you information on local Parkinson’s disease support groups, as well as the numbers to call if you have questions or need advice.

The American Parkinson’s Disease Association has a useful tool for anyone trying to find support in their community, where you can search by zip code to find groups, classes and resources in your area.

Alternatively, you can search for online support groups for Parkinson’s disease if you don’t feel like meeting up in person. Online support groups can be a great help for those in the later stages of Parkinson’s, where driving and getting around become increasingly difficult.

Some people with late-stage Parkinson’s disease have difficulty with speech, while others find that tremors and dyskinesia (involuntary movements brought on my medication) make it difficult to type on a computer or smart device. Therefore, there is no one-size-fits-all approach to Parkinson’s support groups. It can be helpful to try a few different Parkinson’s disease support groups to find out what works best for you.

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Parkinson's disease causes are mostly unknown. Doctors know that the condition develops when nerve cells die in the brain, but there is no finite reason why this occurs. Over the years, vast amounts of research have been done in this area to determine whether genetics, lifestyle factors or both cause Parkinson's. While Parkinson's disease isn't always preventable, these studies have provided some insight into possible Parkinson's disease causes.

Parkinson’s Disease Causes: The Facts

There is no known cause for Parkinson’s disease, so sadly there is no way to avoid it. However, Parkinson’s disease is found to be more common in men than women. It mostly affects people aged 65 and over. However, early-onset Parkinson’s can occur in younger adults.

Scientific research has identified the following possible causes for the disease:

• Genetic factors: The disease can run in families, but Parkinson's isn’t always hereditary. There is no reason to suspect that you will get Parkinson’s just because a blood relative has it.
• Low dopamine levels: Dopamine plays an essential role in sending messages to the part of the brain that controls coordination. Those with Parkinson’s are reported to have low dopamine levels, making it harder for them to control their movements.  
• Low norepinephrine levels: Norepinephrine is another neurotransmitter responsible for controlling automatic bodily functions, such as blood circulation and bowel movements. Parkinson’s disease causes the nerve endings that produce norepinephrine to die, leading to problems like fatigue, constipation and low blood pressure (hypotension).
• Lewy bodies in the brain: Research has found that people with Parkinson's disease often have clumps of protein, known as Lewy bodies, in their brain. These Lewy bodies can also be linked with other conditions, including Parkinson's disease dementia.  

So, how do you get Parkinson’s disease? On the whole, scientists agree that the condition is caused by a complex set of genetic and environmental factors, many of which are unknown. There is currently no cure for Parkinson’s disease, though clinical trials are taking place all over the world as we speak.

How to Prevent Parkinson’s Disease

There is no definite way to prevent Parkinson's disease. However, research suggests that the following lifestyle factors can make a difference:

Eating turmeric: Turmeric is an antioxidant, so it can help to prevent Lewy bodies in the brain, according to a laboratory study. Berries, apples and red grapes can also have the same effect.  

Avoiding aldehydes: Some scientists have linked aldehydes (toxic chemicals found in many reheated cooking oils) to increase the risk of neurodegenerative diseases, including Parkinson's disease and dementia.

Banishing toxic chemicals: Exposure to pesticides, herbicides and other toxins can increase the risk of neurological diseases. You should try to avoid these chemicals and make sure you wear the appropriate protective clothing if you do have to make contact.

The causes of Parkinson’s disease are largely unknown. However, these recent findings do help to shed light on the condition. Many people with Parkinson’s find that information helps them feel reassured and in control.

If you still have questions concerning Parkinson’s disease causes and treatment, it’s best to consult your doctor or contact a reputable organization for support, such as the National Parkinson’s Foundation Helpline (1-800-4PD-473-4636).

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Parkinson’s disease OFF episodes occur in people who take medication containing levodopa for Parkinson’s disease symptoms. An OFF episode refers to the time when levodopa stops working as effectively as it should, which typically occurs in the later stages of the disease. This causes a return of symptoms such as slowed movement and Parkinson’s gait. Parkinson's disease patients often feel better during ON periods when they have just taken a dose of levodopa, but their symptoms may return while they are waiting for their next dose. So, what exactly are Parkinson’s disease OFF episodes and why do they happen?

Parkinson’s Disease OFF Episodes: What are OFFs?

Parkinson’s disease OFF episodes refers to periods of the day when Parkinson’s medication does not work well, causing the worsening of Parkinsonian symptoms. Typically, patients have higher occurrences of OFFs in the morning following a treatment-free period overnight. The medical term for this is morning akinesia.

OFF episodes are part of the Parkinson’s disease ON/OFF phenomenon that affects patients in the late stages of Parkinson’s. This happens when patients have been taking levodopa for 3-5 years, and the medication stops working as well as it did.

Characteristics of OFF episodes include motor fluctuations such as:

• Stiffness
• Slowed movement
• Frozen gait (inability to move at all for seconds or minutes)
• Difficulty speaking and/or slurred speech

These symptoms are caused by the Parkinson’s disease medication wearing off, usually around 3 hours after a dose or overnight. By contrast, ON periods can feel like someone has turned on a light. You may suddenly feel more energetic and able to move around freely. ON periods are when you feel at your most capable because your symptoms are controlled.

Unless your doctor makes changes to your medication, you will experience more OFF episodes than ON episodes between doses. Thankfully, there are various ways to manage Parkinson’s disease OFF episodes when your Parkinson’s medication is not working.

How to Manage Parkinson’s Disease OFF Time

Parkinson's disease OFF time can be both upsetting and debilitating. You may not understand why your symptoms have returned, and you may find it difficult to go about your daily life during these episodes. Here are some ways you can manage Parkinson's disease OFF time:

• Medication: Your doctor may prescribe a new levodopa drug, such as one with controlled release to make your ON periods last longer. You might have to take other medications on top of your current prescription to help you manage your symptoms. Alternatively, you may need to increase your existing medication or shorten your internals between doses.
• Surgery: If your symptoms are severe and don't respond to medication, your doctor may suggest surgery. Brain surgery for Parkinson's disease is called deep brain stimulation and involves inserting electrodes inside the brain that connect to a neurotransmitter in your chest. The neurotransmitter will send electrical stimulation to the parts of your brain that control movement. Many patients see a marked change in symptoms after having DBS.
• Diet: Most doctors recommend taking levodopa medicines at least 30 minutes before you eat. This is because protein can slow down the absorption of the drug, making it less effective. Eating a healthy balanced diet is vital for all areas of health, so your doctor may refer you to a dietician to ensure you stay physically well.
• Scheduling: In the later stages of Parkinson’s disease, it’s not uncommon for medications to stop working as effectively. For this reason, specialists often suggest planning your day around your ON and OFF periods so you can make the most of your ON time. This might mean you avoid certain activities during OFF episodes or ensure there is someone to care for you when your symptoms are severe.
• Symptom tracking: Whether or not you’re experiencing OFF episodes, it can be useful to track your symptoms so you can give your healthcare provider a full view of your condition. Certain Parkinson’s disease medications can affect the memory, so it’s worth writing down symptoms and side-effects if you think you will forget them.
• Complementary and homeopathic therapies: Exercises such as yoga, tai chi and massage have been found to be helpful for those with Parkinson's disease. Multiple studies have found a link between stress and the worsening of PD symptoms, so finding ways to relax is incredibly important.

While Parkinson's disease OFF episodes can be distressing, they don't signal the end of successful treatment. If your Parkinson's disease medication is wearing off, it's important to consult your doctor right away. He or she will be able to tailor your treatment plan to help you deal with your symptoms and manage your OFF time more effectively.

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Parkinson's disease psychosis occurs in around 50% of PD patients. In Parkinson's disease, hallucinations and confusion are relatively common, often occurring as side-effects of Parkinson's medications. These symptoms can also be indicative of Parkinson's disease psychosis, however, so it's important to consult your doctor if you think you might be delusional or psychotic. In the meantime, here is everything you need to know about Parkinson's disease psychosis, including symptoms and treatment.

What Is Parkinson’s Disease Psychosis?

Parkinson’s disease psychosis is a neuropsychiatric condition that occurs in over half of all people with Parkinson's disease. Although it is relatively common, few people speak up about their experiences of psychosis, whether or not they have a neurological condition like PD.

According to recent studies, only 10% of people with Parkinson’s disease psychosis report their symptoms to their physicians. However, the symptoms of Parkinson's disease psychosis can put you and other people at risk, so it's important to speak up, even if the symptoms are mild. Remember: your symptoms may be a result of your medication; they don't indicate that anything is wrong with you or that you are mentally unwell ("How Parkinson’s Disease Affects Your Mental Health").

Parkinson’s Disease: Symptoms of Psychosis

Common symptoms of psychosis in Parkinson’s disease include:

• Visual hallucinations: Seeing things or people that aren't there
• Auditory hallucinations: Hearing voices and other noises that no one else can hear. Parkinson’s disease and auditory hallucinations are more common in people over the age of 65
• Tactile hallucinations: Touching or feeling something that isn’t really there
• Olfactory hallucinations: Imagining strong smells
• Confusion: Not being sure what’s real and what isn’t. In Parkinson’s disease, hallucinations and confusion can occur as a result of certain PD drugs, so your doctor may wish to change your medication if you report these symptoms
• Paranoia: Believing that people aren't who they say they are, or that your loved ones or doctors are trying to hurt you. You may also feel an intense suspicion of abandonment or extreme jealousy of others who are well
• Delusions: Irrational or illogical beliefs not based in reality 
• Agitation: A state of high anxiety or extreme restlessness
• Argumentative and aggressive behavior: Lashing out at others or refusing help

Confusion and delusional thinking are common in PD psychosis, so you may not be able to identify psychotic symptoms in yourself. Usually, Parkinson's disease psychosis is noticed by loved ones or care staff. However, if you think you're displaying some of the signs, report them to your doctor immediately. Psychotic episodes can be incredibly frightening and upsetting, but there's no need to suffer in silence.

What Causes Parkinson’s Disease Psychosis?

Hallucinations and psychosis in Parkinson's disease may occur as a result of chemical and physical changes in the brain. Drugs used to treat Parkinson's disease can also cause psychotic symptoms, so your doctor should monitor you closely when you start taking a new medication.

Although Parkinson's disease psychosis is scary and upsetting, there are various ways to treat the symptoms. Your doctor may wish to withdraw your medication to see if it is causing your psychosis, or you might be prescribed an antipsychotic. Antipsychotic medications commonly used for people with Parkinson's disease psychosis include clozapine, quetiapine, and ziprasidone.

If your psychosis does not go away with a change of medication, your doctor may run tests to rule out intercurrent physical illness, electrolyte imbalance and systemic infection. They may also suggest specific lifestyle changes, such as improving your sleep health, avoiding sensory overload and seeking full-time care, if that’s something you don’t already have.

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Parkinson's disease and mental health is a complex issue. While Parkinson's disease doesn't exactly cause mental health issues, it can increase your likelihood of depression, anxiety and even psychosis. Sometimes, these symptoms show up long before other signs of Parkinson's, making them difficult to diagnose and treat. What's more, certain Parkinson's medications can add to the emotional challenges that often come with the illness. All of this can take a toll on your Parkinson's disease and mental health, so what's the solution?

Parkinson’s Disease and Mental Health: What’s the Link?

The relationship between Parkinson's disease and mental health is not straightforward. This is because, when it comes to the brain, no one is entirely sure what causes either Parkinson's disease or mental illness. However, there is no evidence to suggest that a pre-existing mental health condition increases your risk of developing Parkinson's disease ("Parkinson’s Causes: How Do You Get Parkinson’s Disease?"). On the other hand, a diagnosis of Parkinson's disease does make you more susceptible to developing mental health conditions.

Anxiety and depression are the most common mental health symptoms in people with Parkinson's. Signs to look out for include:

• Changes in appetite, either eating too much or too little
• Excessive tiredness
• Stress or irritability
• Lack of interest in hobbies and activities
• Feeling hopeless or “down” most days
• Feeling fearful or constantly worried

The mental health symptoms of Parkinson's disease can also affect your physical symptoms and vice versa. For example, some people find that their anxiety increases when they have OFF episodes where their medication doesn't work as well. Others report feeling depressed as a result of worsening symptoms.

If you're struggling with the mental or emotional effects of Parkinson's disease, you should talk to your doctor. He or she may suggest changing or adjusting your medication.

How are Mental Health Problems Treated in Parkinson’s Disease?

Mental health problems in Parkinson's disease can be treated with a combination of medication, talking therapy and lifestyle changes. Your doctor may also suggest joining a Parkinson’s support group so that you can share your challenges with other PD patients. 

Other ways to care for your mental health if you have Parkinson's include:

• Getting outside as much as possible: Taking a walk becomes increasingly difficult as Parkinson's disease progresses, but daylight and fresh air can do wonders for your mental wellbeing. Scientists say that just five minutes a day in nature can boost overall mood and self-esteem. 
• Gardening: Gardening has many physical and cognitive benefits and promotes social interaction. Research has also found that gardening has a positive impact on those with dementia, cancer and other long-term health conditions.  
• Eating a healthy diet: Doctors often talk about the link between food and mental health, but did you know that diet is essential for Parkinson's treatment, too? Try to eat a balanced diet filled with whole grains, fruit and vegetables, and ask your doctor about any foods you should avoid if you're taking medications.  
• Spending time with others: Both Parkinson's disease and mental health problems can be isolating. Try to ensure you spend as much time around other people as possible, including friends, family and the people you meet at support groups. Although you may not always feel up to socializing, lack of social connectedness can have a negative impact on your life with PD, so it's important to spend time with others whenever you can.  
• See your doctor: While numerous positive lifestyle changes will improve your mental health with Parkinson's disease, symptoms such as hearing voices, visual disturbances, extreme anxiety or thoughts about harming yourself or others should always be reported to your doctor. These may be signs that you need closer monitoring and treatment.  

Parkinson's disease and mental health problems are not easily cured. However, there are a variety of treatment options and lifestyle changes that can boost your mental wellbeing and improve your overall quality of life.

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Parkinson's disease surgery – known as deep brain stimulation – is one of the possible treatment options for Parkinson's disease. Deep brain stimulation was initially approved to ease tremors in PD patients in 1997,  but it was later used to treat patients in the advanced stages of Parkinson's disease. The surgery is also offered to patients in the early stages of Parkinson's disease who do not respond to medication. Learn more about the effectiveness of Parkinson's disease surgery and what it involves.

What Is Parkinson’s Disease Surgery?

Parkinson's disease surgery is a brain operation called deep brain stimulation (DBS). The surgery is also used to treat epilepsy, obsessive-compulsive disorder (OCD) and a condition called "essential tremor."  DBS is widely considered one of the most significant neurological breakthroughs in recent history, posing a potential treatment for major depressive disorder, stroke recovery and addiction. Parkinson's disease brain surgery aims to interrupt problematic electrical signals from targeted areas in the brain and reduce PD symptoms.

How Does DBS Surgery Work?

Deep brain stimulation involves electrodes (also known as "leads") being inserted into the brain through a small opening in the skull. These electrodes have an extension of insulated wire that passes under the skin of the head, neck and shoulder, before connecting the lead to a neurotransmitter or ("battery pack") the size of a stopwatch. The neurotransmitter is implanted under the skin, usually near the collarbone. The role of the neurotransmitter is to deliver electrical stimulation to the parts of the brain affected by Parkinson's disease to block PD symptoms. The device will be turned on a few weeks after the surgery and will be adjusted to find the right setting for you.

Deep brain stimulation cannot cure Parkinson's disease, nor will it slow down the progression of symptoms. However, most people notice a marked reduction in symptoms after DBS, although many continue to take medication in small doses. The surgery may help you manage the effects of Parkinson's disease so that you can lead a more comfortable life with the condition.

Am I Eligible for Parkinson's Disease Surgery?

Before surgery, you will have a series of tests to make sure deep brain stimulation is the right option for you. You'll also be given a brain imaging scan to map the areas of your brain where the electrodes will be inserted.

According to The Parkinson’s Foundation, you may be eligible for DBS if you meet the following criteria:

• You've experienced PD symptoms for more than five years.
• Your symptoms interfere with your daily life and activities.
• You have ON/OFF fluctuations despite consistent medication.
• You have dyskinesias (involuntary movements of the arms, legs and head).
• Your symptoms do not get better with medication.
• You are unable to tolerate Parkinson’s disease medications due to adverse side-effects.
• Your tremor cannot be managed with medication.
• You have tried various combinations of Parkinson’s disease medications under the supervision of a neurologist who specializes in movement disorders.

In some cases, surgery may be offered to you even though you’ve responded well to Parkinson’s disease medications like carbidopa/levodopa, especially if the duration of response is deemed insufficient. Each Parkinson’s disease patient is different, so your symptoms and prognosis will be evaluated on an individual basis so that you and your doctor can decide on an appropriate treatment plan.

Parkinson’s Disease Brain Surgery: What to Expect

Parkinson’s disease brain surgery can either be done under general anesthetic or with you awake and alert with a local anesthetic to numb your skull. Either way, you shouldn't feel anything during the procedure because there are no pain receptors in the brain. The surgery is performed in two parts: one for the insertion of electrodes into your brain, and one for the placement of the neurotransmitter in your chest.

After surgery, your device will be turned on at the doctor’s office and you will be given a remote control to take home with you. From then onwards, your doctor will work with you to help you manage your symptoms. You may also decide to turn the device off at certain times. It could take a few months to find the right setting for you.

What Are the Risks?

As with any surgery, there are risks associated with deep brain stimulation. If you have DBS, you have about a 3% risk of seizure, infection and confusion. Parkinson's disease deep brain stimulation also carries a small chance of stroke. Once the neurotransmitter device is turned on, you may experience side-effects such as numbness, muscle tightness, tingling sensations balance problems or mood changes; these can be managed with help from your doctor.

Your doctor will work with you to assess your Parkinson’s disease and surgery eligibility and discuss the advantages and disadvantages of this treatment route. If you have any questions, do not hesitate to run them past your treatment provider or call the National Parkinson’s Foundation helpline on 1-800-4PD-INFO (473-4636) for more information.

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The Parkinson's tremor affects 80% of people with Parkinson's disease. Sadly, it is also one of the more difficult symptoms to treat. The PD tremor is characterized by a quivering movement or shakes that occurs at rest, but it presents differently in everyone. People in the early stages of PD usually experience tremors starting in one hand, leg or foot, but the tremor may eventually progress to both sides of the body. Find out the effects of Parkinson's tremor on the body and explore ways to treat motor symptoms of the disease.

What Does Parkinson’s Tremor Look Like?

The classic Parkinson's disease tremor is characterized by a slow and rhythmic movement that appears at rest and disappears with activity. Tremors can affect any part of the body, including the jaw, face, hands, legs and arms, but they most commonly present in the fingers. For some, the tremor only ever occurs on one side. For others, the tremor may spread to both sides of the body or different areas, such as the legs, feet, jaw or tongue.

The Parkinson's disease tremor may be noticeable and attract attention. Others may experience "internal tremors" which have no outward signs at all. Either way, many people with Parkinson's disease find their tremors upsetting or shocking. Communicating with your healthcare team can help you manage your tremor and its impact on your emotional and physical health.

Parkinson's disease motor symptoms don't always occur at the start of the illness. It can take months or years to progress through the stages of Parkinson's disease and see the effects on your body. What's more, the Parkinson's disease tremor is the only PD symptom that can improve with time. Many find that their tremors diminish or disappear as the disease progresses.

Parkinson’s Tremor: Effects on the Body

Parkinson’s disease causes damage to the nerves in the brain, causing a reduction of dopamine cells and an accumulation of alpha-synuclein – also known as Lewy bodies. This damage is what causes the motor symptoms of Parkinson’s disease, such as tremors and Parkinson’s disease gait.

Despite what many people think, the Parkinson's tremor isn't the most challenging symptom of Parkinson's disease. For many, tremors are irritating or uncomfortable, but they aren't debilitating. There is evidence to suggest that those who experience tremor as a major symptom have milder versions of the disease and live longer, though no one knows quite why this happens.

Tips for Dealing with Parkinson’s Disease Tremor

Because the Parkinson's tremor appears at rest, many people find that exercise helps control their symptoms. Here are some tips to help you limit the effects of Parkinson's tremor:

• If the tremor presents in your jaw, try chewing gum to keep the area moving.
• Foot tremors present when you are sitting or lying down, and they always disappear when you stand up. Therefore you should try to avoid long periods of inactivity, as staying still may worsen your tremor symptoms.
• Finger twitching and the "pill roll" tremor refer to tremors in the thumb and fingers. You may find hand exercises such as rotating your hands, moving your fingers or squeezing a stress ball will help ease your symptoms. If you feel self-conscious about your tremor, you can always hide your hands in your pockets or place them under a table until the shaking subsides.

Treatment for the Motor Symptoms of Parkinson's Disease

There are many ways to deal with Parkinson’s disease motor symptoms, including medications, occupational therapy and lifestyle adjustments. You may find that tremors make you more susceptible to accidents – such as tripping, falling or spilling hot liquids – so you must take care and ask for the help and support you need.

Unlike other Parkinson's motor symptoms, tremors can be hard to treat with medication. However, medicines can be helpful for treating symptoms such as Parkinson's disease gait impairments, which can have a major impact on your life. The gait of Parkinson's disease presents slightly differently in each patient. Some experience the Parkinson's disease shuffling gate, which can make movement markedly slower and make it look like you are "dragging your feet." You may also experience reduced arm movement while walking.

In Parkinson's disease, freezing of gait is characterized by hesitation before stepping forward, or a feeling like your feet have frozen to the floor. Frozen gait usually only lasts for a step or two, but you will need to be careful when crossing busy streets and try to minimize your risk of falling wherever possible.

You can talk to your doctor about medications to try, as well your surgical and homeopathic options. However, there is no cure for Parkinson's disease and no way to stop the symptoms entirely, but scientists are working to change that.

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The Parkinson's disease brain stops producing dopamine cells, which in turn causes problems with movement and coordination known as motor symptoms. We all have a basic understanding of how Parkinson's disease affects the brain, but what really happens when someone has Parkinson's disease? Let's explore the facts surrounding the Parkinson's disease brain and how it differs from a normal, "healthy" brain.

The Parkinson's Disease Brain: What We Know

Parkinson's disease is a degenerative disorder of the nervous system, which most scientists agree originates in the brain. We know that Parkinson's disease causes damage to the nerves in the brain, which in turn reduces dopamine cells, but did you also know that this leads to an accumulation of alpha-synuclein, known more commonly as Lewy bodies? This damage is thought to be what causes the motor symptoms of Parkinson's disease, though scientists still have many questions as to how this works.

Parkinson's Disease Brain vs. Normal Brain: What's Different?

It's not yet possible to spot the difference between a brain with Parkinson's and a normal, "healthy" brain on an MRI scan. However, since Lewy bodies were first found in the substantia nigra in 1927, doctors have known they are a feature of Parkinson's disease. The presence of these Lewy bodies is thought to be what separates people with Parkinson's disease from the general population. However, Lewy bodies can only be diagnosed with certainty during a brain autopsy after death.

What Exactly Are Lewy Bodies?

Lewy bodies are "clumps" of protein that accumulate in the outer layers of the brain, also known as the cortex. In addition to Parkinson's, they are also a feature of dementia. Although we don't know precisely what part Lewy bodies play in Parkinson's disease or dementia, we do know that they are not the sole cause of Parkinson's disease and its various symptoms. Some studies indicate that dopamine cells die before they even reach this part of the brain, but this is unconfirmed.

Despite the enigma of the Parkinson's brain, many scientists have identified Lewy bodies as a potential target for new treatments. These treatments for Parkinson's disease could be available in a matter of years, not decades.

Is Parkinson's Diagnosed in the Brain?

Parkinson's disease is one of the most challenging neurological disorders to diagnose and treat. If your doctor suspects you have Parkinson's disease, you will usually be referred to a neurologist for further tests. These tests will involve certain movements and exercises to check your symptoms.

A neurologist will look for motor symptoms such as:

• A tremor that occurs at rest
• Slowed movement (bradykinesia)
• Muscle stiffness (rigidity)

If you have two or more of these symptoms and your doctor has taken blood tests to rule out other causes, it's likely you will be diagnosed with Parkinson's disease. Your symptoms will be closely monitored to see any progression of Parkinson's disease, which can take years.

Is There a Parkinson's Disease Brain Scan?

MRI brain scans and single photon emission computed tomography (SPECT) scans are often performed to rule out other causes of your symptoms, including strokes or a brain tumor.  However, neither of these scans are diagnostic of Lewy bodies. There is no Parkinson's disease brain scan, and no tests can conclusively show that you have Parkinson's disease.

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