Parkinson's disease – more than just trembling hands

Shaking limbs are not the most alarming symptom of Parkinson’s disease. “Even if this is quite a vexing problem, it usually means a good prognosis as it is a sign of a milder course of the disease", says prof. Andrzej Bogucki, Head of the Polish Association of Parkinson's Disease and other Movement Disorders.

In patients with Parkinson’s disease, the patients' limbs can be shaking not only while holding a glass of water. Many people experience such tremors at rest – which pertains, for example, to the head and this gets stronger as a result of strong emotions.

Slowness of voluntary movement, spasms

Patients with PD much more often experience a slowness and decreased intensity of movement, as well as stiffness of muscles and problems with balance. They have significant difficulties starting any movement, in particular, any precise movements. Even walking may pose considerable difficulties. In more advanced stages of the disease, the patients’ gait is characterised by the small “shuffling" steps.

Danuta Michalska, a retired nurse, serves as an example. She told journalists during a press conference that she was unable to go to the toilet unattended. She supported herself on crutches, while her husband helped her to shift her legs.

Some patients are more disturbed by dyskinesia – uncoordinated and involuntary movements of the limbs or of the entire body. This dyskinesia may be just a tremor of the legs while the patient is sitting, but sometimes it also happens that a patient is jerked about involuntarily with movements of all his limbs simultaneously.

The Honeymoon Phase

Most people know only the initial phase of the disease - when the patient is still able to move around. Doctors call this the “honeymoon phase", and it usually lasts a couple of years. During this phase, the patients are generally able to control the symptoms with the use of medications and are still capable of leading quite a normal life and to continue in their employment.

However, four or five years following the onset of the disease, oral medications (with L-DOPA)cease to be effective. Thus, patients take them increasingly often and in increased doses, but to no avail. Ryszard Zembaczyński, Mayor of Opole, and who suffers from PD, said to journalists during a conference, that he took medications 22 times per day – almost every hour – even during the night. A pill, even if it was effective – worked for a moment only, but sometimes it had no effect at all – he said.

The “Off" periods

Within a ten year period following the onset of the disease, most patients with PD develop new symptoms that are unmanageable with the medications available so far. A person suffering from Parkinson’s disease can be in the so-called “off" state, and is totally immobilised for several hours during the day. This happens when medications stop working.

When such a person feels insignificantly better, he or she proceeds to the “on" period – stiffness and the slowness of movements being less intensive, but involuntary movements (dyskineses)occur. These are often very violent, which often make it impossible for the patient to function independently.

Decrepitude is advancing; patients are unable to perform everyday routine tasks. They cannot walk, dress themselves, eat or drink unaided. They totally rely on other people’s help. They experience syncopes, stupor, depression and speech troubles.

However, this portrayal of Parkinson disease is quite unfamiliar to society since patients in advanced stages of the disease rarely leave their homes.