Types of Parkinson’s Disease is discussed in this article.James Parkinson first described the major manifestations of this syndrome, which is characterized by tremor, muscular rigidity, and loss of postural reflexes. Not only is it one of the most frequently encountered of all the basal ganglia disorders, but parkinsonism is a prominent cause of disability due to diseases of all types.
SECONDARY OR SYMPTOMATIC PARKINSONISM
In a long list of diseases and conditions of the nervous system parkinsonism has occurred as the predominant manifestation. These include poisoning with carbon monoxide, manganese, or other metals; brain tumors in the region of the basal ganglia; cerebral trauma; degenerative diseases; intoxications, particularly with the phenothiazine group of drugs; and infectious processes, such as encephalitis. Cerebral arteriosclerosis has been implicated by some authorities who have even designated a special form of arteriosclerotic parkinsonism.
However, it is exceedingly doubtful that such a disorder exists, and pathologic studies to date have not confirmed a vascular basis for the Parkinson syndrome. In most instances of secondary parkinsonism, neurologic abnormalities involving other areas of the nervous system are found, and the parkinsonism itself may show variations from the usual picture. Of all the conditions noted, only two are frequently encountered: postencephalitic and drug-induced parkinsonism.
Postencephalitic Parkinsonism
One of the most prominent sequelae of the epidemic of encephalitis lethargica (von Economo’s disease) that occurred between 1919 and 1926 was the parkinsonian syndrome. The syndrome developed after mild as well as severe encephalitis lethargica, and, although in most instances they immediately followed the acute infectious process, in some patients prominent symptoms were not evident for intervals of up to ten years. Parkinsonism appears to have been a unique sequelae of this form of encephalitis because it has rarely followed any other known viral encephalitides. There are still a significant number of survivors of encephalitis lethargica, and the evolution and consequences of this form of parkinsonism differ from others, so its clinical recognition is of importance.
Postencephalitic parkinsonism has a number of distinctive or unique features, including the following: (1) A history of encephalitis lethargica during the epidemic period 1918-1919. Since the pandemic of influenza occurred concurrently with encephalitis, it is essential that careful documentation be undertaken in differentiating these two infectious processes. (2) In addition to any or all of the parkinsonian symptoms indicated above, one or more of the following neurologic deficits may be found: hemiplegia, bulbar or ocular palsies, dystonic phenomena* tics, or behavioral disorders. (3) The parkinsonism itself is as a rule incompletely developed and has been static or slowly progressive over a period of years. (4) Episodes that have been termed oculogyric crises. These consist of attacks in which spasms of conjugate eye muscles occur so that the eyes are deviated upward, downward, or to one side for minutes or hours at a time.
Drug-Induced Parkinsonism
The use of phenothiazine derivatives as psychotherapeutic or antiemetic agents has resulted in the occurrence of a number of extrapyramidal syndromes. These reactions are in some instances dose-dependent, and in others they are related to individual susceptibility. They occur with increasing incidence in lower dosage and earlier after administration in direct relation to their potency and alterations in chemical structure from piperidines to piperazines. The reactions cover the entire gamut of extrapyramidal manifestations, but most frequently a Parkinson-like picture is seen. It primarily affects adults and is characterized by varying degrees of akinesia, rigidity, and tremor, which is rarely of the classic pill-rolling variety. In children dyskinetic movements, such as torticollis, facial grimacing, and choreoathetosis predominate.
The symptoms disappear when the drugs are withdrawn, usually within days, but on occasion they have persisted for months. In some subjects permanent remnants of parkinsonian symptoms have been found years after elimination of the drugs. In most instances the occurrence of basal ganglia symptoms can be prevented or minimized by the simultaneous administration of one of the centrally active anticholinergic agents, such as Cogentin or Artane.
Treatment And General Principles of Types of Parkinson’s .
Until such time as the etiology and pathogenesis of parkinsonism are defined, its treatment must be considered as symptomatic, supportive, and palliative. It is only in the exceptional case of symptomatic parkinsonism resulting from the use of drugs or occurring in association with specific disease processes that treatment of the causative factor may result in total eradication of symptoms. The more frequently encountered patient will require lifelong treatment consisting of the administration of specific medications, supportive psychotherapeutic measures, physical therapy, and in rare instances surgical intervention.
Judiciously employed combined treatment of this sort may control the symptoms of parkinsonism in a large proportion of patients for extended periods of time. In fact, in most it will allow for relatively normal activities of living during most of the phases of this disorder. Further, the introduction of new therapeutic approaches holds promise of forestalling or preventing the progressive disabling nature of this disorder and the appearance of new symptoms. However, at the time of this writing, the use of these new agents provides insufficient experience from which firm conclusions can be drawn.
Supportive Psychotherapy.
The major symptoms of parkinsonism are markedly influenced by psychic factors, and a patient’s outlook and. motivation will affect the extent to which he car overcome disability. It is important for the physician to provide reassurance, encouragement, and sympathetic understanding to the patient an; family so that they may meet the numerous difficulties to be encountered at various stages of the illness. To allay anxieties both should be counseled regarding the meaning of various symptoms, the nature of the disease in terms of its long and variable course, and the potential that most patients can lead active and productive lives for long periods after symptoms begin.
