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Parkinson's disease

Morbus Parkinsoni · Parkinsonova nemoc

What it is

Dopamine cells in the substantia nigra die off; movement slows and stiffens.

Symptoms & signs

  • Resting tremor
  • slowness (bradykinesia)
  • rigidity
  • shuffling gait
  • small handwriting
  • loss of smell
  • constipation
  • REM sleep acting-out

🚩 Get help if…

  • call 112 / 911 now High fever with rigid muscles and confusion after stopping or missing medicines
  • call 112 / 911 now Choking, or fever and cough after food goes down the wrong way
  • see a doctor soon Falls or sudden freezing that keep happening
  • see a doctor soon Seeing things that are not there, or sudden confusion

Where it strikes

Medical treatment

  • Levodopa/carbidopa
  • dopamine agonists
  • MAO-B inhibitors
  • COMT inhibitors
  • deep brain stimulation of the subthalamic nucleus
  • apomorphine pump

Natural & lifestyle

  • High-intensity exercise and boxing programmes (may slow progression; early trials)
  • tai chi for balance
  • physiotherapy
  • fibre and fluids for constipation
  • vitamin D

Emerging & experimental

  • Alpha-synuclein antibodies (prasinezumab)
  • GLP-1 agonists (lixisenatide positive in a phase 2 trial, exenatide negative in phase 3)
  • stem-cell dopamine grafts
  • focused-ultrasound subthalamotomy
  • gene therapy (AAV-GAD)

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Mucuna pruriens (velvet bean, natural levodopa) — small trials matched levodopa; its dose is uncontrolled early / small studies
  • Tango and other dance — trials improve balance and walking mixed evidence
  • Cannabis — patients report benefit; trials disagree mixed evidence
  • Terazosin — observational data suggest slower progression; trials early early / small studies
  • Coenzyme Q10 — a large trial (QE3) found no benefit not confirmed in trials

ICD codes