The Parkinson's Disease – Neurology Example

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"The Parkinson's Disease" is a remarkable example of a paper on neurology. Mr. John Adams is a Caucasian male who is 64 years old. He was diagnosed with Idiopathic Parkinson's disease at the age of 58 with initial symptoms of resting tremors in his hands and muscle rigidity when attempting to undertake tasks that he had previously accomplished with ease. The disease was in its initial stages, which explain the mild symptoms.   Resting tremors, muscle rigidity, and bradykinesia are the three main symptoms associated with  Parkinson's  disease. Mr. Adams has used medication,   Carbidopa/Levodopa  25/100 mg, two to three times daily to  manage the symptoms of the condition while continuing to live independently.     During a routine hospital visit, it was observed that Mr.

Adams appeared unkempt and struggled to move around as freely as he had on a previous hospital visit. He was also noticed to have significant cognitive impairment showing reduced concentration and delayed response in his execution of simple motor tasks. Mr. Adams's condition has continued to deteriorate despite his commitment to taking the prescribed medication. This deterioration has now necessitated the hiring of a nurse to assist Mr.

Adams with his  everyday  living tasks.   Figure one shows the gradual increase of Parkinson's' disease in males and females according to age.   While the initial symptoms were mild  and only included difficulties in movement and tremors in hand  and some muscle rigidity, Mr. Adams's  condition has continued to  deteriorate. This is because the disease advances with age.     He is now showing signs of  depression, including moderate to  severe mood swings, dysfunction of the autonomic nervous system, for example, bladder dysfunction, impaired gastrointestinal motility, and impairment in cognition.     These are  symptoms  that are associated with the  deterioration of the  condition  and mostly occur in the later stages of the disease.   Mr.

Adams  also experiences difficulties in sleeping, and as such, he  has to  take medication to aid him to  sleep.   There are currently no biochemical tests to confirm  diagnoses. Still, a combination of clinical signs and history confirm this and post mortem the presence of  Lewy  bodies in the neurons of the substantia  nigra  to provide final confirmation. In patients with Parkinson's, substantia  nigra  degenerates at a faster rate than ordinary people.   Mr.   Adams  presented with typical symptoms,   due to the signs that he showed and the fact that his age made him a prime candidate for Parkinson's  disease (Waters, 2008, p.   161). There are several complications that Mr.

Adams has had to  deal with due to his condition.   Chapuis  et al. assert that the most common complication to patients of Parkinson's disease is in the disruption of the motor skills.     The difficulty in swallowing  is  also one of the complications that have made it necessary for the patient to change his lifestyle to meet his dietary needs.   This is one of the symptoms or complications that face patients with this condition at later stages. The difficulty in  swallowing occurs  due to the loss of both the voluntary and involuntary muscle control  (Le  Witt and Oertel, 1991, p.

51).   He has also been faced with the problem of dementia. This caused by the significant loss of functionality in the brain that is associated with the condition. For patients with the disease, the rate at which the substantia  nigra  in mind dies is higher than that of ordinary people  (Iyer  2000). Dementia presents itself in difficulty in concentrating  and in following conversations  (Ekman et al. 1995)  Parkinson's disease is one of the diseases that  do  not have a cure  as yet, and patients often take medication to control the symptoms of the condition and slow down the rate of deterioration.

The most effective treatment plan for patients with the disease is treated with dopamine.   This means that the medication that the patient is taking is to help him in the management of the symptoms and help him live a comfortable life.   Mr. Adams is currently undergoing counseling therapy as part of his treatment plan.   This therapy is part of the care and support that is given to patients with the condition.   The treatment is, however, used together with medication  (dopamine) to  manage the symptoms and the complications arising from the situation. In the United States, deep brain stimulation  therapy has recently been approved by the Food  and  Drug Association.   This therapy is done by electronic stimulation of parts of the  brain and  should be considered for use in the UK as it has shown positive results upon application in the United States.

This is according to clinical trials, such as the one conducted by  Weaver et al. (2009).     It is expected that the therapy will also help him in stopping the tremors and regaining control of the ability to move around freely  (Weaver  FM, Follett K, Stern M, et al. , 2009, p.   65).     In addition to brain stimulation therapy,   Mr.

Adams  has to  take the medication that is usually prescribed for Parkinson's disease. These  medications  include Carbidopa and Levodopa. The Carbidopa is given together with  Levopida  to help delay its conversion to dopamine until such a point that the drug reaches the brain.   Levodopa  is converted into dopamine by the brain. Carbidopa works as a decarboxylase inhibitor that prevents the Levodopa  from turning into dopamine before it gets to the brain  (Katzenschlager  and Lees, 2004).   The treatment of the condition becomes more complex as the disease advances. At the advanced stage, the situation is managed through a combination of rehabilitative measures, speech therapy, nursing care, and occupational therapy.

(Varanese et al. ,  2010).     This means that Adams is undergoing a combination of the medication  and the treatment because of the deteriorating nature of his symptoms.   The mixture is essential as it helps in the treatment of the physical signs as well as the emotional complications that are brought about by the condition.   Adams is being observed to ensure that he continues to respond to the combination of the medication and the therapy. If his symptoms continue to deteriorate, then the option of surgery  will be explored. Neurosurgical treatment is directed at either GPI or STN (Eskandar  et al. ,  2010).   This is because the operation can target the specific parts of the brain that have been affected by the condition.     The limitation of the treatment options that are explored  is that they have numerous side effects that make life uncomfortable for the patient.

Such side effects include vomiting and nausea. Another complication to the medication is that it does not cure the condition. The drug only seeks to manage the symptoms. The symptoms  that Mr. Adams has  had,   however, continued to get worse despite the medication  (Kum et al. , 2009, p.   1035).     In addition to the medication, Mr.

Adams has been advised and has gone ahead to make some lifestyle changes to help him manage his condition.   These changes include making changes in his diet. This was made necessary by the fact that he sometimes had difficulties in swallowing hard solid foods as he cannot control his  muscles (Factor and  Veiner, 2007).     As such, his diet now consists  of  softer foods that are easy to swallow yet are balanced to meet his dietary needs. He has also had to undergo  physical therapy to help him regain coordination in his movements.

Several adjustments have had to be made to his house to ease his life. These adjustments include  the installation of railings and banisters to help him move around the house comfortably.     The research on the condition is still ongoing. There is, therefore, hope that with research, patients such as Adams will have better ways of managing the symptoms and complications that arise as a result of the condition.   In the meantime, Adams continues to be under medication, and his case is continuously evaluated. This makes it possible for new symptoms to be detected and treated early enough.

The complications of the condition can also be managed appropriately.      

References

Chapuis, S. et al 2005, Impact of the motor complications of Parkinson's disease on the quality of life. Movement Disorders, 20(2).

Ekman ,R., ,et al. 1995, ECT in Parkinson's disease. Changes in motor symptoms, monoamine metabolites and neuropeptides. Journal of neural transmission, 10 (2-3).

Eskandar, E, et al ‘Surgery for Parkinson’s Disease.’ Retrieved from http://neurosurgery.mgh.harvard.edu/functional/PDsurgery.htm.

Factor, S., Veiner, W 2007, and Parkinson’s disease: diagnosis and clinical management, Demos Medical Publishing, New York.

Katzenschlager, R., Lees, A., 2004, Treatment of Parkinson’s disease: levodopa as the first choice. Journal of Neurology, 249(2).

Kum, et al., 2009., Risk factors in development of motor complications in Chinese patients with idiopathic Parkinson’s disease Journal of Clinical Neuroscience, (16) 8, 1034-1037.

Le Witt, P., Oertel., W., 1999, Parkinson's disease: the treatment options, Taylor and Francis, New York.

Varanese, S. et al 2010, treatment of Parkinson’s disease. Parkinson’s disease. 2010 (2010).

Waters, C 2008, diagnosis and management of Parkinson’s disease, Professional Communications Inc., New York.

Weaver FM, Follett K, Stern M, et al., 2009, Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA, 301(1):63-73.

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