Parkinsonism is caused by brain disorders, brain injuries, or certain drugs and toxins.
People with parkinsonism, like those with Parkinson disease Parkinson Disease (PD) Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more , have tremors that occur when muscles are relaxed, stiff muscles, slow movements, and problems with balance and walking.
Doctors try to identify the cause of parkinsonism by asking about conditions known to cause it and by using brain imaging to look for a possible cause.
The cause is treated if possible, medications may be used to relieve symptoms, and general measures (such as simplifying daily tasks) may help people function better.
(See also Overview of Movement Disorders Overview of Movement Disorders Every body movement, from raising a hand to smiling, involves a complex interaction between the central nervous system (brain and spinal cord), nerves, and muscles. Damage to or malfunction... read more .)
Parkinsonism does not include Parkinson disease although the disorders included in parkinsonism resemble Parkinson disease in some ways. There are two main types of parkinsonism:
Secondary parkinsonism refers to a group of disorders that have a different cause from Parkinson disease.
Atypical parkinsonism refers to a group of degenerative disorders that have some different symptoms and different changes in the brain and that respond to treatment differently. People with these disorders have a worse prognosis.
Causes of Parkinsonism
The most common cause of parkinsonism is
Use of medications that block or interfere with dopamine’s action
Certain drugs and toxins interfere with or block the action of dopamine and other chemical messengers that help nerve cells communicate with each other (neurotransmitters). For example, antipsychotic medications, used to treat paranoia and schizophrenia, block dopamine’s action. Dopamine is a key neurotransmitter in the basal ganglia (collections of nerve cells located deep within the brain), which help smooth out muscle movements.
Various other conditions can cause parkinsonism:
Degenerative disorders, such as Alzheimer disease Alzheimer Disease Alzheimer disease is a progressive loss of mental function, characterized by degeneration of brain tissue, including loss of nerve cells, the accumulation of an abnormal protein called beta-amyloid... read more , multiple system atrophy Multiple System Atrophy (MSA) Multiple system atrophy is a progressive, fatal disorder that causes symptoms resembling those of Parkinson disease (parkinsonism), loss of coordination, and malfunction of internal body processes... read more , corticobasal ganglionic degeneration Symptoms , frontotemporal dementia Frontotemporal Dementia Frontotemporal dementia, which refers to a group of dementias, results from hereditary or spontaneous (occurring for unknown reasons) disorders that cause the frontal and sometimes the temporal... read more , and progressive supranuclear palsy Progressive Supranuclear Palsy (PSP) Progressive supranuclear palsy is characterized by slow movements, muscle stiffness (rigidity), problems moving the eyes, and a tendency to fall backward. Progressive supranuclear palsy progresses... read more
Viral encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more , including West Nile virus encephalitis and a rare brain inflammation that follows a flu-like infection
Structural brain disorders, such as brain tumors Overview of Brain Tumors A brain tumor can be a noncancerous (benign) or cancerous (malignant) growth in the brain. It may originate in the brain or have spread (metastasized) to the brain from another part of the body... read more and strokes Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more
Head injury Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more , particularly the repeated injury that occurs in boxing (making a person punch-drunk)
Drugs and medications, especially metoclopramide and prochlorperazine (used to relieve nausea) and antipsychotic medications Antipsychotic Drugs Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate motor behavior that indicate loss of contact with reality. A number... read more
Toxins, such as manganese, carbon monoxide, and methanol
Symptoms of Parkinsonism
Parkinsonism causes symptoms that are similar to those of Parkinson disease Symptoms Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more . They include
A tremor that occurs in one hand while the muscles are relaxed (a resting tremor)
Difficulty maintaining balance and walking
The disorders that cause parkinsonism may also cause other symptoms or variations of parkinsonian symptoms.
Some symptoms may indicate the cause is probably not Parkinson disease. They include
Prominent memory loss that occurs during the first year of the disorder (indicating dementia)
Symptoms of parkinsonism on only one side of the body (often due to certain brain tumors or corticobasal ganglionic degeneration)
Low blood pressure, difficulty swallowing, constipation, and urinary problems (sometimes due to multiple system atrophy Multiple System Atrophy (MSA) Multiple system atrophy is a progressive, fatal disorder that causes symptoms resembling those of Parkinson disease (parkinsonism), loss of coordination, and malfunction of internal body processes... read more )
Falls and confinement to a wheelchair within the first months or years of a disorder
Abnormalities in eye movements
Hallucinations and visual-spatial problems (such as difficulty finding rooms at home or parking a car) that develop early in the disorder
Symptoms that do not lessen in response to treatment with levodopa
Inability to express or understand spoken or written language (aphasia Aphasia Aphasia is partial or complete loss of the ability to express or understand spoken or written language. It results from damage to the areas of the brain that control language. People may have... read more ), inability to do simple skilled tasks (apraxia Apraxia Apraxia is loss of the ability to do tasks that require remembering patterns or sequences of movements. People with apraxia cannot remember or do the sequence of movements needed to complete... read more ), and inability to associate objects with their usual role or function (agnosia Agnosia Agnosia is loss of the ability to identify objects using one or more of the senses. Symptoms vary depending on where the brain is damaged. Doctors determine whether people have agnosia by asking... read more ) due to corticobasal ganglionic degeneration
In corticobasal ganglionic degeneration, the cerebral cortex (the part of the brain that contains most of the nerve cells) and the basal ganglia deteriorate progressively. Symptoms usually begin after age 60 (see figure ).
People with corticobasal ganglionic degeneration have stiff muscles that affect one side of the body more than the other. As the disorder progresses, moving their limbs becomes increasingly difficult. Coordination and balance are poor, muscle twitch, and swallowing becomes difficult. Thinking is impaired, and people have difficulty finding, saying, and understanding words. Many people lose control of one hand (on the more affected side)—called alien hand syndrome. The hand may move on its own. For example, it may spontaneously open or make a fist.
Diagnosis of Parkinsonism
A doctor's evaluation
Usually brain imaging
Use of levodopa to see whether it helps
Doctors ask about previous disorders, exposure to toxins, and use of drugs that could cause parkinsonism.
Brain imaging, such as computed tomography Computed Tomography (CT) Computed tomography (CT) is a type of medical imaging that combines a series of x-rays to create cross-sectional, detailed images of internal structures. In computed tomography (CT), which used... read more (CT) or magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more (MRI), is usually done to look for a structural disorder that may be causing the symptoms.
If the diagnosis is unclear, doctors may give the person levodopa (a medication used to treat Parkinson disease) to rule out Parkinson disease. If levodopa results in clear improvement, Parkinson disease is the likely cause.
Treatment of Parkinsonism
Treatment of the cause if possible
Sometimes medications to help relieve symptoms
General measures, such as staying as active as possible
The cause of parkinsonism is corrected or treated if possible. If a drug is the cause, stopping the drug may cure the disorder. Symptoms may lessen or disappear if the disorder causing them can be treated.
The medications used to treat Parkinson disease (such as levodopa Levodopa/carbidopa Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more ) are often not effective in people with parkinsonism but can sometimes result in temporary improvement.
If an antipsychotic medication is causing bothersome parkinsonian symptoms and an antipsychotic medication needs to be taken indefinitely, doctors substitute another antipsychotic medication if possible. However, if the medication cannot be changed, amantadine or a medication with anticholinergic effects Anticholinergic: What Does It Mean? , such as benztropine, may relieve symptoms.
Remain as active as possible
Simplify daily tasks
Use assistive devices as needed
Take measures to make the home safe (such as removing throw rugs to prevent tripping)
Physical therapists Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more and occupational therapists Occupational Therapy (OT) Occupational therapy, a component of rehabilitation, is intended to enhance a person's ability to do basic self-care activities, useful work, and leisure activities. These activities include... read more can help people implement these measures.
Good nutrition is also important.