Understanding Parkinson’s disease and debunking myths

May 9, 2024

Providence Brain & Spine Team

[5 MIN READ]

A Providence neurologist debunks some of the most common myths surrounding Parkinson’s disease.
Learn the difference between Parkinson’s and a more common condition called essential tremor.
For situations in which medication doesn’t provide relief, deep brain stimulation is a proven method of treating Parkinson’s.

Parkinson’s disease awareness: Understanding the facts

Parkinson’s disease (PD) affects nearly 1 million people in the United States. That’s 1 million people — moms, dads, sisters, brothers, grandparents, best friends — who are living with this progressive neurological disease. So we’re sharing information on common myths about Parkinson’s, how to detect and diagnose it, and the differences between Parkinson’s and essential tremors.

Debunking myths about Parkinson’s disease

Perhaps because PD is so common, there are many common misconceptions and myths about it. We asked Melita Petrossian, M.D., a neurologist at Pacific Neuroscience Institute in Santa Monica, California, to debunk some of the most common myths.

Myth 1: Once you have a Parkinson's diagnosis, there's not much you can do to improve your health.

Dr. Petrossian: Patients with PD feel better with physical therapy and exercise of multiple types, including cardiovascular, strength training, stretching, balance training and skill-based exercise (e.g., boxing, dance, ping-pong). When PD patients exercise, they can improve muscle bulk, bone density and cardiovascular health, as we know.

But more importantly, they can make the brain use dopamine more efficiently, create new connections between brain cells, and reduce the spread of PD in the brain. Exercise helps patients improve their energy level, functional abilities, gait and balance, and strength of voice. So not only do they feel better in the present, but they also function better in the future. Exercise can prevent the progression of PD.

In addition to exercise, medications can really help patients feel better and move more easily. Though there are some complications or side effects that can arise, most patients feel greatly improved on medications such as levodopa, which gets converted in the brain to dopamine.

Myth 2: PD only affects movement.

Dr. Petrossian: PD’s motor (movement) symptoms (rest tremor, slowness, stiffness, postural instability) are more obvious externally, but some patients find their quality of life more affected by non-motor symptoms of PD. Some of these symptoms are nonspecific, and there can be multiple causes. For example, constipation and urinary frequency and urgency are quite common, but can also occur in patients without PD. More specific symptoms include loss of sense of smell, dream enactment behavior and trouble swallowing. Patients can also suffer from depression, anxiety and cognitive decline, and even (in advanced stages) dementia and hallucinations. It is important to note that not every PD patient will experience most or all of these symptoms, but awareness of symptoms that can be PD-related can foster conversations with a neurologist or movement disorders specialist.

Myth 3: PD is fatal.

Dr. Petrossian: PD is not fatal. Most patients can continue to have a good quality of life for many years by using medications and exercising — though of course their life experience may be different than it was before the PD diagnosis. Because there is more “work” necessary to maintain a good quality of life, such as exercise, diet, sleep quality and quantity, and taking medications on time, some patients describe PD as ‘not a death sentence, but a life sentence.’

Detection and diagnosis of Parkinson’s

It can be difficult to diagnose Parkinson’s, particularly in its early stages. Most patients can be diagnosed just based on the clinical signs and symptoms, without biomarker studies. Sometimes blood work and/or an MRI are necessary to rule out alternative diagnoses. In cases where the signs on neurological exam do not clarify the diagnosis, biomarker tests such as DaTscan, Syn One biopsy, and SynTap can be used.

Early signs of Parkinson’s

The newest criteria for diagnosing Parkinson’s was developed by the International Parkinson and Movement Disorder Society (MDS). To consider a diagnosis of Parkinson’s disease, a person must have bradykinesia (slowness of movement). In addition to bradykinesia, a person must also have one or more of the following:

Shaking or tremor in a limb that occurs while it is at rest.
Stiffness or rigidity of the arms, legs or trunk.
Trouble with balance and falls.

Parkinson’s vs. essential tremor: Knowing the difference

Tremor is often one of the first noticeable symptoms of Parkinson’s. People may notice their hands shaking when they are at rest. It typically improves during sleep or activity.

It is important to remember that not all tremors are a sign of Parkinson’s disease. In fact, a more common neurological disorder called essential tremor is sometimes confused with Parkinson’s. The most noticeable difference between the two is that a tremor caused by an essential tremor usually occurs during movements like writing, eating or drinking. In addition, they tend to go away at rest, which is the opposite of tremors caused by Parkinson’s.

Other differences include:

Parkinson’s tremor can start in a single digit, whereas essential tremor usually affects the whole hand.
Tremor in lips and legs at rest is more concerning for PD.
Essential tremor doesn’t cause other health problems, while Parkinson’s is defined by slowness and smallness of movements, and can lead to a stooped posture and balance problems.
For some people, essential tremor may not interfere much with their life, while Parkinson’s tends to require more intervention.

Treatment options for Parkinson’s

Medications can help people with Parkinson’s manage problems with walking and movement, and help them reduce their tremors. These medications either increase or enhance the action of dopamine in the brain.

In some cases, a doctor may determine that deep brain stimulation (DBS) is the best option. “DBS has been used for 20 years for tremor and PD symptoms and can be a life-changing treatment in certain patients,” says Dr. Petrossian. “Some patients may have significant tremor despite medication. Other patients initially have good control of symptoms with levodopa (the most commonly used medication), but then develop dyskinesias (abnormal involuntary movements not including tremor) or motor fluctuations (shorter number of hours that the medication’s benefit are felt and increasing hours of feeling “off”).”

“DBS is electrical stimulation that balances overactive abnormal motor signals in the brain, and can be compared to a pacemaker for the brain,” Dr. Petrossian continues. “The implants are placed in very specific targets in the brain, with the battery under the skin of the chest.”

Find help and hope

Parkinson’s disease is a complex condition — but it’s one you can manage when you work closely with a team of experienced and compassionate neurologists. If you’re concerned you or a loved one may have Parkinson’s, talk to your primary care doctor right away. They can perform an initial evaluation and, if necessary, refer you to a neurology specialist to get to the bottom of what’s causing your symptoms. It’s the first step to finding answers and discovering hope.

Contributing caregiver

Melita Petrossian, M.D., is a neurologist at Pacific Neuroscience Institute in Santa Monica, California.

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