The Nervous System & Dopamine
To understand Parkinson’s, it is helpful to understand how neurons work and how PD affects the brain .
Nerve cells, or neurons, are responsible for sending and receiving nerve impulses or messages between the body and the brain. Try to picture electrical wiring in your home. An electrical circuit is made up of numerous wires connected in such a way that when a light switch is turned on, a light bulb will beam. Similarly, a neuron that is excited will transmit its energy to neurons that are next to it.
Neurons have a cell body with branching arms, called dendrites, which act like antennae and pick up messages. Axons carry messages away from the cell body. Impulses travel from neuron to neuron, from the axon of one cell to the dendrites of another, by crossing over a tiny gap between the two nerve cells called a synapse. Chemical messengers called neurotransmitters allow the electrical impulse to cross the gap.
Neurons talk to each other in the following manner :
Parkinsons Disease Vs Essential Tremor Early Symptoms How They Differ
As many as one million Americans currently live with Parkinsons disease and approximately 60,000 Americans are diagnosed each year. Around the world, more than 10 million people worldwide are living with the disease, according to the Parkinsons Disease Foundation.
A new study published in the journal Brain has shed new light on the genetics behind essential tremor, which is frequently misdiagnosed as Parkinsons disease. Understanding the differences between both diseases is key to reducing the prevalence of medical mistakes. Heres everything you need to know about both diseases.
Researchers are examining the genetics behind how essential tremor affects the body.Photo courtesy of Simon Gerard
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Behavior And Lifestyle Changes
Essential tremor can be affected by emotional stress, nicotine, and caffeine. Limiting stimulants and keeping your stress level down by practicing self-care and prioritizing your mental health can help reduce symptoms of ET.
Here are some other lifestyle changes you can make at home according to Hopkinsmedicine.org:
- Use heavier, sturdier utensils with larger handles for easier gripping
- Invest in clothing with Velcro or button hooks
- Use straws for drinking
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What Therapies Treat Shaky Hands
Your doctor may recommend one or more lifestyle changes as a way to possibly help ease the symptoms of essential tremor. Suggestions may include to:
- Use heavier objects. You may need to replace lightweight or delicate objects, such as glasses, silverware, or plates, with heavier versions. The extra weight may make the item easier to handle.
- Use specially designed utensils and tools. Gripping and controlling pens, pencils, garden tools, and kitchen utensils may be difficult if you have shaky hands. You may need to seek out versions of these items that are designed for individuals with grip and control issues. For example, there are many adaptive utensil options available on .
- Wear wrist weights. The extra weight on your arm may make control easier. Find a great selection of wrist weights here.
Why Are Parkinsonian Symptoms Worse In The Morning
Most patients with advanced Parkinsons disease experience fluctuating symptoms, known as ON and OFF episodes, when they take medications such as carbidopa/levodopa. When you first take a dose, you may experience an ON episode where you are energetic and able to move around freely. OFF episodes can occur when youre waiting for your next dose of medication, resulting in a marked decline in physical ability and a returning of symptoms.
Some people find that Parkinsonian symptoms are worse in the morning. The medical term for the daytime worsening of Parkinsonian symptoms is morning akinesia, affecting around 60% of Parkinsons patients. OFF episodes occur when levodopa medications become less effective over time, resulting in motor fluctuations. These periods usually start first thing in the morning after a treatment-free night.
Parkinsons disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
People with Parkinsons often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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What Is The Difference Between Essential Tremor Andparkinson’s
The exact cause of essential tremor is unknown while Parkinson’sdisease is better understood.
In Parkinson’s disease, neurons located in the part of the brain thatcontrols movement become impaired or die. These neurons usually produce achemical called dopamine which enables regular body movements. When the neuronscan’t produce necessary levels of dopamine, tremors can occur, along withrigidity of limbs and decreased coordination.
The Role Of The Cerebellum In Essential Tremor
Certainly, many studies have suggested that the cerebellum does not function normally in essential tremor. This may explain why some people with essential tremor have other cerebellar findings on their neurological examination, such as ataxia or poor hand-eye coordination.??
In the last decade, we have become increasingly aware that the cerebellum does more than coordinate movement it may help to coordinate thoughts and perhaps emotions as well. Studies have connected cerebellar activity with the dorsolateral prefrontal cortex, a region of the brain classically associated with problem-solving, attention, and memory.??
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Living With Parkinson’s Disease
As Parkinson’s develops, a person who has it may slow down and won’t be able to move or talk quickly. Sometimes, speech therapy and occupational therapy are needed. This may sound silly, but someone who has Parkinson’s disease may need to learn how to fall down safely.
If getting dressed is hard for a person with Parkinson’s, clothing with Velcro and elastic can be easier to use than buttons and zippers. The person also might need to have railings installed around the house to prevent falls.
If you know someone who has Parkinson’s disease, you can help by being a good friend.
What Are The Symptoms Of Parkinson’s Disease
The symptoms of Parkinson’s disease include tremors or trembling difficulty maintaining balance and coordination trouble standing or walking stiffness and general slowness.
Over time, a person with Parkinson’s may have trouble smiling, talking, or swallowing. Their faces may appear flat and without expression, but people with Parkinson’s continue to have feelings even though their faces don’t always show it. Sometimes people with the disease can have trouble with thinking and remembering too.
Because of problems with balance, some people with Parkinson’s fall down a lot, which can result in broken bones. Some people with Parkinson’s may also feel sad or depressed and lose interest in the things they used to do.
The symptoms of Parkinson’s disease appear gradually and get worse over time. But because Parkinson’s disease usually develops slowly, most people who have it can live a long and relatively healthy life.
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What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
Can Cbd Really Help With Tremors
Tremors are caused by conditions, such as neurodegenerative diseases, anxiety, and brain injury.
Scientific studies have yet to determine how cannabidiol may affect tremors. However, scientists are now investigating its capability to reduce symptoms of the movement disorder.
In January 2019, the University of California, San Diego, called for volunteers for a double-blind study on how medical cannabis may affect essential tremors .
Dr. Nahab explained that there are currently no pharmacological agents developed for ET. For years, epilepsy medications have been used as off-label treatment.
Also, modern treatment for severe ET involves deep brain stimulation surgery. DBS is an invasive procedure where a device is implanted into the brain.
The researchers, led by neurologistDr. Fatta Nahab, are expected to share their findings in December 2020.
In a clinical trial conducted on Parkinsons disease patients by the University of Colorado, the authors examined CBDs efficacy and tolerability . The study measured appropriate CBD dosing and its ability to reduce tremors.
A positive outcome from ongoing CBD studies may lead to a natural solution to treating tremors.
Although CBDs efficacy on tremors is yet to be seen, many studies attributed its positive effects on several brain conditions, such as neurodegenerative diseases, stroke, brain injury, and anxiety .
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How Can You Tell The Difference Between Essential Tremor And Parkinsons Disease
Essential tremor is a neurological disorder that causes tremors, generally of both hands, but also the head and voice. It is often confused with Parkinsons disease, but the tremor in essential tremor is an action tremor, which means that the tremor is most noticeable when the limb is in use or moving and improves when the limb is at rest. This is opposite of the tremor seen in Parkinsons disease, which is most noticeable when the limbs are relaxed and at rest, and lessens when the affected limb is in use.
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Other Tremors And How It Differs
A Parkinsonian tremor has a few distinct characteristics, though it may be easy to confuse with other types of tremors depending on the other symptoms a person shows. Doctors will look for and rule out other types of tremors to confirm their diagnosis.
The National Institute of Neurological Disorders and Stroke notes that some common tremors include:
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Exercise And Healthy Eating
Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress.
You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy.
How Is Parkinson’s Disease Treated
If a doctor thinks a person has Parkinson’s disease, there’s reason for hope. Medicine can be used to eliminate or improve the symptoms, like the body tremors. And some experts think that a cure may be found soon.
For now, a medicine called levodopa is often given to people who have Parkinson’s disease. Called “L-dopa,” this medicine increases the amount of dopamine in the body and has been shown to improve a person’s ability to walk and move around. Other drugs also help decrease and manage the symptoms by affecting dopamine levels. In some cases, surgery may be needed to treat it. The person would get anesthesia, a special kind of medicine to prevent pain during the operation.
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How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
What Is The Difference Between Essential Tremor Vs Parkinsons Disease
Essential tremor vs. Parkinsons disease have several noticeable differences. Essential tremor symptoms are more pronounced during activity, whereas Parkinsons tremors tend to occur more regularly at rest. Essential tremor is typically only associated with tremors, while Parkinsons disease generally includes tremors along with rigidity, problems walking, and issues with balance.
The amplitude and frequency of tremors also differ between essential tremor and Parkinsons disease. Essential tremor symptoms tend to be of a lower amplitude with a higher frequency, and Parkinsons disease tremors are more often higher amplitude with lower frequency.
Essential tremor is most often tied to a family history, and Parkinsons disease is rarely tied to family history. Essential tremor is roughly 10 times more common in the U.S. than Parkinsons disease.
Another interesting difference is that alcohol may improve tremors for essential tremor patients but tends to have no effect on tremors of Parkinsons patients.
A by the International Essential Tremor Foundation.
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Is Head Tremor The Same As Essential Tremor
Head tremor is often described as an oscillation of the head, causing it to move side to side or up and down. The tremor can be rhythmic like a pendulum or irregular and more pronounced. While head tremors can be one of many types of tremors experienced by those with essential tremor, they are also seen in patients with dystonia.
Characteristics Of Pd Tremors
The tremors of PD characteristically occur at rest, stop with voluntary action, and recur again after you hold your new position for a few minutes. PD tremors can affect the hands, arms, face, jaw, legs, and/or feet, and are often slightly more prominent on one side than the other.
The tremor almost always begins in the hand before affecting other parts of the body, and it usually looks like you are rolling a pill between your thumb and index finger. Thats why its called a pill-rolling tremor.
A pill-rolling tremor is the most common type of PD tremor, but shaking tremorswhich may involve the hands or other areas of the bodycan also occur.
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Other Symptoms Of Parkinsons Disease
In addition to these primary motor symptoms, there are secondary motor symptoms that can occur in people with PD, including a shuffling gait , micrographia , a mask-like expression, or speech difficulties. There are many non-motor symptoms that people with PD experience, such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking. 1,2
Several other neurological conditions mimic PD, which may make diagnosis difficult. Diagnosis is made by a neurologist and is generally based on clinical assessment of the main motor symptoms, a gradual progression of symptoms, and the relief of motor symptoms with levodopa therapy.3 Treatments are more successful the earlier the symptoms are diagnosed. Therefore, it is important to see a movement disorder specialist as soon as PD is suspected.
What Are The Symptoms Of Parkinsons Disease
According to the Public Health Agency of Canada, an estimated 84,000 Canadians aged 40 or older have been diagnosed with Parkinsons disease, a disorder that most often occurs after age 50, and is more likely to affect men than women.
This neurodegenerative disease can start with small signs, and then get progressively worse, eventually causing trouble with movement, rigidity, stiffness, and other symptoms. One of the most well-known signs and symptoms of Parkinsons disease are tremors or shaking.
About 70 per cent of people with the disease experience a resting tremor, and it can become more noticeable during stress or excitement. A resting tremor occurs even when a person isnt moving it might be a slight shake in your finger, thumb, hand, chin, lip, or lips when your body is at rest and your muscles are relaxed.
These tremors are one of the most common symptoms and often tip people off to the disease, but when Parkinsons patients think back, they sometimes realize they experienced other symptoms of the disease before the tremors began. Here are the ones you should know.
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Medications For Essential Tremor
Propanolol and primidone are two of the medicines often prescribed to treat essential tremor.
Propanolol blocks the stimulating action of neurotransmitters to calm your trembling. This beta blocker is effective in 40% to 50% of patients and is less useful in reducing head and voice tremor. It is usually avoided in patients with asthma, emphysema, congestive heart failure or heart block, and should be used with caution by people with diabetes who are on insulin. These drugs may reduce exercise tolerance, lower blood pressure or heart rate, exacerbate depression and cause impotence. Other adrenergic blockers with fewer side effects include atenolol, nadolol, metoprolol and timolol.
Primidone controls the actions of neurotransmitters. Some patients starting primidone may experience a first dose phenomenon during which they have transient feelings of unsteadiness, dizziness and nausea during the beginning stages of treatment. This is usually short-lived. Sedation is another common side effect and can be reduced by following a slowly escalating dose schedule. Most patients are able to tolerate the side effects, and studies have shown that 60% to 100% of patients respond positively.
If primidone or propranolol are not effective by themselves, a combination of both may provide relief for some patients.