The Journal of the American Medical Association.

Parkinson Disease P arkinson disease involves the nervous system, specifically, movement and control of muscles. Parkinson disease affects more than 1 million individuals in the United States. Because it is more common in older persons, the incidence (number of new cases) of Parkinson disease is increasing as the population grows older. Parkinson disease was first described in 1817 and was originally called " shaking palsy. " Medical researchers later discovered that parkinsonian symptoms were due to degeneration of nerve cells in an area of the brain called the substantia nigra. These cells supply dopamine, a chemical that modulates movement, to other areas of the brain called the basal ganglia. Parkinson disease is progressive and leads to severe limitations in activity and quality of life if the disorder is not treated. Neurologists (doctors who specialize in treating diseases of the nervous system) and neurosurgeons (doctors who specialize in surgery of the nervous system) individualize each person' s treatment to manage the symptoms and slow the progress of Parkinson disease. The January 21, 2004, issue of JAMA includes an article about treatment of Parkinson disease. The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424. • Levodopa (a synthetic medication) replaces dopamine for patients with Parkinson disease, improving symptoms of tremor and rigidity. • Carbidopa helps reduce adverse effects of levodopa and increases the amount of dopamine in the brain (and not in the rest of the body). • Several other medications are available to decrease symptoms or slow the progression of Parkinson disease. • Antidepressants may be prescribed if depression occurs. • Pallidotomy—a probe delivering electrical current is used to create a permanent lesion (scar) in a specific area of the brain (the globus pallidus) to lessen rigidity, tremor, and abnormal movements (dyskinesias). • Thalamotomy—electrical current creates a small, permanent lesion in the area of the brain called the thalamus. This helps reduce tremor and rigidity. • Deep brain stimulation—an electrode is placed into a specific deep brain structure. Electrical …