For correct understanding and proper communications with your doctor you need to understand your symptoms :

ON periods : This is the feeling that you get when you have taken medication. In early stages of the disease, patient mentions that he almost becomes normal after taking medication. We call this ON period.

RESTING-TREMORS-PIN-ROLLING-TREMORSOFF periods : This are the symptoms experienced when the effect of medicine goes away. Patient may start getting tremors or stiffness. He may find difficulty in moving, walking, turning in bed or even speech.

Dyskinesia : This are flowing, dancing like movements that occur as the sideeffect to medical treatment. They usually are seen after taking medicines, usually at the peak dose effect. However, in some patients, the dyskinesias also occur when the effect of medicine is wearing off. One should be able to differentiate this from the tremors as both have different treatments.

Tremors : Tremors are the most obvious features of Parkinson’s disease. 75% of Parkinson’s disease have tremors BRADYKINESIA-AS-SEEN-IN-TOE-TAPPINGat rest. The tremors readily disappear during manual activities in contrast to the tremors of essential tremors.

Bradykinesia is the most characteristic clinical sign of Parkinson’s disease. It correlates well with the striatonigral deficits of the disease. Bradykinesia may be initially manifested by a subtle lack of spontaneous and adventitious movements. They have paucity of facial expression-“facial masking”. Bradykinesia also produces slowness of movements with a characteristic decrement in amplitude of repetitive movements. COG-WHEEL-RIGIDITYBradykinesia results in drooling due to a lack of spontaneous swallowing, soft monotonous speech, a reduced arm swing when walking and short, sometimes shuffling footsteps.

Rigidity is due to increased muscle tone. In combination with resting tremors, this produces cogwheel rigidity when the limb is passively moved. One of the most disabling symptoms of Parkinson’s disease is gait freezing, also referred as a gait initiation failure or a magnetic gait. It is a manifestation of akinesia.

POSTURAL-INSTABILITY1Loss of postural reflexes or physical mobility is the most dangerous of motor impairment in Parkinson’s disease. When combined with axial rigidity and bradykinesia, the loss of postural reflexes places an individual at extreme risk of falling. Falling often results in fracture, and is the cause of severe morbidity and mortality in Parkinson’s disease. Patients eventually assume a slowly progressive flexed posture, involving neck, trunk, elbows and knees. An extreme form of flexed trunk is called Camptocormi.

Non – Motor symptoms of Parkinson’s disease

Cognitive dysfunction

  • Dysexecutive syndrome
  • Visuospatial dysfunction
  • Dementia
  • Psychosis

Gastrointestinal problem

  • constipation, abnormal distension
  • Seborrhoea
  • Sweating

Mood disorders

  • Anhedonia, apathy
  • Anxiety
  • Depression

Sleep problem in Parkinson’s disease

  • Sleep fragmentation
  • REM sleep behavior
  • Excessive day time sleepiness
  • Altered sleep-wake cycle

Sensory symptoms in Parkinson’s disease

  • Pain
  • Paresthesia
  • Burning
  • Akathisia
  • Restless legs syndrome

Autonomic dysfunction in Parkinson’s disease

  • Bladder problem
  • Sexual dysfunction
  • Hypotension

Behavioural disorders

  • Dopamine dysregulation syndrome (hedonistic homeostatic dysregulation)
  • Punding
  • Impulse control disorders

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