Question

I've got Parkinson's, and my wife tells me I never smile any more. My doctor says that's part of the disease, but is there any treatment that helps this specific problem?

Answer

Unfortunately no known treatment can halt or reverse the breakdown of nerve cells that causes Parkinson's disease. However, medication can relieve many symptoms. Surgery to treat symptoms also can be effective in a small number of people. It is important to realize that Parkinson disease (PD) develops differently in each individual and therefore treatment is also individual. Although there is no known cure, many patients respond to drug and physical therapy. Surgical procedures in selected patients can be helpful in some cases. A fixed facial expression, causing the inability to smile, is a symptom which usually occurs in a more advanced stage of Parkinson's disease. You would therefore be advised to discuss your particular concerns with your treating doctor, who knows you and the stage of Parkinson's that you are at and is therefore the best person to advise you.
 

As you will know, Parkinson's disease is a disorder of nerve cells in a part of the brain that produces dopamine. Dopamine is a chemical messenger that the brain uses to help direct and control body movement. In Parkinson's disease, these dopamine-producing nerve cells break down, dopamine levels drop and brain signals that direct movement become abnormal. The classic symptoms of Parkinson's disease are tremor (shaking), stiff muscles and slow movement. The following symptoms are usually present in a more advanced stage of PD - May have stooped posture, a fixed facial expression, speech problems or problems with balance or walking. They may also experience a loss of intellect. Tremor usually is the first symptom people notice. Unlike most other tremors, the "resting" tremor of Parkinson's disease is most severe when the person is awake but not moving around. Emotional and physical stress tend to make the tremor worse. Sleep, complete relaxation and intentional movement or action usually reduce or stop the tremor. Up to 25% of people with Parkinson's disease do not have tremor.
No known treatment can halt or reverse the breakdown of nerve cells that causes Parkinson's disease. However, medication can relieve many symptoms. Surgery to treat symptoms also can be effective in a small number of people.
 

As we mentioned above, Surgery can ease some of the symptoms of Parkinson disease, but it is not a cure. Because of the risks associated with brain surgery, it is usually not considered unless all appropriate medications have been tried unsuccessfully. When considering surgery, it is important to see both a neurologist and brain surgeon who specialize in the treatment of Parkinson disease.
 

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