Q: I am unable to walk, work and move around normally. My body movements and limbs are moving involuntarily, just like a semi-spastic patient. Working and moving around has become difficult. The problem started around 2 years back. I was a normal and active working lady. My husband and 2 grown up children are having a hard time because of my present condition. I had an accident 17 years ago. Our vehicle toppled hitting a road divider, I had multiple bruises all over my body and I suppose my head also hit but there was no blood or fracture. I was fine after 20 days and was back to work. All these years I have faced no problems of consequence. This problem started around 3 years ago. How to get effective treatment for this?

A:The features you describe are very suggestive of Parkinson's disease, which is seen more commonly with advancing age but may also be a delayed neurologic sequela following head trauma. Parkinson disease is a chronic, progressive movement disorder caused by neuro-degenerative changes. It occurs when a group of cells in an area of the brain called the substantia nigra begin to malfunction and die. These cells in the substantia nigra produce a chemical called dopamine, which is a neurotransmitter (chemical messenger) that sends information to the parts of the brain that control movement and coordination. In this disease the dopamine-producing cells begin to die and the amount of dopamine produced in the brain decreases. When approximately 80% of the dopamine-producing cells are damaged, the symptoms of Parkinson disease appear. The 3 cardinal signs of the disease are resting tremor (shaking), rigidity (stiffness), bradykinesia (slowness of movement), and postural instability (difficulty with balance) and 2 out of 3 are required to make the clinical diagnosis. Postural instability occurs late in the disease, Treatment aims at controlling the signs and symptoms for as long as possible while minimizing side effects. Drugs usually provide good symptomatic control for 4-6 years following which disability progresses despite best medical management. Symptomatic therapy is dopamine replacement therapy and this can be achieved using several groups of drugs. a) Dopamine prodrugs (levodopa); b) Dopamine agonists (directly stimulate post-synaptic dopamine receptors); c) Catechol-O-methyltransferase (COMT) inhibitors (inhibit the peripheral metabolism of levodopa); d) Anticholinergics (provide benefit for tremor in approximately 50% of patients); and e) MAO-B inhibitors (inhibit the activity of MAO-B oxidases that are responsible for inactivating dopamine). Newer neuroprotective therapies aim to slow the underlying loss of dopamine neurons and Selegiline is the medication that has been studied the most. Surgery can ease the symptoms of Parkinson disease, but it is not a cure. As it poses risks, it is only considered when 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. Stereotactic techniques include thalamotomy and chronic thalamic stimulation. They are effective in reducing medically refractory tremor while thalamic deep brain stimulation (DBS) involving high-frequency stimulation also helps. Please contact a neurologist who can examine you and advise appropriately.