Parkinson's Disease and Movement Disorders

What is Parkinson's disease?

The symptoms of Parkinson's disease are caused by degeneration of a structure of the brain called the substantia nigra. This causes a lack of a neurotransmitter called dopamine.

Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer’s disease. A study in Singapore showed that Parkinson's disease occurs as commonly as in the West. Three out of every thousand individuals, aged 50 years and above, have this disease. 

What are movement disorders?

Movement disorders refer to a group of neurological conditions that result in disorders of normal body movements. This may refer to conditions that slow down body movements such as Parkinson's disease or conditions that are associated with abnormal or increased body movements. 

The disorders we often see in our movement disorders clinics include:

• Ataxia: Red ability to coordinate voluntary movements that may result in problems with walking and balancing
• Chorea: Jerky, irregular, relatively rapid, involuntary movements that can affect the face or limbs.
• Dystonia: Slow, twisting, involuntary movements associated with forceful muscle contractions or spasms. This may affect the eyes (blepharospasm), muscles of the face, jaws, neck, upper limbs and/or lower limbs. At times these spasms occur on performing a specific task such as writing (writer’s cramps)
• Hemifacial spasms: Involuntary twitching or spasms that affect one half of the face, including the eye muscles, resulting in uncontrollable eye closure
  
• Myoclonus: Brief, involuntary, jerk-like twitching or contractions of muscles
• Myokymia: Fine persistent quivering or rippling of muscles
• Tremors: Rhythmic, involuntary, to-and-fro shaking movements that often affect the arms, hands or head.
• Tics: Repetitive, purposeless muscle movements (motor tics) or vocalisations (vocal tics) that arise from an irresistible urge that is temporarily relieved following the execution of the movement or vocalisation

These abnormal movements may arise from a variety of diseases and careful evaluation is necessary to determine the underlying cause.

As Singapore’s population continues to age, the number of people with Parkinson's disease and movement disorders, such as essential tremor, dystonia, chorea and myoclonus will rise. As with many other medical conditions, these diseases currently do not have a cure. However, there are effective treatments available to control symptoms and improve daily function. Minimally invasive surgery is also available to treat patients with advanced disease.

The Parkinson Disease and Movement Disorders Programme emphasises the provision of comprehensive clinical services coupled with strong research initiatives. A multi-disciplinary team of neurologists, neurosurgeons, nurse clinicians, therapists and medical social workers, work together to provide the best care for our patients.

What are the symptoms of Parkinson's disease?

The major symptoms of Parkinson's disease include:

• Shaking of arms or legs when at rest
• Stiffness of arms, legs or body
• Slowness of movement and walking
• Stability problems when walking or standing
  

Other common signs include a expressionless face (masked facies), softer voice, smaller handwriting, drooling of saliva, difficulty swallowing, and walking difficulties. There is no simple laboratory tests to diagnose Parkinson's disease and doctor make the diagnosis based on a set of symptoms or signs.

How is Parkinson's disease treated?

Parkinson's disease is a slowly progressive disorder. There is currently no cure. 

Medications

However, there are effective medications that can improve the symptoms of the disease. Your doctor will be able to recommend the most appropriate medications depending on your symptoms, age and other medical conditions. Treatment has to be individualised and medications that are suitable for one patient may not be ideal for another.

Deep brain stimulation (DBS)

For patients with more advanced disease, limited neurosurgery called deep brain stimulation (DBS) may further improve symptoms. This involves the implantation of a wire into the brain to electrically stimulate that area.

How are movement disorders treated?

After the type of abnormal movement has been classified and the cause established, the next step is to reduce the frequency or severity of these movements so as to improve function or reduce discomfort. Oral medications are the main type of treatment used to control these movements. 

For some of these disorders such as facial spasms or dystonia, botulinum toxin injections may be useful to relieve the symptoms.

Research

Research is a major emphasis of this programme at the National Neuroscience Institute. Both patient-based and laboratory-based research are conducted at the Institute under strict ethical guidelines. Doctors and scientists work together closely to understand the causes and find better means to treat patients with Parkinson’s disease and other movement disorders. Patients who are interested to participate in these research initiatives are encouraged to approach their treating doctors.

Community Care Partners Programme (CCPP)

In October 2007, our Parkinson Disease and Movement Disorders Centre initiated Singapore’s first-ever organised outreach programme for the Parkinson community. The NNI-CCPP is a programme that aims to enhance the delivery of community care and support to the Parkinson community by tapping on the well-integrated network of community healthcare facilities in Singapore. The NNI and its CCPP partners work together to ensure that the PD community receives the best possible coordinated care. Our CCPP Partners help provide the crucial link between NNI and the PD patients in the community.

NNI Parkinson Disease and Movement Disorders Centre

The Parkinson Disease and Movement Disorders Centre at the National Neuroscience Institute (PDMDC NNI) is dedicated to the comprehensive care, research, education and training into Parkinson’s disease and movement disorders. We have a multidisciplinary team of healthcare professionals and research scientists, through a unique partnership between NNI and two major hospitals in Singapore: Tan Tock Seng Hospital (TTSH) and Singapore General Hospital (SGH).

Since 2006, our Centre has been designated as a Parkinson's Foundation (PF) Centre of Excellence. This is a designation awarded by the PF to healthcare institutions that excel in Parkinson-related comprehensive care, research and community outreach programmes. NNI is proud to be one of the two PF Centre of Excellence in Asia.