Parkinson's Syndrome

What is Parkinson’s syndrome?

Parkinson’s syndrome (Parkinson’s disease) is a slowly progressive neurodegenerative disease in which nerve cells in the brain that produce the messenger substance dopamine die off. The dopamine deficiency leads to the typical movement disorders. The disease usually appears after the age of 50.

Symptoms

Cardinal symptoms

  • Bradykinesia/akinesia – slowing and reduction of movements, e.g. small-stepped gait, quiet voice, reduced facial expression
  • Rigidity – muscle stiffness felt as a tough resistance during passive movement
  • Resting tremor – rhythmic trembling, typically of the hands at rest (pill-rolling tremor)
  • Postural instability – balance disorders and increased tendency to fall (in the later course)

Other symptoms

  • Impaired sense of smell (often an early sign)
  • Sleep disorders (REM sleep behavior disorder)
  • Constipation
  • Depression and lack of drive
  • Cognitive impairment in the later course
  • Pain, especially shoulder-arm pain
  • Increased salivation
  • Quiet, monotone speech

Causes

  • Idiopathic Parkinson’s syndrome (Parkinson’s disease) – most common form, cause not fully understood. Death of dopaminergic neurons in the substantia nigra
  • Genetic factors – familial clustering in rare cases
  • Secondary Parkinson’s syndrome – caused by medications (e.g. neuroleptics), circulatory disorders, or other diseases
  • Atypical Parkinson’s syndromes – multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD)

Diagnostics

The diagnosis is made primarily on clinical grounds:

  • Detailed medical history – symptom progression, medication history, family history
  • Neurological examination – assessment of mobility, muscle tone, tremor, gait and balance
  • L-Dopa test – improvement of symptoms after administration of L-Dopa suggests Parkinson’s disease
  • Neurosonography – ultrasound of the substantia nigra (transcranial sonography) can provide clues
  • Laboratory tests – to rule out other causes
  • Imaging – MRI to rule out structural causes, and DaTSCAN if needed (referral)

Treatment

Drug therapy

  • L-Dopa (Levodopa) – most effective therapy, converted to dopamine in the brain
  • Dopamine agonists (e.g. Pramipexole, Ropinirole) – stimulate dopamine receptors directly
  • MAO-B inhibitors (e.g. Rasagiline, Safinamide) – slow the breakdown of dopamine
  • COMT inhibitors (e.g. Entacapone) – prolong the effect of L-Dopa
  • Amantadine – for dyskinesias and as acute therapy

The therapy is adjusted individually and regularly optimized over the course of the disease.

Non-drug therapy

  • Physiotherapy (gait training, balance exercises)
  • Speech therapy (speech and swallowing training)
  • Occupational therapy (coping with everyday life)
  • Regular physical activity
  • Psychological support for depression

Disease monitoring

  • Regular neurological examinations
  • Adjustment of medication to the course of the disease
  • Monitoring of side effects (dyskinesias, impulse control disorders)

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Last updated: 2026-07-04