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Glossary of Terms
- Ablation:
- Surgical destruction or removal of tissue, as in pallidotomy, the surgical ablation of the globus pallidus.
- Actylcholine (Ach):
- The chemical neurotransmitter released by the cholinergic nerves. Actylcholine regulates the delivery of messages from neurons to skeletal muscle fibers, smooth muscle fibers, effector organs, and between nerve cells in the brain and spinal cord.
- Action Tremor:
- A tremor that develops or increases when limbs or body are moving voluntarily such as when eating, writing or drinking.
- Activities of Daily Living (ADL’s):
- Functions typically performed in a person’s daily routine, including dressing, bathing, eating, hobbies, socializing and toileting.
- Agonist:
- A chemical or drug that enhances neurotransmitter activity. In Parkinson’s disease, dopamine agonists activate dopamine receptors in the brain, thereby mitigating symptoms.
- Akinesia:
- Absence of muscle movement.
- Akinetic:
- Having Akinesia, loss of the ability to move all or part of the body.
- Alpha-Tocopherol:
- Vitamin E.
- Alpha 2-adrenergic agonist:
- A drug that reduces the activity of the neurotransmitter norephinephrine and may result in reduced heart rate, lowered blood pressure, and have sedative effects.
- Amantadine:
- A drug that affects both the dopamine and glutamate systems and may reduce the involuntary movements associated with advanced Parkinson’s disease.
- Ambulatory:
- Able to walk, often used to describe patients who do not need a wheelchair or are not confined to bed.
- Amino Acid:
- The chemical building blocks from which all proteins in the body are formed. There are 20 different amino acids, some (essential) must be supplied by diet, some (nonessential) are manufactured by the body.
- Amitriptyline:
- An antidepressant medication that raises the level of neurotransmitters in the brain. Brand names Elavil and Endep. Especially useful for depressed patients with insomnia, restlessness and nervousness.
- Antagonist:
- A drug that blocks a receptor, preventing stimulation.
- Anticholinergic:
- A substance, often a medication, whose effects block acetylcholine. Anticholinergic drugs used for Parkinson’s disease include Artane and Cogentin and may help reduce rigidity, mild tremor and drooling.
- Antihistamine:
- A drug that opposes the chemical histamine, once used to treat some of the symptoms of Parkinson’s disease.
- Antioxidant:
- An agent that prevents the loss of oxygen in chemical reactions. Certain antioxidants are thought to neutralize free radicals. Free radicals are believed to impair functioning and destroy neurons and other body cells.
- Apomorphine:
- (Apokyn) A self-injectable dopamine agonist used as rescue therapy for severe off periods.
- Artane:
- The brand name of the anticholinergic drug trihexyphenidyl.
- Astrocyte:
- A large glial cell with thread-like projections that connect with neurons and capillaries which form part of the blood-brain barrier.
- Ataxia:
- Loss of balance or loss of coordinated movement.
- Athetosis:
- Slow, involuntary movements of the arms, head and legs.
- Atrophy:
- Wasting or loss of a cell, tissue or organ.
- Augmentation:
- May result from the use of certain medications, particularly levodopa. Augmentation is characterized by the worsening of Parkinson symptoms.
- Autonomic Nervous System:
- The part of the nervous system that regulates involuntary vital function, including the activity of the heart, smooth muscles and glands.
- Axon:
- The long, thread like extension of a nerve cell that transmits nerve impulses away from nerve cell bodies.
- Basal Ganglia:
- The basal ganglia are located at the base of the brain and are composed of three main parts; the caudate nucleus, the putamen, and the globus pallidus. The basal ganglia are responsible for normal movements such as walking.
- Benzodiazepenes:
- A class of pharmaceuticals that lower the activity in the brain by acting on the central nervous system. This class of drugs is useful for reducing anxiety, restlessness and agitation, and for promoting sleep. This class of drugs includes Valium and Xanax.
- Bilateral:
- Occurring on both sides of the body.
- Blepharospasm:
- Spasms of the eyelid, blinking, or involuntary closing of the eyelids.
- Bradykinesia:
- One of the cardinal symptoms of Parkinson’s disease, characterized by the gradual loss of spontaneous movement and difficulty in performing repetitive movements. Slowness.
- Brainstem:
- The region of the brain consisting of the medulla oblongata, pons, and midbrain. Most of the 12 pairs of cranial nerves arise from the brain, regulating breathing, digestion, heartbeat, blood pressure, pupil size, swallowing and other basic functions.
- Bromocriptine:
- A dopamine agonist used to treat the symptoms of Parkinson’s, brand name Parlodel.
- Bruxism:
- Involuntary grinding or clenching of the teeth, particularly during sleep or stress.
- Bupropion:
- An antidepressant that inhibits the reuptake of dopamine, serotonin and norephinephrine. Brand names, Wellbutrin, Zyban and Wellbutrin SR.
- Buspirone:
- A medication for the treatment of anxiety that works by stimulating serotonin receptors. Brand name, Buspar.
- Carbidopa:
- A drug usually given in combination with levodopa, the combination is called Sinemet. Carbidopa prevents the breakdown of levodopa in the body before it reaches the brain and helps reduce nausea. Brand name Lodosyn.
- Central Nervous System (CNS):
- The brain and spinal cord. The CNS plays an essential role in the coordination and control of the entire body.
- Cerebellum:
- The part of the brain that is involved in coordination of movements.
- Cerebral Cortex:
- The largest part of the brain, and the part responsible for thought, reasoning, memory, sensation and voluntary movement.
- Citalopram:
- A medication used to treat depression that works by preventing the reuptake of serotonin. Brand name, Celexa.
- Chorea:
- Involuntary, uncontrollable dance-like movements.
- Co-contraction:
- The simultaneous contraction of agonist and antagonist muscles.
- Cogwheeling:
- Stiffness in the muscles characterized by slow, jerking movements.
- Computed Tomography Imaging or Scanning (CT) :
- An advanced diagnostic scanning technique that produces cross-sectional images of tissues and organs.
- COMT Inhibitors:
- Drugs that block catechol-O-methyltransferase, an enzyme that breaks down dopamine. COMT inhibitors include Comtan and Tasmar.
- Constipation:
- Decreased ability of intestinal muscles to move stool through the bowels.
- Controlled-release:
- A formulation of a drug that is absorbed slowly by the digestive system, prolonging the duration of the effect of each dose.
- Decarboxylase inhibitor:
- A drug that hinders the conversion of dopa to dopamine.
- Deep Brain Stimulation:
- A surgical procedure that is highly effective for patients suffering from Parkinson’s disease. During surgery, permanent electrodes are implanted in various parts of the brain, through which continuous pulses of electricity are passed.
- Degenerative:
- Marked by deterioration, notable deterioration of the function or structure of tissue.
- Dementia:
- The loss of intellectual abilities, notably impaired judgment, memory loss, loss of abstract thinking abilities, disorientation, and personality disintegration.
- Dendrite:
- A thread-like extension of a nerve cell that serves as an antenna to receive messages from axons.
- Desipramine:
- A tricyclic antidepressant that elevates mood and relieves depression by raising levels of neurotransmitters in the brain. Brand name, Norpramin.
- Differential Diagnosis:
- Distinguishing between two or more similar diseases by comparing and contrasting signs, symptoms, laboratory tests and other diagnostic procedures.
- Dopa decarboxylase inhibitors:
- Drugs that block the conversion of levodopa to dopamine outside the brain, so that more dopamine can reach the brain. Carbidopa is a dopa decarboxylase inhibitor.
- Dopamine:
- A brain chemical that assists in the transmission of messages from one cell to the next. Dopamine governs movement, balance and walking and is deficient in Parkinson’s patients.
- Dopamine Agonist:
- A drug that mimics the action of dopamine and stimulates the dopamine receptors.
- Dopamine autoreceptor:
- A dopamine receptor that prevents excess dopamine release as levels rise.
- Dopamine receptor:
- A molecule on the neuron that is receptive to stimulation by dopamine or a dopamine agonist. Five types of dopamine receptors have been identified.
- Dopamine receptor antagonist:
- A pharmacologic agent that hinders receptor activity by preventing its stimulation by dopamine.
- Dopamine transporter:
- Returns the released dopamine to the cell that produced it so that is can be reused.
- Double-blind trial:
- A research trial in which neither the patients nor the researchers know which patients are receiving the drug being tested and which are receiving a placebo.
- Drug Induced Parkinsonism:
- Parkinson symptoms which arise from drugs used to treat other conditions. Drug Induced Parkinsonism is common with the use of Reglan and certain antipsychotics.
- Dysarthria:
- Difficult, slurred, poorly articulated speech.
- Dyskinesia:
- Abnormal muscle movements that may appear as side-effects of long-term drug treatment for Parkinson’s. Involuntary dance-like or wiggling movements caused by medications.
- Dysphagia:
- Difficulty swallowing.
- Dystonia:
- Muscle contractions of spasms resulting in abnormal postures such as a foot turned inward.
- Enzyme:
- A substance that speeds up a chemical reaction without being changed or consumed in the process.
- Escitalopram:
- An antidepressant classed as a serotonin reuptake inhibitor. Brand name, Lexapro.
- Esophageal atony:
- Lack of normal muscle tone within the esophagus.
- Extrapyramidal nervous system:
- The system of nerve cells, nerve tracks and pathways that connects the cerebral cortex, basal ganglia, thalamus, cerebellum, reticular formation and spinal neurons, responsible for the movements such as balance and walking. The extrapyramidal nervous system is often damaged in Parkinson patients.
- First-degree relative:
- Relatives including a person’s mother, father, siblings, and natural children.
- Festination:
- Rapid, short, shuffling steps when walking.
- Flexion:
- The act of bending, as opposed to extending, a joint or a bent, curved posture.
- Fluoxetine:
- An drug commonly used in the treatment of depression and obsessive-compulsive disorders that works by inhibiting the release or affecting the action of serotonin. Brand name, Prozac. (SSRI)
- Free Radicals:
- Unstable molecular fragments that can damage cells. One hypothesis holds that free radicals damage the nigral cells and lead to Parkinson’s disease.
- Freezing:
- A temporary, involuntary inability to move often seen in patients with advanced Parkinson’s disease.
- Froment’s sign:
- Increased resistance to passive movement of a limb.
- Gait:
- The style of walking. Gait disturbances are commonly seen in Parkinson’s disease.
- Gait apraxia:
- Loss of ability to sequence and perform the movements required in walking. Incoordination and poor balance.
- Gamma-aminobutyric acid (GABA):
- GABA is the primary inhibitory neurotransmitter in the brain and it inhibits the electrical activities of nerve cells.
- Globus pallidus:
- A structure deep within the brain that processes and transmits information from the basal ganglia to the areas of the brain that regulate complex motor functions. The site for pallidotomy and one of the sites for deep brain stimulation surgery in Parkinson’s disease.
- Glutamate:
- The amino acid that plays an essential role in starting and transmitting nerve impulses.
- Hallucinations:
- Perceptions that occur in the absence of external stimuli while a person is awake. Hallucinations may be auditory, visual, olafactgory, tactile or gustatory.
- Hereditary:
- Inherited or inborn.
- Hoehn and Yahr Scale:
- Scale used to rate the global severity of the motor symptoms of Parkinson’s disease. Scores range from 0 (no signs of the disease) to 5 (wheelchair bound or bedridden.)
- Hypokinesia:
- Decreased motor activity.
- Hyperkinetic:
- Having excessive movement.
- Idiopathic:
- Of unknown cause. Most Parkinson’s disease is idiopathic.
- Implantable Pulse Generator (IPG):
- The nuerostimulation device that is placed near the collarbone as part of DBS surgery. ( Battery .)
- Inhibitor:
- A substance that blocks or interferes with a particular chemical reaction of biologic activity.
- Intention Tremor:
- A tremor that occurs when a person attempts voluntary movement, the tremor tends to increase as the limb reaches a target.
- Isoleucine:
- As essential amino acid.
- Kinesigenic:
- Abrupt, involuntary movements that are provoked by sudden motions or unexpected stimuli.
- Lateral:
- Toward the side, or, on or from the side.
- Lenticular nucleus:
- A group of nerve cells located in the basal ganglia containing the cells of the Levodopa (L-dopa): Levodopa is the most effective anti-Parkinson drug that is changed into dopamine in the brain.
- Levodopa induced dyskinesias:
- Abnormal, involuntary movements that may occur with prolonged use of levodopa.
- Lewy Body:
- Abnormal pigmented spheres inside brain cells found in the substantia nigra and other brain structures in people with Parkinson’s disease.
- Lewy Body Disease:
- Also called Lewy Body Dementia or Diffuse Lewy Body Disease. Onset is typically in the late 50’s through the 70’s and is more common in men than women. Lewy Body Disease has symptoms of dementia as well as extrapyrimidal signs and is therefore often confused with PD. In Lewy Body Disease, the Lewy Bodies are usually found in the cortex, versus the midbrain in Parkinson’s disease.
- Livido Reticularis:
- A bruise-colored mark on the skin usually found below the knee and on the forearm of persons treated with amantadine. Usually benign.
- Magnetic Resonance Imaging (MRI):
- A diagnostic scan that is particularly valuable for studies of the brain and spinal cord.
- MAO-B Inhibitors:
- Inhibit the enzyme monoamine oxidase B. MAO-B helps break down dopamine, inhibiting it helps prolong the action of dopamine in the brain.
- Micrographia:
- Very small handwriting seen in Parkinson patients.
- Mirapex:
- A dopamine agonist, pramipexole.
- Mirtazapine:
- An antidepressant that increases the amount of noradrenaline and serotonin in the brain. Brand name, Remeron.
- MPTP:
- A heroine-like drug that causes Parkinson’s disease in intravenous users. MPTP is now manufactured in the laboratory for use in animal studies.
- Myelin:
- The sheath or covering around axons, serving to speed transmission of nerve signals.
- Myoclonus:
- Jerking, involuntary movements of the arms and legs, usually occurring during sleep.
- National Institutes of Health:
- Among the world’s foremost medical research centers, NIH is one of eight health agencies of the US Department of Health and Human Services.
- Neostriatum:
- The part of the brain made up of the caudate and putamen.
- Neurodegenerative:
- Characterized or pertaining to new deterioration of the structure or function of tissue within the nervous system.
- Neuroimaging:
- Imaging (picture) of the brain and spinal cord through CT (computed tomography scanning), MRI (magnetic resonance imaging), or PET (positron emission tomography.)
- Neuroleptic Drugs:
- These drugs include Haldol, Compazine, Stelazine and Chlorpromazine, and are used in the treatment of serious psychiatric conditions. Use of these medications can produce or aggravate symptoms of Parkinson’s disease.
- Neuron:
- A nerve cell
- Neurotransmitter:
- A chemical messenger produced in nerve cells and permitting communication from the brain to other parts of the body.
- Nigrostriatal system:
- Referring to the substantia nigra and the striatum.
- Nigrostriatal Degeneration:
- Degeneration or destruction of the nerve pathways between the substantia nigra and the striatum, common in Parkinson’s disease.
- Norepinephrine:
- Chemical messenger involved in governing involuntary movements. The release of norepinephrine deepens breathing, raises blood pressure, increases heart rate and regulates mood.
- On-Off Phenomena:
- Describes the abrupt and unpredictable changes in the Parkinson patients mobility in response to levodopa treatment. On is a good response, off a poor response.
- Orthostatic Hypotension:
- A rapid decrease in blood pressure when changing body position, often from sitting to standing. Orthostatic Hypotension can cause dizziness, light-headedness and fainting.
- Palilalia:
- The repetition of the same words or phrases over and over.
- Pallidotomy:
- A surgical procedure for Parkinson’s disease in which part of the globus pallidus is destroyed, now widely replaced by Deep Brain Stimulation.
- Palsy:
- Paralysis of a muscle or group of muscles.
- Paraesthesia:
- Often unpleasant sensations, often called “pins and needles,” feelings of tingling or numbness, or fluctuations of warmth and coldness.
- Parkinson’s Face or Mask:
- A mask-like loss of facial expression with infrequent blinking that is characteristic of Parkinson’s disease.
- Parkinsonism:
- A clinical state characterized by tremor, rigidity, bradykinesia, stooped posture and shuffling gate.
- Parasympathetic Nervous System:
- The Parasympathetic Nervous System and the Sympathetic Nervous System form the Autonomic Nervous System which controls the function of the heart, glands and smooth muscle. The Parasympathetic Nervous System serves to conserve or restore energy.
- Parlodel:
- A dopamine agonist, bromocriptine.
- Paroxetine:
- A drug useful for the management of depression, obsessive-compulsive disorders, and panic disorders. A serotonin reuptake inhibitor. Brand name, Paxil, Paxil CR.
- Pathogenesis:
- The origination and development of a disease.
- Pathophysiology:
- The effects of a disease on functioning.
- Periodic apnea:
- The temporary cessation of spontaneous breathing, characterized by lack of airflow, chest wall movements, or an obstruction of the airway due to poor control of the tongue or impaired coordination of the upper airway muscles.
- Pergolide:
- A dopamine agonist. (Permax)
- Peripheral edema:
- Swelling of the arms or legs due to fluid accumulation.
- Phonation:
- Referring to the production of speech.
- Physiatrist:
- A doctor specializing in rehabilitation.
- Placebo:
- A placebo is given to test subjects and is indistinguishable from the active drug. Placebos are sometimes referred to as sugar pills.
- Positron Emission Tomography (PET):
- A computerized imaging technique that shows structures and chemical and metabolic activities in the brain.
- Postural Instability:
- Difficulty with balance.
- Postural Tremor:
- Tremor that increases when hands are stretched out in front, or in any position against gravity.
- Precursor:
- A substance that precedes another in a biochemical reaction, for example, levodopa is a precursor to dopamine.
- Propulsive Gait:
- Steps that become faster and faster as they become shorter and shorter, so that the gait passes from walking to running. Propulsive gait is typical in Parkinson’s disease and may precipitate falls.
- Putamen:
- A structure of the brain in the basal ganglia. Cells in the putamen receive input from other regions of the brain, are processed and relayed to control voluntary movement.
- Range of Motion (ROM):
- The extent that a joint will move from being fully extended to fully bent. Passive ROM is tested while the limb is relaxed, active ROM is movement controlled by the patient.
- Receptor:
- A structure located on the nerve cell that receives neurotransmitters (for example, dopamine) sent from other nerve cells.
- Refractory:
- Resistant to treatment
- Resting Tremor:
- Tremor of the limbs or body while the body is at rest.
- Restless Legs Syndrome:
- A movement disorder characterized by uncomfortable sensations in the calves or thighs. These sensations cause an uncontrollable need for the patient to move the legs. Arms are sometimes affected. The sensations often occur at night and often result in sleep disturbances.
- Retropulsive Gait:
- Walking that is propelled backwards.
- Requip:
- A dopamine agonist that increases the availability of dopamine to the brain.
- Rigidity:
- Increased resistance and muscular stiffness common in Parkinson’s disease.
- Seborrhea:
- Increased oily skin secretions in those with Parkinson’s disease.
- Seborrheic Dermatitis:
- Inflammation of the skin associated with seborrhoea.
- Selegiline:
- A drug that inhibits the enzyme that destroys dopamine. Brand name Eldepryl.
- Serotonin:
- A neurotransmitter regulating the delivery of messages between neurons. Serotonin is thought to play a role in regulating consciousness and mood.
- Sertraline:
- An antidepressant medication of the selective serotonin reuptake inhibitor class. Brand name, Zoloft.
- Shaking Palsy:
- Antiquated term for Parkinson’s disease.
- Sialorrhea:
- An excess production of saliva, or the increased amount of saliva accumulated in the mouth due to swallowing difficulties. Drooling.
- Side Effect:
- Often an adverse and unintended effect of a drug.
- Single Photon Emission Computed Tomography (SPECT):
- A scanning technique particularly useful in detecting chemical changes to the central nervous system and heart.
- Sinemet:
- The brand name for the formulation containing carbidopa and levodopa.
- Sinemet CR:
- A controlled release version of Sinemet that works for a longer period of time.
- Stereotactic:
- The use of precise coordinates to identify structures deep in the brain. Stereotactic methods are used in deep brain stimulation.
- Striatum:
- An area of the brain (located in the basal ganglia) controlling movement, balance and Substantia Nigra: The area of the brain where dopamine is produced. Degeneration of the substantia nigra leads to Parkinson ‘s disease.
- Sustention Tremor:
- see Postural Tremor
- Symmetrel:
- A pharmceutical product that releases dopamine from the substantia nigra.
- Sympathetic Nervous System:
- With the Parasympathetic Nervous System, forms the Autonomic Nervous System. The Sympathetic Nervous System activates during times of stress to regulate involuntary responses. These responses are often referred to as the “fight or flight” response.
- Synapse:
- The junction between two neurons.
- Tardive Dyskinesia:
- Characterized by abnormal, involuntary movement of the face, mouth or arms. A side effect of long-term use of medications such as those of the antipsychotic class.
- Thalamus:
- The part of the brain that relays information from most sensory organs to the cerebral cortex and receives and processes messages from the body about heat, cold, pain, pressure and touch.
- Thalamotomy:
- Brain surgery in which part of the thalamus is destroyed to control tremor, rarely used in Parkinson treatment.
- Toxin:
- A poisonous substance.
- Transient:
- Temporary
- Trazodone:
- An antidepressant that inhibits the reuptake of serotonin and may also directly increase its action. Brand name, Desyrel.
- Tremor:
- Rhythmic shaking of limb, mouth, tongue or other body parts.
- Trimipramine:
- A tricyclic antidepressant that works by raising the brain’s level of norepinephrine to more normal levels. Also has anti-cholinergic actions. Brand name, Surmontil.
- Tryptophan:
- An essential amino acid
- Unilateral:
- Affecting or confined to one side only. Parkinson symptoms usually begin unilaterally.
- Upper Motor Neurons:
- Nerve cells that control movement. They extend from the brain to the spinal cord.
- Valine:
- An essential amino acid.
- Venlafaxine:
- An antidepressant that is believed to work by inhibiting the release of or affecting the action of neurotransmitters in the brain. Brand name, Effexor.
- Wearing Off Phenomena:
- The tendency for each drug dose to last for increasingly shorter periods of time. The Wearing Off effect tends to increase with long-term exposure to levodopa treatment.
- Zydis:
- Zydis is a drug delivery system in which the effective agent is incorporated in freeze-dried wafers that dissolve quickly in the mouth.
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