Parkinson’s disease and abnormal movements

Parkinson’s disease is a chronic, progressive and degenerative neurological disease. It primarily affects movement control, which may cause tremors, slowness of movement, muscle rigidity, and balance and postural disorders. Over time, the disease may also affect other functions, such as sleep, mood, attention, memory, or certain automatic functions of the body (for example, digestion or blood pressure). The disease is linked to the progressive destruction of neurons located in an area of the brain called the substantia nigra. These neurons produce dopamine, a chemical messenger essential for coordinating and controlling voluntary movements. The decrease in dopamine disrupts communication between the different areas of the brain involved in movement, which explains the onset of symptoms.

Motor symptoms

The best-known signs are:

• Tremors at rest,
• Slowness of movement (bradykinesia),
• Muscle rigidity,
• Balance and gait disturbances. 

Non-motor symptoms

The disease is also often accompanied by less visible symptoms:

• sleep disturbances,
• loss of smell,
• constipation,
• mood disorders (anxiety, depression),
• fatigue, pain, cognitive impairment. 

The exact causes are not yet fully known, but several factors are involved:

• Genetic factors: certain rare genetic variations increase the risk.
• Environmental factors: exposure to certain chemicals (pesticides, heavy metals), certain solvents or head injuries could increase the risk.
• Advanced age: the disease is more common in older people, although cases in younger people also occur (before the age of 40). 

The number of people living with Parkinson’s disease in Belgium is estimated at between 30,000 and 50,000, with approximately 2,000 to 3,000 new diagnoses each year. It is the second most common neurodegenerative disease in the country after Alzheimer’s disease.

Screening and diagnosis

The diagnosis is clinical and is based on a careful neurological examination of the patient. There is no single blood test that confirms the disease, but certain tests (MRI, dopaminergic scintigraphy) can help to rule out other causes. The general practitioner often refers the patient to a specialised neurologist, who establishes the diagnosis and proposes an appropriate treatment plan.

Symptomatic treatments

At present, there is no curative treatment, but several options can help manage the symptoms effectively:

• Dopaminergic medications, such as levodopa, which replace the dopamine lacking in the brain.
• Dopamine agonists and other classes of medication, used according to the symptoms and their progression.
• Medications that modulate the action or metabolism of dopamine:
  • MAO inhibitors (MAOIs) and COMT inhibitors (COMTIs), which allow dopamine or levodopa to act for longer in the brain;
  • Amantadine, which can improve certain motor symptoms and help reduce involuntary movements associated with treatment.
• Rehabilitation therapies (physiotherapy, occupational therapy, speech therapy) to maintain mobility, balance, speech and quality of life.
• Deep brain stimulation (DBS), offered to some people when medication no longer controls the symptoms sufficiently, by implanting electrodes in the brain.

Brussels University Hospital has a clinic specialising in the diagnosis and management of movement disorders, including those caused by Parkinson’s disease (the Parkinson’s disease and Abnormal Movements Clinic). We offer personalised care focused on quality of life and the patient’s goals, including through a multidisciplinary approach that addresses both motor and non-motor aspects (cognition, sleep, pain, mood, independence, etc.). When necessary, we refer patients to advanced therapies and specialised care pathways. The H.U.B. Abnormal Movements Clinic team includes specialist physicians and multidisciplinary healthcare staff, including neurologists specialising in movement disorders, a physiotherapist, a speech therapist, neuropsychologists and a psychologist.