What causes Parkinson’s? How is it treated? Causes Parkinson’s disease – Drkharkar

This concise information about the cause of Parkinson’s disease, diagnosis and treatment is from a handout that I give to my clinic patients.

I hope it helps you.

You can download the original PDF by clicking here: [Parkinsons Patient Information Handout]. Its free for use and distribution.

For more extensive information, you can read the complete Parkinson’s Patient Guide.

What is Dopamine?

There is a small part at the back of our brain. It is called the midbrain.

Dopamine helps with movement

The cells in the midbrain produce a chemical called Dopamine.

Dopamine goes from the back to the front of the brain, and it helps in maintaining a good mood and proper movement. 

What is Parkinson’s Disease?

In some people, the midbrain cells slowly decrease in number.

Cause of parkinsons disease is reduction in dopamine levels

The amount of Dopamine in the brain becomes low. People find it difficult to move due to low Dopamine.

This problem is called “Parkinson’s Disease”.

Which movement problems are seen in Parkinson’s disease?

Low dopamine produces 3 main problems:

  1. Shaking of hand or leg (Tremor)
    hand shaking or hand tremor is one of the symptoms of parkinsons disease
  2. Slowness of all movements including walking, talking, dressing & facial movements.
  3. Stiffness of the hands, legs or back

In addition, Parkinson’s disease patients also frequently have imbalance. They can fall easily.

Are any other problems seen in Parkinson’s disease?

Yes, many. You may not realise that these problems are due to Parkinson’s disease.

constipation is a common symptom of parkinsons disease

  1. Constipation
  2. Trouble smelling food
  3. Talking/shouting while sleeping.
  4. Depression, Anxiety, hallucinations.
  5. Excessive sleepiness during the day.
  6. Trouble swallowing food
  7. Sexual dysfunction
  8. Abnormal sweating
  9. Trouble breathing
  10. Feeling lightheaded on standing up.

How is Parkinson’s disease diagnosed?

Parkinson’s disease is usually diagnosed based on your symptoms and your physical examination.

I and many other doctors order some basic tests including an MRI of the brain and blood tests. These tests are usually normal.

Brain disease diagnosis with medical doctor seeing Magnetic Resonance Imaging MRI film diagnosing elderly ageing patient neurodegenerative illness problem for neurological medical treatment

A very high resolution MRI (3T) can sometimes demonstrate the decrease in midbrain cells.

What is a f-DOPA scan?

The exact test to diagnose Parkinson’s disease is called “f-DOPA scan” (or TRODAT scan).

This test measures the exact amount of dopamine in the brain.

fDOPA scan can confirm the diagnosis of parkinsons disease

But this test is very expensive (Rs 20-30,000). It is done only when the diagnosis is unclear. Perhaps it is needed in 2 in every 100 patients.

What is the treatment for Parkinson’s disease?

The treatment is very simple. We give the patient extra dopamine.

The type of dopamine that can be given by mouth is called Levodopa. Levodopa is converted into Dopamine inside the brain.

Levodopa is a cheap, safe and extremely effective medication.

A few brand-names in India are: Syndopa plus, Tidomet, LCD, Sinement etc.

Why are there so many other medications?

As Parkinson’s progresses, your symptoms will change.

These symptoms are controlled by combining medications.

Parkinsons medications may need to be changed as you grow older

For example:

  1. If the effect of levodopa goes away after a few hours, then a medication called “entacapone” may be added.
  1. If you have excessive disco-like movements due to levodopa, these are called “dyskinesias”. “Amantadine” may be added.

There are many such examples.

When is Deep brain stimuation (DBS) done?

In some people, it becomes difficult to manage symptoms using only medications.

This usually happens many, many years after diagnosis. At this stage, a surgery called Deep Brain Stimulation (DBS) can be done.

Deep brain stimulation DBS is a surgery for Parkinsons disease

Two small very thin wires are placed in your head. These wires are connected to a battery. The battery is placed below the skin.

DBS is a relatively safe, very effective treatment for late stage Parkinson’s Disease.

I will tell you if it is time to consider DBS. In some people, DBS is not required at all. You can also discuss it with me at any time.

Why don’t many people get DBS?

I think there are 4 reasons:

A major problem is cost.
Unfortunately, the DBS device is not manufactured in India. Hence it is expensive. 

DBS device used for the treatment of parkinsons disease

Some people are scared of any kind of surgery.
DBS is a brain surgery, but only two small holes to put two wires are done on the skull. It is a relatively safe surgery.

Many people want a guarantee.
There is nothing like a “100% guarantee” in medicine. But DBS benefits most people with Parkinson’s disease.

Many people have never heard about DBS.
Now you have!

Are there some Medications I should avoid?

Certain medications decrease dopamine levels in the brain. They make Parkinsonism worse.

Try to show me any medications prescribed by other physicians before taking them, unless it is an emergency.

Many medications used for psychiatric issues such as schizophrenia.

Sometimes also given for “good sleep” & depression.

Haloperidol, Risperidal, Olanzapine, Aripiprzole, Trifluoperazine and many more. 

Clozapine and Quetiapine usually do not cause problems. 

Some medications for mood and depressionFluphenazine, Tranycypormine, Rarely, Lithium
Some anti-nausea medicationsMetoclopramide, Levosulpuride (Most problematic medication).

High doses of domperidone about 30-40 mg/day,

Flunarazine, rarely cinnarizine

Some heart and blood pressure medicationsAmiodarone, methly-dopa

Any other instructions?

  1. Show me all the medications you are taking. All medications, for any condition.
  2. Take your Parkinson’s medications at the exact same time every day.
  3. Take levodopa on an empty stomach. No food 30 minutes – and if possible 1 hour before and after taking levodopa.
    Parkinsons medications should be taken at least 1 hour before or after food
  4. Take levodopa with one full glass of water.
  5. Before coming for follow-up visits, please fill out the diary for at least 2 days.

Parkinson’s Diary

Take 5-6 xerox copies of the Parkinson’s diary page. You can download blank forms from drkharkar.com

Before coming for follow-up visits, please fill out the diary for at least 2 days.

Please use the following words.

  • OFF = When your symptoms are present/severe.
  • ON = When your symptoms are better.
  • DYSKINESIA: Excessive and abnormal movements, like a disco dance.


Make many Xerox-copies of this blank table, and write in those xerox copies.

Keep the original blank for reuse.

Sleeping?Took Levdopa? (Note time)What was your status?How  were you functioning?

0 = Worst 3 = Best

Other problems

e.g. Constipation, could not wear clothes, nightmares, shouting etc

Midnight – 4 AM□ ON □ ON with dyskinesias


   0   1   2   3
5 AM – 6 AM□ ON □ ON with dyskinesias


   0   1   2   3
6 AM – 7 AM□ ON □ ON with dyskinesias


   0   1   2   3
7 AM – 8 AM□ ON □ ON with dyskinesias


   0   1   2   3
8 AM – 9 AM□ ON □ ON with dyskinesias


   0   1   2   3
9 AM – 10 AM□ ON □ ON with dyskinesias


   0   1   2   3
10 AM – 11 AM□ ON □ ON with dyskinesias
   0   1   2   3
11 AM – 12□ ON □ ON with dyskinesias


   0   1   2   3
12 Noon – 1 PM□ ON □ ON with dyskinesias


   0   1   2   3
1 PM – 2 PM□ ON □ ON with dyskinesias


   0   1   2   3
2 PM – 3 PM□ ON □ ON with dyskinesias


   0   1   2   3
3 PM – 4 PM□ ON □ ON with dyskinesias


   0   1   2   3
4 PM – 5 PM□ ON □ ON with dyskinesias


   0   1   2   3
5 PM – 6 PM□ ON □ ON with dyskinesias


   0   1   2   3
6 PM – 7 PM□ ON □ ON with dyskinesias


   0   1   2   3
7 PM – 8 PM□ ON □ ON with dyskinesias


   0   1   2   3
8 PM – 9 PM□ ON □ ON with dyskinesias


   0   1   2   3
9 PM – 10 PM□ ON □ ON with dyskinesias


   0   1   2   3
10 PM – 11 PM□ ON □ ON with dyskinesias


   0   1   2   3
11 PM – Midnight□ ON □ ON with dyskinesias


   0   1   2   3

Keywords – Causes Parkinson’s disease, symptoms of parkinsons disease, i cured my parkinsons disease, how to prevent parkinsons disease, parkinsons disease causes symptoms and treatment, what causes parkinsons disease dopamine, how to test yourself for parkinsons, treatment of parkinsons disease

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message

NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.6 87 reviews

  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ a year ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ a year ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ a year ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ a year ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

Leave a Comment

Noted as one of the best Neurologists in Mumbai

India Today Magazine - 2020, 2021, 2022, 2023

Outlook India Magazine - 2021, 2023

Ex-Assistant Professor, University of Alabama, USA

Outlook India - Best neurologist in Mumbai