Tuesday, 26 July 2011

Parkinson's Disease

Published in Panorama

Dealing with Parkinson’s Disease.

Parkinson’s Disease (PD) is a slowly progressing degenerative disease affecting some station, a special nuclei in the brain which is responsible for keeping the tones and movement of the muscles. It is a disorder that affects movement, muscle control, and balance. The incidence of PD is about 2-3/1000 individuals above the age of 65 years and between 1-2/1000 people above the age of 70 years. However, the incidence may be much higher since it often goes unreported as it is not an infectious disease. It is also a disease which is seen to be affecting more men than women, says Dr.Kasid Noouri, Specialist Neurologist, Welcare Hospital, Dubai.

While the cause of the disorder is not fully known, it is believed that the deficiency of dopamine, a neurotransmitter in the brain is responsible for it. Dopamine itself dwindles as a part of age-related degeneration. Besides dopamine, environmental factors are also indicated in the disorder, particularly environmental toxins. Drugs used for certain disorders or diseases as for instance drugs used for psychiatric disorders like schizophrenia, lead to a depletion of dopamine; hence they are also considered to be contributory factors. According to recent research, free radicals and toxins are indicated in Parkinson’s Disease. Individuals with free radicals may have problems of clearing the toxins from the liver and they have deposition of more than the required level of iron in their brain. All these factors damage the cells producing dopamine, thereby contributing to Parkinson’s, explains Dr.Noouri.

Although dopamine deficiency is clearly indicated as the primary defect in Parkinson's disease, other contributory factors as environmental toxins, herbicides, pesticides exposure to carbon monoxide fumes are also associated with the disorder.

Is PD strictly a disorder of old age? Are there situations where younger individuals may be affected by it? Dr.Noouri explains that while it is mostly a degenerative disorder associated with old age, in rare instances, it may even occur in younger individuals. The condition termed Juvenile onset Parkinson’s can occur in individuals as young as 40 years of age. These patients may have abnormal movements and stiffness rather than tremor and rigidity that is typically associated with PD.

Dr.Noouri adds, “It is usually a disease of the elderly but we have cases where younger people are affected with Parkinsonian features. These people have features of Parkinson’s Disease but they are not Parkinson’s. These include people with cerebro-vascular disease, people who have had some infection in the past, boxers who have had repeated blows to the head region and consequent brain injury.”

What are the symptoms of Parkinson’s and how early do they manifest? Dr.Noouri explains, “The main feature of this disorder is tremor – resting tremor - and this may be the earliest manifest feature of Parkinson’s along with feeling of tiredness and difficulty in movement. Close to 80% of the affected people, manifest with tremors in the hand which occur mainly at rest. Very often, these patients may experience hand tremors when they are at rest. On the other hand, when you give them a cup of tea or coffee, they are able to hold the cup with any signs of the tremor! Most often the onset of the disease is one sided which may make people believe it to be paralysis. But in PD, there is no loss of motor power; the person cannot initiate the voluntary movement because of the disorder. Movement slows down as a result of the disease. For instance, the individual might be able to hold things very well with his/her hand in the early stage of the disease, but gradually the movements slow down. The symptoms usually present gradually and may go unnoticed by the patient, initially.

A second presentation of Parkinson’s is associated with rigidity. Stiffness in the extremities and backbone is another symptom of PD due to which the individuals may have a stooped posture, difficulty in maintaining their postural reflexes and hence have a tendency to fall. The individuals may also have a stooped posture, have imbalance and swaying movements with a tendency to fall.

Dr.Noouri explains that all symptoms don’t come on day one, but appear over a period of time, usually over a few years. The patient may experience movement disorder and finds difficulty in initiating movement, stopping movement and also be unable to maintain body balance. The individuals may experience memory disturbance, confusion, depression and dementia. As the disease progresses, the tremors increase and movement is slowed down significantly. There is loss of expression of the facial muscles, excess salivation, drooling and sweating. In extreme cases, the patient may find it difficult to swallow food and may even become bed ridden. At this stage they may require to take soft and liquid diet and care has to be taken to see that they do not choke over food or have infection because of feeding problems.

Once the disease sets in, how rapidly does it progress?
It is a progressive disease but with the medications we use and with physiotherapy, we may be able to slow down the progress of the disease.

It is important to rule out other conditions, symptoms of which may mimic PD, says Dr.Noouri. For instance, the individuals may simply suffer from depression and hence not be interested in pursuing any activity, including initiating movements of daily activity. Also, hypothyroidism is associated with slowness of movements and loss of facial expressions. Besides there may be other conditions resulting from heavy metal poisoning, symptoms of which may resemble that of PD. Hence it is essential to rule out these conditions before treatment for PD are begun.

To diagnose the disease in its early stages is very difficult since its symptoms may mimic that of other diseases or conditions. Tremor and the facial expression are in themselves a good indication of Parkinson’s. Normally when we walk, we tend to swing our arms; but this does not happen in Parkinson’s because the individuals’ arms become stiff. However, CT Scan, MRI, EEG or blood tests may be indicated to rule out other diseases or conditions which can give rise to Parkinson’s and hence, are treatable.

Once diagnosed, how is Parkinson’s treated? Dr.Noouri explains, “Unfortunately, the disease is not curable. But with the medications we use and with physiotherapy, we may be able to slow down the progress of the disease and improve the quality of the person’s life. Treatment is basically symptomatic: for instance, if the patient has tremors, we use anti-muscular medication; for rigidity, we use dopamine. While Parkinson’s is not a life threatening disease, its tragedy lies in the fact that it is neither predictable, nor preventable nor curable and it is progressive in nature!


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