Patients, or their relatives, notice that general movements including walking, dressing, grooming become slower. The normal swing of the arms during walking is reduced on one side. As the disease progresses, blinking and facial expressions become less giving a ‘mask-like’ appearance. Swallowing becomes slower, the speech becomes softer and the handwriting becomes smaller.
Parkinson’s disease, a common neurological disorder has claimed many famous victims. Here MediScene meets Dr. Thashi Chang, Specialist Neurologist and Senior Lecturer in Clinical Medicine at the University of Colombo for a conversation about the nature of the symptoms, a doctor’s approach to treating it and finally, what you can do for yourself at home if you’re struggling with Parkinson’s.
What are Movement Disorders? How does Parkinson’s Disease (PD) fit into this category?
There are specific areas in the brain that control and coordinate movements of the body and limbs by sending chemical messages to other parts of the nervous system. Disruption to this communication system impairs the ability to produce voluntary movement or to stop unwanted involuntary movements. This group of conditions is called movement disorders.
There are two basic types of movement disorders:
- Hyperkinetic (too much movement)
Disorders that include excess, unwanted movement such as tremors, dystonia and tics.
- Hypokinetic (too little movement)
Disorders associated with slowness, stiffness or rigidity such as Parkinson’s disease (PD).
PD, first described by Dr. James Parkinson in 1817, is one of the most common disorders of the nervous system.
How common is PD in Sri Lanka?
PD is a common neurological disorder – exactly how common is difficult to be sure. We do not have data for Sri Lanka. Currently, we are conducting a community survey to find out the prevalence of PD.
What are the symptoms of PD?
The typical features of PD are slowness, stiffness and tremor. These symptoms develop very gradually over a period of months to years, often first noticed by a friend or relative who may suggest that the person is ‘slowing down’ or has a tremor.
Patients often find that they have increasing stiffness particularly in their arms and legs, sometimes causing muscle aches. The stiffness further disables walking and manual tasks already affected by slowing down.
The tremor begins in a hand or foot, usually on one side, and is typically present at rest and disappears when the person moves the limb to pick something up. It is made worse by stress, anxiety and excitement but disappears during sleep.
In the later stages, the strides become shorter and the person walks with small steps. Patients feel increasingly unsteady on their feet and may suffer falls.
What causes Parkinson’s disease (PD)? Is there a genetic component to consider?
The area of the brain affected in PD is called the basal ganglia, which includes an area called the substantia nigra that produces the chemical messenger called dopamine. PD results from the loss of dopamine cells in the substantia nigra. This fall in the level of dopamine interferes with the signals from the substantia nigra that are required for movement.
What causes the loss of dopamine cells is not known. Although a few genes have been identified associated with PD, most cases of the disease do not show a clear genetic factor and therefore usually do not pass from one generation to the other.
Who is most at risk of developing the disease? Does the disease afflict one gender more than the other?
Although the disorder may start at any age from the third decade of life onwards, it is much more common after the age of 50 years. Men are slightly more frequently affected than women.
How is PD diagnosed?
There is no test that can diagnose PD. The diagnosis is based on the clinical judgment of the doctor based on the pattern of symptoms and physical signs. Tests including brain scans are only done to exclude other conditions that may mimic PD.
Can PD be cured?
Unfortunately, similar to disorders such as diabetes and high blood pressure, there still isn’t a cure for PD. However, there is effective treatment that can provide relief from symptoms and allow the patient to lead a normal active life.
How is PD treated?
Medications aim to increase the depleted dopamine levels in the brain either by replacement (levodopa) or by activating dopamine receptors on nerve cells (dopamine agonists). These drugs are very effective in alleviating the symptoms of PD.
However, these drugs lose some of their potency after a few years of use and are also associated with side effects such as dyskinesias (increased involuntary movements) usually 5 to 10 years after commencing treatment. There are other medications that can be added to enhance the effect of these drugs and reduce their side effects.
How important is an early
diagnosis?
An early diagnosis is important to explain the symptoms but early commencement of treatment is not beneficial particularly in the early stages when the disease is mild and the symptoms constitute only a curiosity and not a disability. Since treatment does not offer a cure and only provides symptomatic relief, it would be sensible to delay treatment until such time that the symptoms begin to interfere with day to day activities or social functioning.
Does PD affect thinking and memory?
Sometimes PD patients experience confusion and hallucinations. These may come from the medication or may be related to the brain cell dysfunction in advanced disease. Levodopa and dopamine agonists make confusion and hallucinations worse. Some patients may experience depression. These symptoms can be treated with dose adjustments and appropriate antidepressant medications.
What can the patient do to
help himself?
Exercise and physiotherapy are important to keep the joints and muscles supple and maintain strength. Additionally, physiotherapy will help to improve walking in patients who lack confidence due to unsteadiness.
There are no specific dietary changes that have been recommended. However, levodopa is better absorbed when not taken with a high protein meal or drink.
A positive attitude about PD and its treatment will help the patient and family to cope.
Learning more about the disease and its treatment will help the patient to tailor the treatment, in partnership with his doctor, to meet the patient’s needs.
A recommended website for further information is http://www.wemove.org/. |
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