Things you want to know about Parkinson's Disease

Dr. Charulata SankhlaConsultant NeurophysicianHinduja Hospital, Mumbai

What Is Parkinson's Disease (PD)?

• A brain disorder that causes a gradual loss of muscle control

• Symptoms of PD tend to be mild initially and can sometimes be unnoticed.

• Typical signs include tremors, stiffness, slowed body movements, and poor balance. Parkinson's was originally called a "shaking palsy," but not everyone with Parkinson's has a tremor

James Parkinson 1817“Involuntary tremulous motion, with lessened muscular power, in part not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace: the senses and intellect being uninjured”

Progression of the disease

• While Parkinson's can be a frightening diagnosis, life expectancy does not change particularly with better care. and prompt treatment

• symptoms progress slowly over 10 to 20years

• Early treatment can allow patients to live a normal life , maintain their job

• We see young patients with PD in India as compared to west

• Two advocates for research development in PD: Boxer Muhammad Ali at age 42 and actor Michael J. Fox at age 30

Early Signs of this disease

It may be subtle and can be confused with other conditions. They include:

• Mild shaking of a finger, hand, leg, or lip• Frozen shoulder• Stiffness or difficulty walking• Difficulty getting out of a chair• Small, crowded handwriting• Stooped posture• A 'masked' face, lack of expression

Tremor

• It is an early symptom and is seen in about 70% of patients

• Usually occurs in a finger or hand when the hand is at rest when patient is walking or watching TV- but not when the hand is in use

• Hands and fingers shake as if rolling a pill between the thumb and index finger

Bradykinesia

• As we grow older, we slow down. bradykinesia in PD patients mean slow movement which impairs daily activities

• They tend to take small steps. They may suddenly stop particularly near doors or in crowded places. Their body does not respond to commands right away

• The PD patients blink less and have mask like face and have a soft voice or slurred speech

Impaired Balance

• These patients have difficulty in turning swiftly

• They tend to develop a stooped posture, with drooping shoulders and their head jutted forward

• They may have a problem with balance. This increases the risk of falling

• They tend to run in small steps forward

Rigidity

• Rigidity means stiff muscles which don't relax

• It is difficult to move patients arms and legs passively , there is some resistance

• Due to rigidity the arms may not swing when a person is walking

• There may be cramping or pain in the muscles

Non motor symptoms

• Night terrors, Restless sleep • Daytime fatigue• Constipation• Increase tendency to pass urine particularly in

night• Difficulty swallowing• Memory problems, confusion, or dementia• Oily skin and dandruff

Can I get PD?

• The average age of onset is 55 as one gets older the chances increase

• Having a family member with PD slightly increases the risk

• Men are more likely to have Parkinson's than women

What happens in Brain?

• A small area in the brain stem called the substantia nigra produces dopamine, a chemical that controls movements, their speed, planning

• In PD these dopamine-producing cells die;

• Resulting in the misplanning and altered speed of the movement. Also there is difficulty in initiating movements

DAT SCAN

Various strategies in treatment of PD

• Multidisciplinary approach• Medical• Surgery• Physiotherapy• Occupational therapy to modify home• Support group to increase awareness• Speech therapy

Drugs in PD

• Levodopa preparations.• Dopamine receptor agonists.• Monoamine oxidase-B inhibitors.• Catechol-o-methyltransferase inhibitors.• Anticholinergics.• Amantadine

Deep Brain Stimulation

• Electrodes are implanted into one of three areas of the brain -- the globus pallidus, the thalamus, or the subthalamic nucleus -- on one or both sides. A pulse generator goes in the chest.

• Electric pulses stimulate the brain to reduce a patient's rigidity, tremors, and bradykinesia.

• It doesn’t stop the progression of PD or affect other symptoms. Not everyone is a good candidate for this surgery. Selection of a proper patient is essential for good outcome postoperatively

Deep brain stimulation

Can we prevent PD?• Various researchers have been trying

to prevent PD or halt progression of disease, but it is too soon to tell whether this works

• Well water drinking in early age have been found to increase the chances of developing the disease

• Coffee drinkers and smokers may have a lower risk of developing Parkinson's (although smoking obviously has other serious health consequences)

The Role of Environmental Toxins

• Exposure to pesticides and herbicides may increase the risk of PD

• There may be genetic susceptibility to environmental exposures

• Workers exposed to manganese in mines in India developed parkinsonian features

Parkinson's and Exercise

• Exercise may actually have a protective effect by enabling the brain to use dopamine more effectively. It also helps improve motor coordination, balance, gait, and tremor. It releases nerve growth factor which may play key role in PD brains. Working out on a treadmill or biking have been shown to have a benefit. Tai chi and yoga may help with balance and flexibility.

Living With PD

Parkinson's affects many aspects of daily life, but with medications and supportive therapies patient can remain active. Medication can help patients cope with mood disorders, such as depression and anxiety. An occupational therapist can provide a home safety evaluation such as to remove fall hazards, throw rugs or cords, and add grab bars in the bathroom. A speech therapist can help with swallowing and speech problems.

Caregivers most important person

• In addition to loosing motor skills PD patients are emotionally low. Depression often precedes motor slowness.

• To do daily tasks are marathon efforts for PD patients and they should be constantly encouraged to do simple tasks independently

• Caregivers need to understand this and provide necessary support to keep patient active and independent

• Support groups and online forums are available

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