By Dr Harold Gunatillake - Health Writer
When you get up one morning, if you become tottery on your feet and tends to fall, and your writing becomes scrawly, the picture is suggestive of Parkinson's disease.
When you wake up in the morning, if you feel spinning suddenly and cannot control your balance when walking, think of "Positional Vertigo" (Benign Paroxysmal Positional Vertigo), not uncommon as one gets older.
Most people over 70 years old may suffer from it, but some could get it even at the age of 30. It is estimated that 4 million people world-wide are suffering from Parkinson's,
In Sri Lanka it is difficult to assess how many are suffering from it as there are no records available. It is easy to diagnose a person with full blown picture of Parkinson's disease even by a lay person. But it is difficult in the early stages, in most situations, clinching a diagnosis as the early symptoms may be common to most other neurological conditions.
Parkinson's disease is a brain stem disorder that causes to lose muscle control gradually. In the full blown picture you see tremors in fingers, sometimes referred to as 'pin-rolling' movement between the thumb and the index finger, with tremors of the other fingers.
Tremors may appear later on and may not be the earliest symptom. Stiffness of the lower extremities is another early symptom observed during the early stages, and subsequently a shuffling gait becomes obvious. General body movements too, slow down with poor balance could be detected in the early stages of the disease. It was originally referred to as "shaking palsy".
It is fortunate that life expectancy is not shortened in this disease though disability is permanent and progressive. Most cases get the disease at the age of 60 or over, and rarely earlier. Boxer Muhammad Ali got it at the age of 42, and actor Michael Fox at the age of 30.
Early signs could be tremors of the fingers as mentioned earlier, or shaking of the hands or legs or lips. Tremors seem to disappear when in use and re-appears at rest. Sleep, complete relaxation, and voluntary movements usually stop the tremors.
Stiffness of leg muscles causes difficulty walking. Balance and posture problems may result in frequent falls. Getting out of a chair is difficult. Hand writing becomes crowded and walks with a stooped posture, as one is trying to catch one'sown centre of gravity. A statue like masked face without much expression could be a later sign. Daily activities like bathing, eating dressing gets harder with progression of the disease.
There could be problems with digestion of food, and urinary incontinence could be a nuisance. Constipation is common. Most of these patients end up with dementia and confusion, similar to Alzheimer's disease. Depression is another late symptom.
What causes the disease?
As these cells secreting the chemical dies, the brain does not receive the necessary messages about how and when to move.Without enough dopamine, patients experience symptoms such as tremors, muscle rigidity, balance problems, slow movement and others. Currently, doctors can treat these symptoms with drugs that boost dopamine levels. However, there are no available treatments to reduce the rate of clinical decline.
Stages of PD
In the brain an amino acid called Levodopais converted to dopamine. Levodopa is being used for a long time and seems to be the most effective medication even today. It reduces the rigidity of the muscles so that one can move much easily. Eventually levodopa may wear off, especially when taken with a high-protein diet. The side effects taking levodopa are nausea, vomiting, drowsiness, hallucinations, and uncontrollable movements of the extremities.
There are drugs that mimic dopamine, called dopamine agonists, which may be more effective to delay the symptoms. They include Apokyn, Mirapex, Parlodel, and Requip. Apokyn can be injected. These medications also have similar side effects.
Most Parkinson's medications fit into one of the following broad categories:
Surgery is an option
The three commonly used surgeries are:
Pallidotomy – a lesion is placed on a different part of the brain to alleviate dyskinesias (wriggling movements).Both pallidotomy and Thalamotomy use radio-frequency energy to permanently destroy a pear sized area in the globuspallidus or the thalamus. These procedures are irreversible and have become less popular than deep brain stimulation.
Deep brain stimulation – an electronic deep brain stimulator is placed in the brain to control tremor. Electrical stimulation helps the brain to reduce rigidity, tremors. It does not stop the progression of the disease or affect other symptoms. It is suitable for selected cases only.
Grafting Nerve (Neural) stem cells
Spinal cord stimulation
The low frequency oscillations or seizures in rats and mice with Parkinson's are similar to those seen in humans with the disease, and the researchers suggest that it is these that impair motor function, so reducing them with electrical stimulation is what restores the motor function.
The researchers anticipate that once the device is proven to be safe and effective in further research and human trials, it will be similar to those already used to treat chronic pain, where small leads are implanted over the spinal cord and connected to a portable generator. During the trial period the generator is external, but a permanently fitted one could be implanted under the skin.
In 1961 he underwent surgery in Edinburgh to relieve the stress from Parkinson disease at the hands of a neurosurgeon, Francis John Gillingham and the operation "proved successful." Despite the success of this operation, he died on April 26, 1977 at his home in Jaffna. He was known for the Bandaranaike-Chelvanayakam Pact which agreed to provide government services in Tamil and devolve powers to a set of provincial councils.
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