How can we help Parkinson’s disease (PD) victims?

By Dr Harold Gunatillake - Health Writer

When you are sixty and over, you get shaky fingers (tremors), stiffening and slower movement in your legs (rigidity), and experience difficulties in attending to your personal affairs, you can be sure that you are a candidate with early symptoms of Parkinson’s disease. Parkinson’s disease affects your voice and smell, too

 You are not alone, the incidence is increasing in most countries, approximately four people per 1000 in Australia, and over a million Americans live with Parkinson’s disease. The incidence in Sri Lanka is not known, but many people do live with it in most rural and town areas and some go undetected in the remote villages.

A male has a 50% higher risk of developing Parkinson's disease than a female.

What is Parkinson’s disease?
The nerve cells in the brain stem (substantia nigra part of the brain) seem to degenerate progressively, especially the ones in the motor system. These nerve cells normally secrete a chemical called dopamine to facilitate conduction of nerve impulses. In PD dopamine manufacture gradually declines, a chemical messenger necessary for smooth controlled movements of the body.

So, PD obviously cannot be cured but can be controlled, in most cases can live an independent productive life.

As the disease progresses one gets involuntary uncontrollable movements of every part of the body. It is an uncontrollable shake. The limbs get rigid due to muscle stiffness and as a consequence you slow down your movements. Walking becomes difficult and the posture becomes stooped. The walk becomes shuffling more than taking normal steps in walking. You become tired and lethargic and no inclination to do any work. Face becomes expressionless.

Causes
The real factors that cause the disease are not known. It is not contagious. It could be the result of exposure to pesticides, chemicals, toxins, or may be genetic factors responsible. What is known is the fact that dopamine the neuronal messenger chemical declines with time?

Factors lowering the risk of developing PD
Curcumin: Curcumin is supposed to prevent clumping of a protein involved in PD.

Flavonoids: adult males who regularly eat foods rich in flavonoids appear to have less chances of developing PD.

Aldehydes in cooking oils: When certain cooking oils heated to a certain temperature and then used again aldehyde forms in the oil and this may be responsible for the degenerating of brain cells, even forming some cancers.

Treatments
Early stages of the disease medications L-DOPA and dopamine, agonists are recommended (An agonist is a chemical that binds to a receptor and activates the receptor to produce a biological response). Dopamine agonists mimic the effects of dopamine in the brain. The neurons react as they would to dopamine. These agonists are available in tablet form and injections, or as a skin patch. Examples include pramipexole (Mirapex), ropiirole (Requip), rotigotine (Neupro) and apomorphine (Akokyn)

With time these dopaminonergic neurons (nerve cells) continue to disappear and the drugs tends to become ineffective at treating the symptoms. There are many medications available but none will reverse the effects of the disease

The choice of this drug treatment depends on many factors, and each patient is personally evaluated to check on which combination would be the best for such patients. Most doctors prescribe levodopa as the first line of treatment. Some are given an agonist, an MAO inhibitor or an anticholinergic.
There are two general approaches in the management of these patients. The first approach is to increase the depleting levels of dopamine in the brain cells and the second approach is to improve the symptoms of Parkinson’s disease, as detailed above.

You need to see a doctor during the early symptoms stage of the disease. Choices of drugs given during the early stages have a strong impact on the long term prognosis of the illness.
The full list of medications is:

Anti-cholinergic drugs like Benztropine, Procyclidine, Orphenodrine and Amantadine are used singly or in combination with other drugs. These drugs have a slight effect on the clinical symptoms.

Levodopa-(Sinemet) - This would be the most potent medication for PD. This is really medication given in tablet form to replace the depleting chemical in the brain cells. Levodopa is transported to the nerve cells in the brain that produce dopamine. Levodopa is then converted into dopamine in the nerve cells. Dopamine functions as a neuro-transmitter at the nerve cell-nerve fibre junctions, or as we call synapses. The definition of synapses is a region where nerve impulses are transmitted and received.

There are long term side effects with Sinemet, such as- increase in involuntary movements, restlessness, confusion or abnormal movements.
To avoid these side effects doctors start with alternatives to Sinemet, such as the dopamine agonists as mentioned earlier, and use Sinemet when the effect of alternatives fails to provide sufficient relief.

Monoamine oxidase-B inhibitors (MAO B inhibitors). This drug is an alternative to levodopa. Examples include selegiline and rasagiline. These inhibitors work by blocking the effects of monoamine oxidase in the brain. Monoamine oxidase destroys dopamine.
Surgery and deep brain stimulation are procedures used when the drugs don’t work.

Cutting Edge Stem Cell Therapy
A breakthrough medical procedure for the treatment of PD is administering cellular building blocks of foetal stem cells into the veins and under the skin. The whole procedure takes about one hour and no side effects detected so far.

These cells travel through the body detecting damaged cells and tissue and attempts to restore them. These cells also stimulate existing normal cells and tissues to operate at a higher level of function, boosting the body’s own repair mechanisms to aid in the healing process. It is said that commonly significant positive results are seen within 3-to six months. (Ref: stemcellofamerica.com)

Complications
Thinking and memory may get affected. (Cognition). This is due to more extensive loss of dopamine function in the brain.

Anxiety and depression
People with PD suffer from anxiety and some with depression. They are concerned about their inability to function normally as other members of the family and become anxious and depressed. They have low appetite and sleep problems.

Dementia
Memory difficulties and diminished capacity to reason or concentration are common findings among these patients.
Constipation: Most PD patients are constipated due to sluggish bowel movements. A diet high in fibre may help.

AGILITAS
Agilitas™ is a world-first product, designed to overcome a debilitating Parkinson’s disease symptom known as “freezing of gait”, which affects around 28,000 Australians.

It was developed after 5 years’ R&D, and has been tested on patients with Parkinson’s disease.

With Agilitas as your personal walking companion, you can walk with confidence through doorways, kitchens and bathrooms, shopping centres and even busy train stations.

It can restore your freedom, independence and quality of life.

By using Agilitas you can reduce and eliminate the need for a cane, walker or wheelchair. You can lessen your reliance on carers, and be more confident that you will be able to quickly manage a “freeze” at home or in public.

This devise is not cheap. In Australia it costs about $2,000. The number to ring, if you are interested is 1800 91 31 41 with your credit card details.

Exercise and physio
Exercise improves mobility and stability. A PD patient can cycle with no difficulty. Cycling is one of the best exercises for general stability and improvement. It helps to release muscle stiffness and joint pains and gives lot of confidence to walk again. Using the treadmill, resistance training and stretching benefits these patients.

With time when dopamine gets totally depleted in the brain cells and medications not effective, exercise would be the best course of action and most rewarding.

Massage, acupuncture or herbal remedies may help.

Conclusion: There is no cure for Parkinson’s disease, but their life could be made comfortable by the above temporising methods. Loving care is most important for these victims. Daily exercise is very important to mobile the joints and lessen rigidity of limbs.

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