KOCHI: A chronic and progressive movement disorder, Parkinson’s disease was first described by Dr James Parkinson exactly 200 years ago in his essay ‘The Shaking Palsy’.
What is Parkinson’s disease?
Parkinson’s disease is the second most common degenerative disease of the brain; it persists throughout the life of the person concerned and worsens over time.
The disease occurs because of the destruction of dopamine producing nerve cells in the brain. When the symptoms of Parkinson’s disease begin, 70-80 per cent of the dopamine producing cells might already be damaged.
What causes Parkinson’s disease?
The exact cause of Parkinson’s disease is unknown. It is suspected that genetic factors and environmental factors like pollution, excessive use of chemicals and pesticides may produce Parkinson’s disease. Usually Parkinson’s disease occurs in people older than fifty years.
It is estimated that 1 per cent of people above the age of 50 years, 1.8 per cent of people above the age of 65 years and 2.6 per cent of people above the age of 85 years develop the disease. What is striking though, is that about 10 per cent of patients develop the disease before 40 years.
Symptoms of Parkinson’s disease
The four cardinal manifestations of the disease are tremor, stiffness, slowness of activities and imbalance while walking. They lose their facial expression and have a vacant look, sometimes with drooling of saliva. They also develop a low volume speech and difficulty in writing.
They bend forward and walk en bloc without swinging their hands. Psychiatric symptoms like depression, anxiety, delusions and hallucinations may occur along with memory loss, sleep disorders, urinary problems, sexual problems and constipation.
How is Parkinson’s disease treated?
Medical management remains the mainstay of treatment of Parkinson’s disease. The most important drug used for treatment is levo dopa.
Levo dopa enters the brain and gets converted to dopamine. Parkinson’s patients usually go through 3 stages when they use levo dopa. In the first stage, called ‘honeymoon period’, the symptoms are milder and the response to levo dopa is very good.
The patient gets round the clock benefit with 3 doses of levo dopa. In the second stage called the stage of motor fluctuations, the benefit of one dose of levo dopa lasts only less than 4 hours.
In the third stage, called stage of dyskinesia, the patient develops uncontrolled movements of the body (dyskinesia). Physiotherapy is extremely helpful in improving balance and preventing falls. Selected patients may benefit from an advanced surgical procedure called deep brain stimulation.