|
Parkinson’s Disease Parkinson’s disease (PD) is named after James Parkinson, a general medical practitioner in London, England. In 1817 he published a small booklet titled An Essay on the Shaking Palsy in which he identified the main features of the disorder. Today, Parkinson’s disease is recognized as affecting 1% of the population over age 60 and 2% over age 80. Most cases occur sporadically; about 5% are genetic. There are about 50,000 new cases yearly. Men and women and blacks and whites are affected about equally. Parkinson’s disease is a movement disorder, because it primarily affects bodily movement, coordination, balance and walking. The cardinal features are slowness, stiffness, tremor, and imbalance. The tremor is the first manifestation in most patients, typically beginning in one arm and present at rest, when the arm is relaxed. The tremor is relatively slow and large amplitude. With time, the patient begins to slow down physically. The speech becomes soft and indistinct. The handwriting becomes small and shaky. Facial movement is reduced, blinking is reduced and the patient develops a blank “masked” appearance. Walking becomes shuffling and slow and the patient may lag behind others during a stroll. After a few years, balance is impaired and frequent falls occur, often straight forward or backward. Other problems develop over time including low blood pressure, which leads to fainting spells. Many people lose weight due to loss of appetite, slowness of stomach action and difficulty chewing and swallowing. Constipation, abnormal sweating, dry eyes and dry mouth and greasy skin are caused by loss of autonomic nerves. Loss or eye movement coordination causes impaired reading. About half of all patients with PD develop memory problems. Hallucinations and confusion increase with disease duration and with exposure to medications used to treat PD. Eventually persons with advanced disease can no longer walk or feed themselves. The outlook for persons with PD has improved tremendously with the advent of effective medications in 1971. Prior to the 1970’s, life expectancy was reduced by 15-20 years. Presently, with treatment, persons with PD have only a slightly reduced life expectancy. Treatment consists of replacing the aging brain’s chemical neurotransmitters with medications. There are approximately 12 medications used to treat PD. Most patients enjoy a good response for 3–7 years (honeymoon phase) before advancing disease reduces the brain’s response to the medications and treatment failures or complications begin. The second phase of PD is characterized by declining response to medications, frequent medication adjustments, and periods of fluctuating performance. Eventually, after 12-18 years, there is little response to medications and increasingly severe side effects. Parkinson’s disease should be evaluated and treated by a specialist. There are several other neurodegenerative diseases which resemble PD but have different responses to treatment and different outcomes. Diseases that can be mistaken for PD include Alzheimer’s disease, hydrocephalus, multiple strokes and drug-related conditions. The choice of medications is complex and changes when new medications become available. A new surgical treatment called Deep Brain Stimulation is available which is highly successful but requires careful patient selection. New medications on the horizon include skin patches to deliver medications smoothly, once-daily pills, rescue medications to treat freezing episodes, and treatments to slow or halt the progression of the disease. Sources for more information:
American Parkinson Disease Association, Inc.
National Parkinson Foundation, Inc. The
Michael J. Fox Foundation for Parkinson’s Research J. Griffin Steel, MD |
