EASIER TO GET PAST PARKINSON

 Parkinson Disease is an age-related neurological illness resulting from the progressive loss in some parts of the brain of nervous cells that produce dopamine, a chemical neurotransmitter. 

It usually begins around age 65, but also appears earlier – though rarely – as “young-onset Parkinson Disease”. The great boxing champion Muhammad Ali, one of the best-known Parkinson sufferers, was diagnosed at 41. He’s now 70. 

Among people older than 65 the disease strikes 1.5 per cent of the population, ranking it as the second most common cause of disability after stroke. An estimated one million people are afflicted in the US.

The symptoms can be mild, even unnoticed, at the beginning. Over time they worsen, and typically include: 

n Tremors – shaking of a hand or foot at rest, but not when the limb is in motion; 

n General slowness of movement called bradykinesia, making simple daily tasks difficult and time-consuming;

n Muscle stiffness in the limbs that makes handwriting and walking difficult and painful. 

As the disease progresses, other symptoms can include insomnia, depression, decreased facial expression, difficulty speaking and problems with the bladder, bowels, balance and coordination. Importantly, the symptoms vary greatly from one victim to another, rendering diagnosis tricky. Other diseases can induce a “Parkinson type of illness”, otherwise known as Parkinsonism. 

 There is no laboratory test to confirm Parkinson. The disease is diagnosed clinically based on a detailed review of the symptoms and a thorough examination of the patient. A CT scan or MRI might be used to rule out other neurological syndromes. Often the initial treatment markedly improves the symptoms, which then confirms the diagnosis. 

Patients with probable symptoms of Parkinson should consult a neurologist specialising in movement disorders. The diagnosis and follow-up evaluations will thus be solely based on his examinations, crucial because the initial choice of drugs could have major implications on the long-term outcome.

The specific root cause of Parkinson remains unknown and there is no cure as yet. Environmental factors, as with exposure to toxins such as pesticides, and genetic factors, as in a family history of Parkinson, are found in some cases. 

Most cases are effectively controlled with a combination of several medications. Over the past decade the development of new medicines has greatly improved their quality of life, and life expectancy is actually quite close to normal. 

Moreover, for those who can no longer be treated with medicines because they’ve become ineffective over time, or because they cause severe side effects, it’s possible to undergo a surgical procedure called deep-brain stimulation to alleviate the symptoms. 

All treatments are aimed at increasing the dopamine supply in the brain to restore neuronal transmission. L-dopa, an immediate precursor of dopamine, will be used, or other products that increase the dopamine in the brain by stimulating the receptors known as dopamine agonists or halting its natural elimination. 

But every treatment must be customised for the individual and adapt to the evolving condition. Fortunately, many patients can now have an active and fulfilling life, particularly if they’re surrounded by caring individuals and do exercises that focus on stretching, improving balance and hand coordination. 

 

Dr Gerard Lalande is 

managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.[email protected].