Understanding the nuances of Parkinson’s Disease

Dr. Sreekanta Swamy

Neurological disorders are among the most disabling illnesses all over the world. Alzheimer’s disease and Parkinson’s disease are the two top disorders among them. Parkinson’s, disease is a brain disorder, seen in elderly population. Fo revery thousand people over 60 years one may get Parkinson’s disease. It is grouped under the umbrella of neurological disorders called movement disorders, because it mainly affects the movements of the body due to impairment of nerve cells in the brain which produces hormone called dopamine that controls the movements of our body.

It is important for the general public as well as the sufferers and their care givers to be aware of the symptoms and newer development in diagnosis and management of this disorder.

Every year on April 11 world Parkinson’s day is observed to create awareness and educate people about this disorder.it is important to educate people because this is the second most rapidly increasing neurodegenerative, progressive brain disease all over the world. It results in progressive disability in the affected person and puts a huge economic burden on the family and society.

Nearly 11.5 million people are living with Parkinson’s disease in the world. It is expected to increase many folds by 2040 as the elderly population increases. It is seen commonly around the age of 60 yrs, even though small percentage of patients are diagnosed at a young age, as the age advances the number of affected people also increases till around 85 years of age.

Age is the single most risk factor to develop Parkinson’s disease, many other factors like exposure to pesticides and other chemicals, environmental pollution are also implicated. Males are affected twice than females. A small percentage can be hereditary.

The disease may go unnoticed for a few years before the actual diagnosis can be done, as it usually evolves and progresses slowly. The symptoms may start to appear when more than 50% of dopamine secretion is reduced. Sometimes few general symptoms may start many years before the actual symptoms of Parkinson’s disease starts, example-patient may have chronic constipation, disorder of smell and sleep abnormalities.

Most common symptoms of Parkinson’s disease are:

1. Most commonly the initial symptoms are shaking (tremors) of the hands, which occurs when they are resting, less commonly, tremors of lip and toes may be observed
2. Rigidity or tightness- people feel the body is stiff, and they must put efforts to move
3. Bradykinesia or slowness- all movement of body may become gradually slow, rarely the thinking process and response also- most often this is dumped as due to old age
4. Inability to maintain balance or postural instability-person tends to lose balance while walking or tends to fall.

All these symptoms slowly progress over months to years, many other symptoms may add on over time, like forgetfulness, low volume speech, difficulty speaking, behavioral changes, abnormal sleep pattern, change is the walking style, stooped posture etc.

Diagnosis is mainly by clinical examination of patients, Sometimes DAT scan, MRI scan may help

Most Parkinson’s disease is due to unknown cause (Idiopathic) were after extensive investigation, cause may not be identifiable. Many other disorders of the brain can mimic like Parkinson’s disease which needs to be identified. And these may not respond to treatment satisfactorily. It is very important to investigate and identify if there are any secondary causes.

As far as the treatment is concerned, even though this disease was described more than 200 years ago, so far there is no permanent cure. It requires a multidisciplinary approach which includes Neurologist, neurosurgeons, psychiatrist, and good rehabilitation team. Whatever treatments are available will help to control the symptoms and try to give good quality life to the patient.

Both drug treatment and surgical treatments are available.

The main drug is Levodopa. Also, there are there are many other drugs available. In the initial few years’ drugs work well, with small doses and less side effects, but over years their benefit becomes less and less and side effects may limit their usage.

Surgical management in the form of Deep Brain Stimulation (DBS) is available for patients who don’t get significant benefit by drugs or develops abnormal movements called dyskinesia and other side effects will benefit from surgical management

Other modalities of management include regular physical exercises, balanced diet, lifestyle management, and many help along with medications. Family support and care giver’s role is most important in managing patient’s daily activities.

Many self-help groups are available to help the patient and the family to exchange the recent advances in the field of management.

By Dr. Sreekanta Swamy, Lead Senior Consultant – Neurology, Aster RV Hospital