Dr S K Gupta
Parkinson’s disease also known as Shaking Palsy was described by James Parkinson in 1817. Patients usually come with tremulous movements of hands, bending forward with stooped posture, stiffness of legs, looks depressed with expressionless face and short shuffling steps. If we see overall worldwide scenario of the disease, the disease is seen in both the sexes and its onset is after 55 years of age with wide range in age from 20-80 years. Onset at younger age is known as “Juvenile Parkinsonism”.
Prevalence of Parkinsonism is approximately 160 per lac and the incidence is almost 20/lac per year. Both incidence and prevalence increases with age. At the age of 70 the prevalence is 550/lac and incidence is 120 per lac per year.
WORLD PARKINSON’S DAY
There are many causes of the disease to occur starting from
* Drugs
* Trauma
* Toxins
* Multiple Strokes
* Infections
* Tumours of basel ganglia
* Metabolic causes
* N.P.H
But the most common type is Idiopathic Parkinsonism where we don’t know the cause and is known as Parkinson’s disease.
Why this disease occurs?
There is degeneration of the cells of brain (Substantia nigra) leading to less secretion of particular neurotransmitter which is known as Dopamine and is responsible for causing Parkinsonism. It is neither contagious nor inherited although genetic factors may play a part in its development.
10 early warning signs of parkinson’s disease are:-
* Tremor or shaking
* Small handwriting
* Loss of smell
* Trouble in sleeping
* Trouble in moving or walking
* Constipation
* A soft or low voice
* Masked face
* Dizziness or Fainting
* Stooping or hunching over
There are four major symptoms which include tremor, muscle stiffness, slow movements and difficulty in walking.
The onset of disease is subtle and will occur gradually. These may include tiredness, and general slowness of movements and speech. In time, the symptoms become more apparent and can include:-
Tremors or Shaking
A common symptom is the uncontrollable shaking of hands or arm on one or both sides of the body. Tremor can also occurs in the legs, feet or chin. Shaking lessens as the effected area is used and stops completely during sleep.
Muscle Stiffness
Muscles can become tight and rigid as they fail to receive messages from the brain to relax. This can cause muscle aches, a stooped posture and slow movements. Walking may be limited to short shuffling steps and because of rigidity these patients tend to fall frequently and injure themselves. Often people with Parkinson’s disease become “frozen” unable to continue movements at all.
Loss of Balance
Parkinson’s disease can lead to problems with balance, causing the individual to fall over. There are slow movements difficulty in getting up from chair or bed and also loss of associated movements of arms while walking, facial expression is commonly known as masked faces. Speech becomes difficult and inaudible.
Hand-writing becomes very small and unable to read himself. Patient then feels difficulty in buttoning, brushing, shaving, etc. Sometimes they have impaired eye movements. The disease may start unilaterally but gradually bilateral involvement is the rule.
Other Problems
Other symptoms include speaking softly in a monotonous voice, difficulty in swallowing and writing. Constipation is also a common problem. Depression, feelings of insecurity and fear often bring distress to the patient and make it difficult to cope with illness both for the patient and for relatives. Memory problems do occurs in some patients.
Diagnosis of the disease is made on clinical features but investigations are done to rule out the secondary causes which are responsible for the disease.
Common investigations are CT Scan / MRI / TRODAT Scan and certain blood tests.
Treatment
There are lots of treatment modalities at present. But as it has been said “Prevention is better than cure”. One should take care of hypertension, Diabetes Mellitus, avoid offending drugs, treatment of infections etc. Since cause of the disease is unknown and medications are usually prescribed to ease the symptoms. The treatment is very specific and requires individualization. Treatment selection will depend on age, stage of the disease and severity of symptoms. In advanced cases where medications are not giving much help the surgery on the area of the brain which causes this condition may be suggested. The surgery is known as deep brain stimulation though it is not the cure, but may help to relieve some symptoms of the disease.
In addition to this treatment these patients are required to have:-
Daily Exercise and Movement
Regular exercise makes muscle stronger and more flexible. Walking is one of the best methods of exercise and this combined with medication, will help general mobility.
Dietary Advise
Eat foods that are high in fibre (vegetable, whole grain bread & cereals) & drink plenty of fluids to help with constipation problems.
Early Treatment and time to time advice of the Neurologist should be sought so that adjustment of doses of the drugs as well as their side effects, if any can be taken care off.
The message of the World’s Parkinson’s day is to make the public aware of the disease and get its treatment as early as possible so that symptomatic care can be given at early stage. In addition to treatment these patients are also required very good family care, sympathetic attitude, group discussions so that they remain socially active in the society.
(The author is a Neurologist)
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