PROFILE

Parkinson's Disease
By: Lisa W., Grade 11, Crescent Collegiate, Blaketown, NF

Parkinson's disease is a disorder of the central nervous system that affects one and one-and-a-half million Americans. Because it is not contagious and does not have to be reported by physicians, the incidence of the disease is often underestimated. Parkinson's disease may appear at any age, but it is uncommon in people younger than thirty. The risk of developing it increases with age. It occurs in all parts of the world and men are affected slightly more often than women. Let’s talk about the history of Parkinson's disease and the affects of the disease on younger patients.

History/Symptoms
The cause of Parkinson's disease is still unknown. Although it has been suggested that people in rural areas have more of a chance of developing the disease than those people living in urban areas. This is because of exposures to pesticides, fungicides or herbicides which is found in contaminated water. Other high-risk environments include regions surrounding petroleum and manufacturing plants. Parkinson's patients may be victims of a previous head injury since it is associated with the degeneration of nerve cells deep within the brain surface. Doctors have discovered that most patients of Parkinson's disease have never smoked. One study found that there was an increase in the incidence of the disease among individuals with a history of mumps compared with those who never had mumps. Onset before age forty is most often associated with family history.

Probably the earliest physical finding of Parkinson's disease is that of a masked face, with significantly reduced blinking giving the patient a "stare". Victims of Parkinson's disease also have trouble with muscular functions which causes many symptoms including vibrations, or shakes. These vibrations usually involve the fingers and the wrist, but sometimes involves the arms, legs, or head, causing the entire body to shake. The vibration occurs mostly when the patient is at rest. It stops or slows down when voluntary muscular movement has been stopped. Luckily, there is no vibration when the patient is asleep.

Other symptoms are drooling and difficulty swallowing which may cause the patient to spill food or liquid from the mouth or to send food to the back of the throat before it is ready to be swallowed. Individuals with drooling, or difficulty swallowing may become more likely to choking on food or drink. People with Parkinson's disease and their caregivers need to take care to watch for signs of choking, food stuck in the throat, or increased congestion after eating. There are many remedies for this problem such as sucking hard candy or chewing gum which may facilitate the swallow reflex. Anticholinergies are not recommended because they make saliva sticky.

The patient may experience nausea, delayed gastric emptying and constipation which can be helped by using asapride, a prokinetic agent that accelerates gastric emptying and colonic transit. Exercise and a high fibre diet can also help.

Another symptom that is associated with Parkinson's disease is foot cramps which can be helped by using muscle relaxants such as cyclobenzaprine and baclofen. Changing the dose or dosage schedule may help since cramping can be caused by either too much or too little dopamine.

Another common symptom of the disease is depression. Approximately forty percent of Parkinson's disease patients develop depression, either endogenous (due to an imbalance of neurotransmitters) or exogeneous (due to the stress of having a chronic debilitating illness states the Pharminfo website. Some other symptoms include weight loss, sleep disturbances, forced eyelid closure, infections, excessive sweating and problems with sexual performance. The speech is slurred, and the handwriting is small and uneven because of the rigidity and the vibration.

In the early stages of the disease, the patient is aware that one leg seems a bit stiff, later, the arms does not swing normally at the side when the individual is walking. The patient has trouble beginning to walk but once they have started they can't stop unless the individual grabs the wall or some other object.

According to the Hoehn and Yahr scale, Parkinson's disease has the following five stages:

Stage I involves only one side of the body.

Stage II involves both sides of the body but does not impair walking.

Stage III impairs balance and walking.

Stage IV markedly impairs balance and walking.

Stage V results in complete immobility.

Even though there is no known cure for Parkinson's disease, if the disease progresses beyond minor symptoms, drug treatment may be indicated. The most commonly prescribed medication is Levodopa which helps replenish some of the lost dopamine. Levodopa almost always loses its efficiency over time as the disease progresses. Administration of the drug is associated with side effects, including response fluctuations, involuntary movements, peakdose chorea, severe end-of-dose symptoms, and psychosis and hallucinations. Levodopa helps smooth the response, although poor absorption of the first dose in the morning can lead to the not uncommon side effects associated with the drug, including nausea, involuntary movements, some mental changes, cardiac irregulations urinary retention.

Other drugs, designed to stimulate the dopamine system or mimic its controlling effect on the nerve cells, are used, such as bromocriptine, perolide, selegilence, and trihexphendyl. Patients with histories of coronary or peripheral vascular disease should not take these drugs. Side effects may include confusion, nasal congestion, liver problems, and swelling of the feet. A combination of Levodopa and Carbidopa called Sinement is usually the drug most doctors use to treat Parkinson's disease. Side effects include large uncontrollable movements called "dyskinesias" and confusion may develop after about eight years. Drug therapy for Parkinson's disease typically provides relief for about ten to fifteen years or more.

Many other medicines have been tried through clinical tests. Among them are such toxic compounds as strychnine and cigarettes made from limsonweed. In nearly all cases the results were less than gratifying.

Parkinson’s Disease and Young People
Many people believe that only old people get Parkinson's disease. Though most Parkinson's patients develop the disease in their late fifties or early sixties, there are younger patients. According to the website Ionet.com () statistics show that at least eight percent develop the disease younger than forty years of age. There is currently a growing concern that the number of young Parkinson's patients is increasing. There are different effects on both the young and the old. Young patients tend to have vibrations, but better balance and walking. Younger patients sometimes have more involuntary movement, caused by the medications, but have fewer problems with thinking abilities. Also, in young patients the disease progresses at a slower pace and they have an easier time dealing with the side effects of the medications. There are different psychological and social effects on Parkinson's disease on a working person with family responsibilities than on a retired person whose children are grown and out of the house.

Many young people have a fear that they will not be able to keep their jobs and support their families. Many are forced to retire early because of this disease.

Another concern of the young patient is the cost of medical treatment. Most young patients are many years away from medicare and must rely on health insurance provided by their employers. This increases the concern about maintaining a job. Some young patients find themselves unable to advance in their careers.

Younger patients and their families find that the misconceptions and prejudices about Parkinson's disease have a greater impact on them than it would have on the older patient. The younger patient often bears a greater burden in trying to hide their illness from neighbours, employers and coworkers. This can result in a state of denial where patients ignore the effect their illness has on them. It may keep younger patients from seeking the kind of help that could make a significant difference in their lives.

Often younger patients deny the existence of the disease even when the symptoms are quite obvious to everyone around them. The closest observers of the symptoms are children of Parkinson’s patients. They will become alarmed if the Parkinson's patient insists that there is nothing wrong when you can see the symptoms quite clearly.

Many children of Parkinson’s patients are reassured when told that, although their parent has an illness that won't go away, that the disease can be managed.

Surgery
Surgical options have become more popular in recent years. To ensure that the best results are gained, surgical applicants must fit certain criteria before the surgery can be considered. They must be otherwise healthy and young. There are three types of surgeries available to Parkinson's patients. One surgery is Thalamotomy, which is a surgery that destroys cells in the brain's thalamus to set right a vibration in the hands or arms for people with few other symptoms. There is little risk involved in this surgery and immediate improvement is seen in 80-90 percent of patients after the operation, full recovery generally takes six weeks.

Another form of surgery available is Pallidotomy, which destroys certain cells in the globus pallidos, the part of the brain that controls movement. This surgery is performed when the patient is conscious and operation may help correct problems in slow movement, vibration, and imbalance.

The last form of surgery available is fetal tissue implantation. This is an experimental technique used to restore the brain's ability to produce dopamine. There is political and ethical disagreement over this procedure which may lead to future development and use of genetically engineered cells for this type of surgery. This surgery can dramatically decrease the need for medication, although this improvement may not begin until six months after the surgery and may not peak for 12 to 24 months.

Regular exercise is very important to people with Parkinson's disease. It keeps them strong and flexible. A physical therapist can help develop and monitor a home exercise program, that will ensure that the Parkinson's patient get their muscles moving, their heart pumping, and that they can keep up with every day.

LINK:
The Parkinson Foundation of Canada