This brain disorder called Parkinson’s disease

by Henrylito D. Tacio

The year was 1991. Canadian actor Michael J. Fox was shooting a movie called “Doc Hollywood” when he noticed a twitch in his left little finger. “How long this had been going I wasn’t sure,” he wrote in his autobiography, Lucky Man. “But now that I noticed it, I was surprised to discover I couldn’t stop it.”

Feeling uneasy, he went to see a doctor who suggested a series of tests. The diagnosis was terse and devastating. “Even the most paranoid fantasy I could think of would not have prepared me for the two words the neurologist bludgeoned me with: Parkinson’s disease,” the actor recalled.

Except to a tight circle of family and friends, Fox kept his condition a secret before finally going public in an exclusive interview with People magazine in November 1998. “It was incomprehensible,” People quoted him as saying of the diagnosis. “The doctor said I would be able to function for years and years. But even taking in those terms was strange.”

Over the next few years, the disease progressed and the entire side of his body suffered stiffness and tremors. Fox’s left arm shook so violently, “I could mix a margarita in five seconds.”

Parkinson’s disease, also called “shaking palsy,” is a slowly progressing, degenerative disorder of the nervous system. It usually attacks people between the ages 50 and 69. However, it may occur in younger persons, especially following brain inflammation (encephalitis) or poisoning by carbon monoxide, metals, or some drugs.

“I was pinning my hopes on the fact that the disease usually begins after age 50,” Fox wrote in his book. “My symptoms showed up in my late 20s. How could I possibly have this old person’s disease?”

There are a few reliable data of global prevalence of Parkinson’s disease. But according to the Geneva-based World Health Organization (WHO), there are an estimated four million people suffering from the disease around the world. Aside from Fox, two other famous victims are Muhammad Ali and Janet Reno.

Parkinson’s disease has existed since Biblical times, but it was only in the 19th century that it was clinically recognized. Because the prevalence of Parkinson’s disease increases with age, the shorter life expectancy in previous centuries probably meant that it was not as noticeable as it is today.

The condition was first established as a clinical entry in 1817 by a British doctor, James Parkinson, in his Essay on the Shaking Palsy. Later, in the 1860s, the French neurologist Pierre Marie Charcott called the condition “Parkinson’s disease,” in honor of the essay author. Today, 186 years after it was first published, Parkinson’s essay continues to be recognized throughout the world as the classic description of the disease.

Symptoms of Parkinson’s disease include tremors that occur while at rest, “pill rolling” movements of the fingers, and a mask-like face. Other symptoms are a shuffling gait, a slightly bent-over posture, rigid muscles, and weakness.

People suffering from the disease may drool, have a heavy appetite, be unable to stand heat, have oily skin, be emotionally unstable, and have judgment problems. The symptoms are made worse by tiredness, excitement, and frustration. It rarely damages the ability to think and reason.

Loss of communication skills is particularly common. “Speech often becomes soft, mumbling, and monotonous in tone,” the UN health agency notes. “There is often reduced facial expression, resulting in a typical ‘mask-like face’ and limited body language. Many people also have problems with their handwriting which becomes small and cramped, making it very difficult to read.”

These communication problems can seriously affect the social and emotional life of both the person with Parkinson’s disease and his or her family. Research has shown that the loss of non-verbal skills has a negative impact on people’s perception of an individual’s abilities. Because of reduced body language, people with Parkinson’s disease are often erroneously labeled unintelligent, uncooperative, and difficult.

Studies have shown that the symptoms of Parkinson’s disease appear when about 80 percent of dopamine is lost. Deep within the brain is an area known as the basal ganglia, of which the main neurotransmitter is dopamine.

Although some people with Parkinson’s disease in the later stages may become mentally confused or demented, most retain their intellectual facilities while living in a body which is becoming increasingly disabled. “This, in itself, can contribute to the boredom, social isolation, and depression commonly experienced by sufferers,” the WHO says.

Like many other brain disorders, Parkinson’s disease is – at the moment – incurable. However, many treatments have been used since James Parkinson published his essay in 1817. Some years ago, it was a common practice for surgeons to insert a small needle into the brain to freeze or incise nerve cells in the part of the brain which governs the symptoms of the disease.

More recently, drug therapies have been developed to restore the deficiency of dopamine. “Parkinson’s disease may be treated with a wide variety of drugs, including levodopa, bromocriptine, pergolide, selegiline, anticholinergics (benztropine or trihexyphenidyl), antihistamines, antidepressants, propranolol, and amantadine,” says the Merck manual. “None of these drugs cures the disease or stops its progression, but they make movement easier and they can prolong functional life for many years.”

Levodopa, which is converted to dopamine in the brain and is available since 1967, has changed the face of treatment and improved the quality and length of life for patients with Parkinson’s disease. “It is a precursor (building block) of dopamine, and has many of its properties,” writes Dr. Isadore Rosenfeld in his book, The Best Treatment. But it has two big disadvantages: “High doses are required to have any clinical benefit, and the amount of the active chemical needed to control the symptoms of the disease are toxic to the brain.”

However, when Levodopa is combined with another drug called carbidopa, much lower doses will suffice. “This combination of Levodopa and carbidopa (Sinemet) comes in various strengths and most patients require three doses daily,” Dr. Rosenfeld claims.

There are two important drawbacks to Sinemet: one, it has side effects, and two, it becomes less effective with time. “Nightmares, hallucinations, and other behavioral changes are the most troublesome adverse reactions of Sinemet,” Rosenfeld notes. “Also, if you’ve been taking the drug for a while and then stop, Parkinson’s symptoms are greatly aggravated.”

But Sinemet’s most discouraging property is its diminished effect after two to five years. “As its potency begins to wane,” Dr. Rosenfeld writes, “the interval between doses becomes progressively shorter, so that unless you take the drug exactly on time, you may suddenly be immobilized, frozen, unable to move – something called the ‘on-off’ phenomenon.”

Because of the complex nature of Parkinson’s disease, management requires a holistic approach that takes into account the affected person’s whole life. These include accurate diagnosis, individual approach, multidisciplinary support, and involving the patient and caregiver.

Good management of the disease starts with an accurate diagnosis that can be made by a doctor with special knowledge on Parkinson’s disease, usually a neurosurgeon or a geriatrician.

The diagnosis of Parkinson’s disease is often a shattering experience both for those diagnosed and their families. It needs to be given in a sensitive way, allowing people to come to terms with the diagnosis and encouraging them to seek further information and advice.

Meanwhile, Fox established the Michael J. Fox Foundation for Parkinson’s Research in May 2000. The foundation aims to raise much needed research funding for and awareness about the disease.

“It’s made me stronger, a million times wiser, and more compassionate,” Fox says of his ordeal. “I’ve realized I’m vulnerable, that no matter how many awards I’m given or how big my bank account is, I can be messed with like that.”

Words of wisdom, these. – ###

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