On Parkinson’s

“Monday Musings” for Monday August 3, 2015

Volume V. No. 31/239

Science Series

No. 87

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Parkinson’s Disease

By Assad Meymandi, MD, PhD, DLFAPA, Dsc (Hon)*

The response to the last week’s column on Alzheimer’s disease was unprecedented. We thought it appropriate to offer a follow up on another debilitating  brain disease, namely Parkinson’s disease. First a brief history:

Parkinson’s disease (PD) was originally diagnosed by James Parkinson, a British neurologist in 1817. We do have evidence that as early as 12 century BC, Egyptians knew about the disease and wrote on papyrus about a king drooling with age. Also the Bible contains a number of references to tremor. An Ayurveda medical treatise from the 10th century B.C. describes a disease that evolves with tremor, lack of movement, drooling and other symptoms of PD. Moreover, this disease was treated with remedies derived from the mucuna family, which is rich in L-DOPA. Galen wrote about a disease that almost certainly was PD, describing tremors that occur only at rest, involving postural changes and paralysis.

In 1817 James Parkinson published his essay reporting 6 cases of paralysis agitans, An Essay on the Shaking Palsy, that described the characteristic resting tremor, abnormal posture and gait, paralysis and diminished muscle strength, and the way that the disease progresses over time. He also acknowledged the contributions of many of the previously mentioned authors to the understanding of PD. Although the article was later considered the seminal work on the disease, it received little attention over the forty years that followed. Nevertheless, early neurologists who made further additions to the knowledge of the disease include Trousseau, Gowers, Kinnier, Wilson and Erb.

Of all these early diagnosticians the most important was Jean-Martin Charcot whose studies between 1868 and 1881 were a landmark in the understanding of the disease. Among other advances he made the distinction between rigidity, weakness and bradykinesia. It was Charcot who championed the renaming of the disease in honor of James Parkinson. In America, there are more than four million patients afflicted with this dreaded and deliberating disease.

James Parkinson (1755-1826) was a polymath. He had vast academic interest in all branches of science, including, geology, environment, medicine specializing in neurology and diagnostics  He held several doctoral degrees. He held strong views of social issues as an activist, and argued with the then British Prime Minister, William Pitt, in support of universal suffrage. His 1817 seminal paper on the topic of paralysis agitans continues to be used to describe Parkinson’s Disease, the clinical features of which are intention tremor, and others listed below.

Diagnosing Parkinson’s s disease is through observation.  It really does not require a million dollar workup to make the diagnosis.  Here are some of the signs and symptoms:

Tremor,or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor. One characteristic of Parkinson’s disease is a tremor of your hand when it is relaxed (at rest).

Slowed movement (bradykinesia). Over time, Parkinson’s disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move.

Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain. Exercise both aerobic and anaerobic is important to fight rigidity.

Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease.

Loss of automatic movements. In Parkinson’s disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.

Speech changes. You may have speech problems as a result of Parkinson’s disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.

Writing changes. It may become hard to write, and your writing may appear small (micrographia)

Brain Lesions

The research neuroscientists who work on the brain talk a lot about neurological diseases such as Alzheimer’s Disease (A-D) and Parkinson’s Disease (PD) as the proteins in the brain become misfolded. This misfolding phenomenon occurs with tau protein and “goo”/amyloid junk-like stuff by misfolding the amyloid cluster into larger plaques. The plaques kill the brain cells. In (PD) the protein called alpha-synuclein clumps in similar fashion. Other protiens called prions clump in conditions like mad cow disease which is a form of animal PD.

Basic Facts of Brain Structure and Function

Way back (and down) the approaching the spinal column sits the brain stem. It is an important part of the brain that produces neurohormonals and chemicals that are responsible for sleep. Much research is concentrated on brain stem to find a safe sleeping aid for billions of people who have sleep disorder. Another part of the brain which is responsible for being awake and alert is the thalamus. A third important structure that plays a majorrole in PD are the basal ganglia (plural for ganglion). In PD, the structure of the basal ganglia is attacked and erosion takes place. Again, the destruction is by misfolding of alpha-synuclein protein.

Treatment is basically by use of anticholinergic drugs, L-dopa or L-dopa like chemicals and dopamine agonist (re-enforcers). Physical exercise is very important in the management of PD. More recently electrical stimulation of the brain has gained ground. If you do have PD, please devote yourself to excercising. And if you do not have DP devote yourself to exercising!…

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012).

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