Tuesday, October 19, 2010

Health Care and Parkinson's


Parkinson's disease is one of a larger group of neurological conditions called motor system disorders. Historians have found evidence of the disease as far back as 5000 B.C. It was first described as "the shaking palsy" in 1817, by British doctor James Parkinson. Because of Parkinson's early work in identifying symptoms, the disease came to bear his name, according to Parkinsons.org. If you or someone you know has Parkinson's disease you are not alone.  In the United States, 50-60,000 new cases of PD are diagnosed each year, adding to the one million people who currently have PD.  In fact, it is estimated that four to six million people around the world suffer from the condition. There is hope, however, as scientists work towards a cure and make progress in identifying the best treatment options for patients, according to the National Parkinson's Foundation.

In the normal brain, some nerve cells produce the chemical dopamine, which transmits signals within the brain to produce smooth movement of muscles. In Parkinson's patients, 80 percent or more of these dopamine-producing cells are damaged, dead, or otherwise degenerated. According to Parkinsons.org, this causes the nerve cells to fire wildly, leaving patients unable to control their movements. Symptoms usually show up in one or more of four ways:
  • tremor, or trembling in hands, arms, legs, jaw, and face
  • rigidity, or stiffness of limbs and trunk
  • bradykinesia, or slowness of movement
  • postural instability or impaired balance and coordination.
Though full-blown Parkinson's can be crippling or disabling, experts say early symptoms of the disease may be so subtle and gradual that patients sometimes ignore them or attribute them to the effects of aging. At first, patients may feel overly tired, "down in the dumps," or a little shaky. Their speech may become soft and they may become irritable for no reason. Movements may be stiff, unsteady, or unusually slow.

As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. According to the National Institutes of Health (NIH), PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time, according to the NIH.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome.  No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.

This may come as a surprise to you, but there is no PD test to confirm whether or not a person has PD, according to Parkinsons.org. PD is a clinical diagnosis and most of the time, the neurologist may order brain scans and blood tests to rule out any other medical conditions, that may have symptoms similar to PD. So, a neurologist will make the diagnosis based on:
  • A detailed medical history and physical examination.
  • A detailed history of your current and past medications, to make sure you are not taking medications that can cause symptoms similar to PD.
  • A detailed neurological examination during which a neurologist will ask you to perform tasks to assess the agility of arms and legs, muscle tone, your gait and your balance. 
  • You may notice that a neurologist records your exam into a table, called United Parkinson’s Disease Rating Scale (UPDRS). UPDRS is a universal scale of PD symptoms and it was created to comprehensively assess and document the exam of the patient with PD and be able to compare it with patient’s future follow up visits, or to communicate about the progression of the PD symptoms in each patient with other neurologists. 
  • The response to medications (that imitate or stimulate the production of Dopamine) causing a significant improvement in symptoms is how the diagnosis of PD is made clinically.
Since the late 1990s, deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, according to the Michael J. Fox Foundation. The procedure is used only for patients whose symptoms cannot be adequately controlled with medications. A neurosurgeon uses magnetic resonance imaging or computed tomography to identify the exact target within the brain where abnormal electrical nerve signals generate the disease's tremors and other symptoms, and a neurostimulator is then surgically implanted to deliver electrical stimulation to that area to block the signals. The goal, ultimately, is to improve the patient's quality of life.Yet despite its effectiveness, there has been no consensus on several aspects of the use DBS, including which patients make the best candidates, where the optimal location for the placement of electrodes is, and the role that still exists for surgical removal of the damaged areas of the brain.


Managing your care, if you have PD, means not only finding the right doctor, but ensuring you are prepared for your visit and talking to your doctors about the right issues. It means, not just taking your medications, but keeping track of when you need to take them. According to the Parkinson's Foundation, it also might mean using other complementary therapies (speech therapy, physical therapy, occupational therapy). People with Parkinson’s are best served by a multi-disciplinary approach that provides not only the expertise of a PD specialist, but also the help of a physical therapist, speech therapist, nutritionist and social worker. Some people also require medical consultants in areas such as psychiatry and neurosurgery. It is important that these healthcare professionals are aware of each other and communicate regularly, and that they all know the full list of treatments and medications that each is prescribing. Start managing your care today by doing the following:

--Work with your Doctor.
--Learn to cope with symptoms.
--Manage your medications.
--Learn more about proper nutrition.
--Exercise.
--Use Complementary Therapies.
--Find Support.
--Stay Independent.
--Become an Advocate.

Parkinson's Disease is very debilitating, and can cause long term health care issues. Learn more from your health care provider if you suspect that you or someone you know may be exhibiting symptoms. Although PD has no cure, you can learn to live with the disease.

Until next time. Let me know what you think.

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