Question: What is Parkinson’s disease? What causes a person to get it? Is it passed on by heredity? Why do people like Michael J. Fox and Muhammad Ali have it so bad while others don’t? — Milli, of Delphos
Milli, you have an incredibly good question. You may have seen people nodding their head or trembling their hands. This may be due to Parkinson’s disease.
The disease is named after the English doctor James Parkinson, who published the first detailed description in an essay on the “shaking palsy” in 1817. Public awareness campaigns about this disease include World Parkinson’s Day, on the birthday of James Parkinson on April 11 and the use of a red tulip as the symbol of the disease.
Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease. Parkinson’s disease is a common brain disorder that affects movement. More than 200,000 people are diagnosed every year with this disease. The disease is more common for ages 60 and older. It is more common in males. About three out of 100 Americans over the age of 60 have Parkinson’s. Evidence is building that Parkinson’s disease may be passed down in families.
It can last several years or be lifelong. It gets worse over time and can affect other brain functions, too, such as learning and memory.
Early signs of Parkinson’s disease may be mild and go unnoticed.
Parkinson’s disease may make people shake their head, hands or feet even when they are not using them. This is called resting tremor. They may make “pill rolling” movement or tapping movements on the table by their fingers. These are called tremors and may cause trembling of hands, arms, legs, jaw and face. The body movements may get slowed down.
Poor balance and coordination are the other feature of the disease. Symptoms often begin on one side of the body and usually get worse on the same side. Sometimes it may affect both sides.
The muscles develop stiffness of the arms, legs and trunk. This stiffness of muscles may affect walking, and walking may slow down. It may cause loss of balance when walking. In advanced cases, sometimes it’s hard for patients to stop walking once they have started. They may develop speech difficulty.
There are no blood tests to diagnose the disease. Tests may be done to make sure there is no other disease causing the symptoms.
What causes Parkinson’s disease? Most patients with the disease have no known identifiable cause. In some patients causes of parkinsonism may be some toxins, infections, side effects of drugs, metabolic derangement and brain lesions such as strokes. These causes may be identified by some tests. Sometimes these patients may improve by certain treatments.
Though it is known that Parkinson’s disease is caused due to the death of dopamine-secreting neurons in the brain, the exact cause of this damage is still unknown. Dopamine is a type of neurotransmitter your body makes and your nervous system uses to send messages between nerve cells. That is why it is sometimes called a chemical messenger.
The disease may be due to an abnormal accumulation of alpha-synuclein protein in the brain.
There are medical and surgical treatments to manage the disease. But there is no cure.
There are different groups of medicines. They are all based on their action related to dopamine. They may increase the dopamine, reduce the destruction of dopamine or make dopamine more effective.
There are some other options. They are used mainly if the medicines are not helping adequately. These options include Botulinum toxin (Botox) injections, deep brain stimulation or Gamma Knife radiosurgery.
The deep brain stimulation uses a small battery-powered device placed inside your chest that sends electrical pulses to your brain. The pulses block nerve signals that cause Parkinson’s symptoms.
Some 4% of those with Parkinson’s disease are diagnosed before age 50, and of those, about half are diagnosed before age 40. When the diagnosis is made early, it is referred to as “young-onset” Parkinson’s disease.
People who get Parkinson’s before age 50 have much the same disease as those who get it later. Usually, those with young-onset Parkinson’s usually have fewer other health problems, and their disease worsens much more slowly than in older people. They also tend to have fewer problems like memory loss, confusion and balance problems.
Michael J. Fox was diagnosed with young-onset Parkinson’s disease in 1991 at 29. Muhammad Ali was one history’s most famous boxers and was also diagnosed early.
Ali won a gold medal in the 1960 Olympic Games at the age of 18. The public observed changes in Ali’s speed and speech many years later. He started losing bouts and could no longer “float like a butterfly and sting like a bee.” However, he was diagnosed at the age of 42. Ali died recently at the age of 74.
Boxing and pesticide exposure both elevate the risk of the disease. Ali had 61 bouts. So boxing may have influenced Ali’s disease, but the data are far from conclusive.
Parkinson’s disease patients may have a full life with adequate treatment.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville.