What you should know about Parkinson’s disease

Parkinsonism is a devastating, progressive disorder of the central nervous system. The most common cause of Parkinsonism is Parkinson’s disease. Many are unaware of the disease. We hope that some of the information in this article might be of help to you or a loved one.

Did you know that Parkinson’s disease has been reported to affect about 800 per 100,000 people in the general population? The age of onset is typically between 50 and 60 years old. When people this age and above are specifically examined, the number affected with Parkinson’s disease increases to 3.6 to 4.9 percent.

Although various abnormalities are observed in the brains of individuals with Parkinson’s disease, the dominant pathological disturbance is the loss of dopamine- producing neurons. Dopamine is thought to modulate and regulate the processes that coordinate voluntary movement. With the reduction of dopamine levels come the symptoms of Parkinson’s disease: tremor, rigidity and slowness of movement, and postural instability.

The tremor usually occurs on one side of the body initially and is most prominent when the affected limb is at rest. The tremor involves the thumb as a "pill-rolling" motion that eventually involves the whole extremity. Rigidity, meanwhile, involves the stiffness of muscles. This may lead to soreness, cramps, and pains. Some people may mistake this rigidity for a musculoskeletal problem such as arthritis.

Bradykinesia or slow movement affects a number of motor functions. This includes a decreased frequency in blinking (which may be mistaken for staring). Fine movements become arduous to perform. Simple tasks like brushing teeth, turning a doorknob, rising from a chair, writing, or even tying one’s shoes can be excruciatingly difficult. People suffering from bradykinesia may also exhibit a slow, shuffling gait, a reduction in arm swing, and dragging of the feet. In later stages of the disease, people may even experience freezing or hesitation when attempting to walk or turn.

As Parkinson’s disease progresses, balance and posture become a problem. Because of this, falls or near-falls become frequent.

Later in the disease, speech is also affected. The voice becomes softer and hoarse. Patients may speak in a monotone, as if lacking in emotion. Swallowing may also become difficult as the muscles of the tongue and the throat are unable to properly coordinate. Drooling of saliva may then result as well as choking or coughing off foods and fluids.

Certain symptoms may be mild in some and more severe in others. Some people may also have symptoms of the disease that others with the disease do not experience at all.

But while these symptoms may be a cause for alarm, the best thing to do once they occur is to consult a physician. He/she will then be able to recommend the specific steps necessary in addressing the problem.

It is important to note, however, that while there is still no known cure for Parkinson’s disease, there are available therapies that can help address these life-altering symptoms.

The medical therapy of Parkinson’s disease is directed at the replacement of dopamine. Levodopa is currently the most effective drug for relieving the symptoms of Parkinsonian Syndrome and is considered by many to be the drug of choice.

Unfortunately, drug therapy has its limits. Although medical therapy usually provides effective treatment of Parkinsonian symptoms for five to 10 years, the majority of patients experience increasingly severe motor fluctuations in response to treatment, as well as drug-induced movement abnormalities. Over time, some symptoms of Parkinson’s disease may become resistant to levodopa treatment and the response to medication may become erratic. Motor fluctuations become unpredictable. Small changes in drug levels may produce large variations in response.

Surgical intervention is considered when medication is no longer clinically effective. One such intervention is deep brain stimulation with the Activa System Parkinson’s Control Therapy. The system has been proven to significantly contain symptoms like tremors, rigidity, slowness, lack of movement, and poor balance in Parkinson’s disease.

The implanted medical device suppresses symptoms through mild electrical stimulation of an area of the brain called the subthalamic nucleus. When nerve signals are modulated by mild electrical stimulation, the abnormal brain signals are blocked and normal movement and function return.

The implantation procedure involves the use of stereotactic image guided neurosurgery with magnetic resonance imaging (MRI) as well as intraoperative test stimulation to ensure that the lead is correctly placed.

Thousands of people throughout the world have already benefited from the procedure. It has been available in Europe, Canada, and Australia since 1995 and in the United States since 1997. In the Philippines, it is exclusively available at the Philippine Movement Disorder Surgery Center (Philmove) at the Cardinal Santos Medical Center in Greenhills.

(Dr. Theodor Vesagas is connected with the Philippine Movement Disorder Surgery Center at the Cardinal Santos Hospital in San Juan. He can be reached at 726-0776 or 727-7653.)