That’s how Janet Reno, diagnosed with Parkinson’s disease at age 57, recalls her neurologist’s advice. She took it to heart, not only returning to her demanding job as US Attorney General but also taking up kayaking. Reno (among other high-profile celebrities that include Muhammad Ali and Michael J. Fox) and millions of people around the world, including thousands of Filipinos, are living with Parkinson’s disease, a progressive disorder caused by a loss of brain cells that produce the chemical messenger dopamine, most noticeably in an area of the brain that controls movement. For now, there’s no cure, but advances in treatment have made it easier for Reno and others to remain active for many years. Physicians are also increasingly recognizing that dopamine-producing nerve cells can be disturbed in brain areas other than those involved in motor control  and even outside the brain  which helps explain a host of mysterious symptoms that can accompany the disorder.
In some cases, Parkinson’s disease is simply inherited; several of the mutations involved have been identified. Heredity alone accounts for only a handful of cases, but studying these cases suggests what may go wrong in Parkinson’s disease. For example, some mutations interfere with the functioning of mitochondria (the energy-producing components of cells). Toxins that interfere with mitochondrial function, such as the chemical MPTP, can also cause Parkinson’s disease. Other Parkinson’s disease genes disrupt the processes that clear away the protein alpha synuclein, which forms naturally inside body cells. Its function isn’t fully known. But excess amounts of it appear to play a role in the death of cells in the substantia nigra. Some current theories link Parkinson’s disease to chronic inflammation, premature aging, or an overabundance of free radicals  molecules that are produced during normal metabolism but may damage cells if not disarmed by protective antioxidants. Discovering the combination of factors that causes Parkinson’s disease will point the way to better strategies for preventing and treating it.
No lab test or scan clinches the diagnosis, but tests may be used to rule out other explanations, such as a stroke or other neurological disease with similar symptoms. If your symptoms improve when you take a single dose of a Parkinson’s medication, it’s likely that you have the disorder. But all these medications have side effects, so your clinician may wait a while before starting drug treatment. "It’s okay to have some of the symptoms as long as they’re not interfering with your professional or other important activities," says Dr. Anne B. Young, head of the neurology department at the Massachusetts General Hospital. "When you’re not able to work, be active socially, or travel, it’s time for treatment."
Several non-drug approaches include rehabilitation treatments to improve strength, flexibility, balance, and stamina. Other types of therapy can help ease swallowing and speech difficulties and teach you new ways to carry out movements and tasks made difficult by Parkinson’s disease. Supplements that may help delay the progression of Parkinson’s symptoms are under investigation. The US National Institute of Neurological Disorders and Stroke (NINDS) is evaluating coenzyme Q10, a compound important for energy production in the mitochondria; some physicians already recommend it on the basis of safety and encouraging preliminary findings. On the other hand, vitamin E does not delay the development of Parkinson’s symptoms and is not recommended.
Once symptoms warrant treatment, patients may receive a dopamine-boosting agent or other drugs such as selegiline and amantadine. Sinemet, an older but effective medication, is also commonly used. Sinemet contains levodopa, an amino acid that is converted into dopamine, combined with an enzyme inhibitor (carbidopa) that helps prevent the conversion of levodopa before it reaches the brain. More than 90 percent of patients respond to Sinemet, with motor symptoms and the ability to carry out normal activities improving by about 50 percent. Possible side effects include nausea and abnormal involuntary muscle movements called dyskinesias.
In April 2006, the American Academy of Neurology announced new guidelines for the management of the on-off phenomenon and dyskinesia. After evaluating research results on a number of medications, they found evidence that two drugs can reduce the amount of "off" time. Entacapone is an enzyme inhibitor that increases the amount of levodopa that reaches the brain. (A medication called Stalevo combines entacapone with levodopa and carbidopa. Another drug, Rasagiline, slows dopamine breakdown. Other drugs have less evidence behind them but may help with your particular symptoms.)
The Academy also reported that deep brain stimulation (DBS) can reduce motor symptoms and the need for medication. In this procedure, the surgeon inserts an electric probe into the subthalamus region of the brain and attaches it to a pacemaker-like device that regulates brain activity with bursts of electricity. DBS doesn’t help with speech or balance, but it can reduce tremors and dyskinesias in the 10-20 percent of patients for whom levodopa loses its effectiveness. Because it’s reversible and adjustable, DBS is generally preferred over surgical techniques that destroy portions of brain tissue. About 30,000 patients in the US now have a DBS device implanted, and use of the technique is becoming more widespread.
Whatever your condition, physical, occupational, and speech therapy can help improve your functioning. Therapeutic exercise can help prevent falls and improve your ability to breathe, speak, and swallow. Take advantage of the excellent practical materials and information offered by the following organizations with their corresponding websites: American Parkinson Disease Association, Inc., www.apdaparkinson.org; National Parkinson Foundation, Inc., www.parkinson.org; and Parkinson’s Disease Foundation, www.pdf.org. I would also recommend the book Parkinson’s Disease and the Family: A New Guide by Nutan Sharma, MD and Elaine Richman, PhD (Harvard University Press, 2005), as an excellent guide for the family in the care of relatives with Parkinson’s disease.
There’s still no cure for Parkinson’s disease, but new treatments can ease the symptoms and prolong independence.