Thursday April 21, 2011

About Parkinson’s

Here are 10 important facts you need to know about Parkinson’s disease.

PEOPLE with Parkinson’s disease (PwP) celebrated World Parkinson’s Day on April 11 to raise public awareness of Parkinson’s disease (PD).Wheel Power spoke to consultant neurologist Dr Lim Shen-Yang on the subject at University Malaya Medical Centre in Kuala Lumpur.

Dr Lim, a Parkinson’s disease and movement disorders specialist, is the lead author of a PD information booklet that is in the process of being published by the Malaysian PD Association.

Dr Lim’s co-authors, Dr Santhi Datuk Puvanarajah and Dr Norlinah Mohd Ibrahim, are also senior neurologists with a special interest in PD. They had this to say in their introduction to the booklet:

“One of the best ways to deal with anxiety or fear is to be informed. We aim to provide accurate and up-to-date information about PD. You will read about some of the common symptoms, treatment options and lifestyle changes that can help you to better manage the disease. It is important to discuss questions or concerns you may have with a doctor or other healthcare professional who is knowledgeable about PD and its treatments.”

They went on to point out that with the right treatment and a positive attitude, people living with PD can continue to maintain a fairly rewarding lifestyle for many more years following the diagnosis.

One of the highlights of the booklet is the “10 Important Facts About PD” section. These are:

1. PD is a degenerative disease of the nervous system affecting the brain. It is the second most common neurodegenerative disorder after Alzheimer’s disease, and affects people of all races.

2. Although PD is more common in older people (affecting approximately 1% of people over the age of 60), younger adults may also be affected (onset can be as early as the teenage years). It is slightly more common in men than women.

3. The common motor (movement-related) problems of PD are “shakes” (tremor) although this is not present in all patients, muscle stiffness (rigidity) and slowness of movement (bradykinesia).

The diagnosis of PD is based on the presence of these motor problems. Imbalance (postural instability) with falls occurs only in the later stages of the disease. Some patients with early-stage PD experience motor symptoms on only one side of the body.

4. Other symptoms unrelated to movement (non-motor symptoms) can also occur. Some examples include fatigue, depression, anxiety, difficulty concentrating, hallucinations, pain, constipation, lightheadedness, urinary difficulties, and sleep disturbances. In some patients, non-motor symptoms can even predate the onset of motor symptoms.

5. The lack of a chemical substance in the brain called dopamine is the cause of the motor (and possibly some non-motor) problems in PD. Dopamine is one of several chemicals (neurotransmitters) used by brain cells to communicate with one another. However, the exact reason why people develop PD is still not fully understood.

6. Genetic factors and environmental factors contribute to the risk of developing PD. However, only 5%-10% of patients have other family members who are also affected by the disease, which is why PD is usually regarded as a sporadic (rather than a familial) condition.

PD does not result from something you have done in the past. It is not caused by overwork or over-indulgence.

7. There is no test currently that can identify PD. Instead, doctors diagnose PD based on the patient’s history and a careful neurologic examination.

There are other disorders that can mimic PD and tests such as a brain scan and blood or urine tests are recommended in some patients to exclude these conditions.

8. There is currently no cure for PD, and the disease worsens gradually over time. Nevertheless, motor symptoms can often be well-controlled with treatment, especially in the earlier stages of the disease. At present, these treatments are mainly based on restoring dopamine in the brain. There are also effective treatments for some of the non-motor symptoms of PD.

9. PD affects everyone differently and treatment needs to be tailored to the individual. Some of these treatment decisions can be complex and ideally your condition should be managed in conjunction with a physician with a special interest in PD.

Often, the benefits of treatments need to be balanced against their potential side effects.

10. Through research and development, the range of available treatments for PD continues to expand. For example, selected patients can experience marked improvement after undergoing deep brain stimulation surgery.

Regarding the last point, Dr Lim points out that three new dopamine agonist medications that provide benefit over 24 hours after a single-dose administration have recently been licensed for use in Malaysia.

The results from an American study showing the positive effects of gene therapy in a small group of patients with PD, made news a few weeks ago.

Dr Lim, who had the opportunity to discuss these findings with Prof Peter LeWitt, lead investigator of this research, considers this an exciting development. However, further study is needed before this form of treatment can be offered in the clinic.