Parkinson's Everything You Need to Know

Chapter One What Is Parkinson's? At the age of sixty-two, Fred began to notice a constant aching pain in his right shoulder. Physiotherapy for a "frozen shoulder" provided some help, but the pain persisted. Six months later, his wife commented to him that she had started to notice that his right arm shook when he was sitting watching TV, and that he tended to walk without swinging that same arm. Puzzled and a little worried, Fred reported his new symptoms to his doctor. After a thorough history and examination, his doctor offered a tentative diagnosis: "What I think we're seeing here, Fred, is the early stages of Parkinson's. I'm going to send you to a neurologist to see if he or she agrees; then we can decide on the best way to treat your symptoms. There are many different options available." Parkinson's is a progressive disorder of the central nervous system. It is named after James Parkinson, a general practitioner in London, England, who was the first person to describe the clinical symptoms of "the shaking palsy," in a report published in 1817. In Parkinson's there is a loss of dopamine in the brain, which causes four main symptoms: tremor, stiffness (rigidity), slow movements (bradykinesia), and loss of balance (postural instability). Dopamine is a neurotransmitter, a chemical used by the brain to relay signals. When there is a loss of dopamine, the brain is not able to generate or transmit the proper signals to control movement. In the beginning, tremor and rigidity often occur on one side only. Parkinson's is one of the most common neurological disorders, affecting 1 percent of adults over the age of sixty-five. The incidence is roughly the same in all countries around the world. It is more common in men, and usually begins between the ages of fifty and sixty-five, with an average age of onset of sixty. However, 5 to 10 percent of people with Parkinson's develop symptoms before the age of forty; this is called young-onset Parkinson's. Young-onset Parkinson's is basically the same illness as the older-onset type but with the following differences: The progression of parkinsonian signs and symptoms is more gradual. Motor complications from the medications tend to appear earlier. Memory disturbances and mental side effects of medications seem to develop later. Involuntary twisting or cramping of the foot (dystonia) is frequently present and is often among the first signs noticed. Parkinson's can also develop under the age of twenty, in which case it is termed juvenile onset. Problems in a gene called parkin are now known to be the cause of the majority of these cases. Once Parkinson's develops, the problem is usually slowly progressive -- that is, it becomes worse. The rate of progress varies in different people, but most require treatment with a dopamine-replacing drug within two years of diagnosis. Some people, especially those with tremor of one arm, may have a very mild form and may require no treatment for a number of years. Overall, those who have tremor initially tend to have a milder type of Parkinson's. The outlook for people with Parkinson's has improved markedly since the development of levodopa therapy in the early 1970s. (Levodopa is a dopamine-replacing drug.) Those who were previously confined to bed became mobile again. With modern drug therapy, disability is reduced at all stages and mortality is decreased. Unfortunately, no currently available therapies have been shown to have a major impact on the progression of the disease. Types of Parkinsonism, and Disorders That May Be Confused with Parkinson's The term "parkinsonism" refers to a group of disorders in which patients notice slow movements, stiffness of the limbs and difficulty walking. The most common slowly progressive condition that causes a parkinsonism is Parkinson'sGrimes, J. David is the author of 'Parkinson's Everything You Need to Know', published 2004 under ISBN 9781552978900 and ISBN 1552978907.