In the 200 years since James Parkinson wrote about the ‘Shaking Palsy’ in a seminal essay way back in 1817, the crippling movement disorder later named after him, has devastated the lives of millions of people around the world. Grimly enough, even as we head into another World Parkinson’s Day on April 11, the birthday of James Parkinson, the disease continues to defy a cure, crippling and killing people everywhere with remorseless disdain.
However, all is clearly not lost: over decades of intense, relentless research, we have now gained a far better, almost complete, understanding of the affliction’s pathology: what causes it and how it sets in and progresses in its degenerating course. Such understanding is driving a fierce word-wide war on the disease with doctors, researchers and scientists working together on several different approaches that may singularly or collectively culminate in a cure in the future.
We, for example, have identified inherited genes, from Park 1 to 11, that result in Juvenile PD, or the onset of the disease among very young people, before they are even 20. The onset of PD between 20 and 45 years is called young onset of PD . Maintaining the quality of life for long years in these groups is a formidable challenge. Similarly, there is now far greater understanding of idiopathic PD (sets in among people 45-years and above) and secondary PD which is caused by drugs, encephalitis (brain fever) repeated head injury and exposure to toxins.
Patients of PD are stricken by a range of serious motor symptoms like rest tremor (shaking of hand and leg), rigidity (tightness of body) and bradykinesia (slowness of movement), which over time may progress to loss of postural reflexes. Non-motor symptoms like loss of ability to smell and disturbed sleep too are common. In advanced stages patients may experience many complications, psychiatric issues and dementia.
Since there are several conditions that mimic the symptoms of PD it is important to clinically differentiate the disease from its impersonators with detailed examination and imaging tests like MRI and PET scans, which studies the functioning of the brain rather than just its anatomy and reveals changes in chemistry that are characteristic of Parkinson’s.
Patients are initially treated with medicines, which unfortunately lose their efficacy over time. As the disease progresses, the medicines produce extreme side effects in 50 per cent of the patients in five years and in 80 per cent in eight years, necessitating a surgical procedure called deep brain stimulation (DBS) of the sub-thalamic nucleus of the brain, which has now emerged as the gold standard for the treatment of drug resistant PD.
Introduced in 1987 this neurosurgical procedure involves the implantation of a device called a neurostimulator, which sends electrical impulses through implanted electrodes to specific targets in the brain (brainnuclei). This highly selective, non-destructive, high-frequency procedure significantly improves the quality of life among advanced PD patients. But it cannot arrest the progress of the disease.
At the next level, therefore, transplantation of cells (adrenal grafts, embryonic stem cells, mesenchymal stem cells and induced pluripotential stem cells) is rapidly emerging as the most exciting and promising approach for fighting the disease. An approach that is most likely to translate into a cure.
However, even as we move towards cracking the Parkinson’s code, a host of supportive measures including diet, exercise, yoga, physical, speech , gait and music therapy and counselling, can go a long way in mitigating the disease and bringing comfort to patients and their caregivers. For effective management of the disease it is essential for care-givers to be armed with as much information as they possibly can and stay abreast with the latest trends in the PD universe.
This in mind, Brains runs an active support group, which supports caregivers with empowering knowledge, information, experiences and much else. In addition this gold standard centre for neuro and spine care runs a dedicated centre for Parkinson’s disease and conducts an exclusive PD clinic every Friday.
For more details visit www.brains.org