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Parkinson Disease a serious disorder

Parkinson Disease (PD) is one of the common neurological diseases, which afflict the general population. It affects the movements of the patient, making it difficult to perform everyday activities such as walking, talking, dressing, eating, etc.

Though it does not lead to an early death in itself, it contributes to this by making the care of such people very difficult.

PD usually starts after the age of 45 years, and then progresses gradually. The initial stages can be very difficult to identify, and many patients go through several rounds of clinics and hospitals before they finally see a neurologist who is able to correctly identify the disease. It affects men and women equally. Sometimes it starts earlier in life, or later, such as after 65 years of age.

There are three major problems that patients with PD face: slowness of all actions, stiffness of limbs, and a shaking of limbs peculiar and typical to the disease. Slightly later, they start getting another even more serious problem: a tendency to fall repeatedly, which is usually due to loss of balance.

In the later stages, i.e. after the first three years, it is fairly easy to identify the problem; but in the first three years, the signs can be subtle and missed easily. Brain scans which are done routinely (CT scan, MRI scan) don’t show any changes in these patients. A PET scan using a particular radio-isotope has been shown to have some sensitivity in differentiating PD from other rarer forms of movement disorders; but this test is not done routinely due to the cost involved and the fact that clinical examination and follow-up sometimes give the same information.

PD is a very serious disorder, and progresses relentlessly. The more seriously afflicted patient may become rigid and unable to move. He may have saliva drooling from his lips, his speech may be too slurred to understand, and his handwriting and signature may change beyond recognition. In the later stages, they may be completely incapable of performing even the minor daily actions we take so much for granted. About 30% of PD patients develop a serious problem with their intelligence: they become demented, and this becomes the main issue in their management.

Fortunately, this lethal disease can be ameliorated in most patients using some easily available medicines. These have to be obtained only after a doctor has prescribed them, and used strictly as advised; but appropriate use of these medications can provide near-complete relief to the patient, in the initial stages at least. Later on, say 4 years after starting the treatment, patients may experience various problems related to the medicines; these include incomplete relief, rapid wearing-off of the effect, rapid fluctuation from an ON state to an OFF state, excessive motor movements referred to as DYSKINESIA, and so on.

Unfortunately, the medications used in PD do not alter the course of the illness, for better or for worse. Which means that the disease will progress relentlessly whether or not one takes these medicines, and definitely not BECAUSE of taking these medicines, as is mistakenly assumed by some misguided patients. Such assumptions are unfortunate, because it leads to the failure of a valuable form of treatment with potential to alter the quality of life of these patients being made available to them due to their or their family’s misconceptions.

Coming back to Parkinson Disease: this is a life-long disease and requires medicines to be taken as long as the patient is alive; in the later stages, the patient may derive benefit from some surgical treatments. The benefit may not appear striking to an outsider, but to the patient they can be dramatic: a patient who has moved from a stage of good control of his Parkinsonism to poor control with lot of dyskinesia and on-off effects with drugs may move back to relatively good control of his disease, and may consider it worth the investment. It gives fairly good quality of life to an otherwise elderly, moribund person.

Many patients with PD also have other illnesses such as Diabetes Mellitus, Hypertension, Heart Disease, Stroke, Cancer, Kidney Disease, and so on, due to the age group; the management of these conditions becomes more difficult due to the immobility resulting from the Parkinsonism. The use of anti-parkinsonian drugs makes a significant difference to the management of these conditions even in the late stages of the illnesses.