25-31 January 2013 #640

Out of grasp

As our population ages it's high time we gathered data and found ways to help patients with Parkinson's cope with their disease
Dhanvantari by Buddha Basnyat, MD
For two months, 57-year-old Ram Bahadur had been staggering around the house and feeling unsteady. He had difficulties turning over in bed, sitting, and getting out of his car. He was drooling, his handwriting became smaller, and his hands trembled while resting. Not wanting to whine, he kept quiet. However, as the months passed, his symptoms got worse so he finally went to see a doctor who told him he had Parkinson’s disease.

Parkinson’s disease occurs when certain nerve cells in the brain deteriorate and cannot produce an important substance called dopamine. As a result, the brain loses its ability to communicate messages about normal muscle movement. What causes these nerve cells to deteriorate is not known. But genetics and age play a huge role in the onset of the disease.

As in Ram’s case, patients may experience tremor in the hands and rigidity of arms, legs, and trunk with a gradual slowness of movement. Emotional changes are also often present, and simple tasks such as talking, walking, and eating may become difficult.

Although Nepali doctors are familiar with the disease, as with most other illnesses in the country, quantitative data is based exclusively on research carried out in developed countries. Approximately one percent of the 65 and older age group and 2.5 per cent of the 80 plus population are affected by Parkinson’s.

The diagnosis is made clinically, so no fancy blood or imaging tests are required except perhaps to rule out other problems which simulate Parkinson’s disease. These ‘look alike’ problems could be drug-induced (for example, anti psychotic drugs) Parkinsonism or post-traumatic Parkinsonism (note: with classic Parkinson’s disease there are no prior triggers like drugs or trauma). Even Alzheimer dementia patients experience rigidity and slowed movements during the later stages of their disease which could throw off doctors trying to make a diagnosis. It is important to make these distinctions because therapy may be different. For example, if the symptoms are due to exposure to certain drugs then the specific drug needs to be stopped or replaced for definitive therapy.

Exercise can help maintain physical and mental functions in Parkinson’s disease, and drugs to increase dopamine levels in the brain or to improve the brain’s ability to respond to dopamine are available. Such medications can reduce tremor, stiffness, and slowness and improve muscle control, balance, and walking. Patients can also find help online among a wide variety of support groups.

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