Humana HealthBeat Transcript Archive

50,000 Americans are diagnosed with Parkinson's disease each year, with more than half a million Americans affected at any time.

The disease usually affects people over the age of 50; only about 5-10 percent of patients are diagnosed under the age of 40.

Parkinson's disease was first described by a British physician, James Parkinson, in 1817, as the "shaking palsy", but it wasn't until the 1960's that researchers found the cause of the classic symptoms of the disease, and therapies were developed to treat it.

The cause of Parkinson's is the loss of brain cells that produce the chemical dopamine. Dopamine acts as a messenger between parts of the brain to produce smooth, voluntary muscle activity. The loss of dopamine causes nerve cells to fire out of control leaving patients unable to control their movements.

When we speak of Parkinson's Disease, we are referring to a set of symptoms, which has no known cause. Parkinsonism refers to the group of disorders with similar symptoms caused by the same mechanism. Other forms of Parkinsonism are components of other known or suspected disorders.

Early signs of the disease are subtle and occur gradually. Symptoms include:

Fatigue
Speaking softly
Handwriting that appears cramped and small
Lack of facial expression, called a "masked face"
Stiffness and slow movement
Tremor

The major symptoms of Parkinson's are:

A tremor in the hands, arms, legs, jaw, and face. "Pill rolling" is a typical tremor of Parkinson's; the thumb and forefinger make a back and forth motion at three beats per second. The tremor usually disappears during sleep or improves with intentional movement, like picking up a glass.
Stiffness of the limbs and trunk and rigidity, which means resistance to movement. If another person tries to move the patient's arm, the arm will move like a ratchet; this is known as "cogwheeling".
Slow movement, which can be unpredictable, and
Difficulty with balance and coordination. Some patients may seem to shuffle with their head leaned forward in order to keep their balance.

Other symptoms can include emotional changes, difficulty with swallowing and chewing, speech changes, bladder and bowel problems, and oily or dry skin.

There is no cure for Parkinson's at this time. Treatment is aimed at controlling the symptoms and slowing the progression of the disease. Most symptoms can be controlled with medication, used singly or in combination.

Surgery may be an option for patients who are not responding to medication or who suffer significant side effects from the medicines. Thalamotomy is a surgical procedure that destroys a specific group of cells in the part of the brain called the thalamus, to reduce tremor.

Another surgical procedure called a pallidotomy involves using a tiny electric probe to destroy a small portion of the brain, the globus pallicus, which is believed to be overactive in Parkinson's patients.

Deep brain stimulation entails implanting an electrode deep in the brain, which can be controlled by the patient with a magnetic device. The stimulation blocks the brain signals that cause tremor.

On-going studies of the factors, which can cause Parkinson's, and alternative treatment modalities offer hope for effectively treating this disease.

January 19
Parkinson's disease
	50,000 Americans are diagnosed with Parkinson's disease each year, with more than half a million Americans affected at any time. The disease usually affects people over the age of 50; only about 5-10 percent of patients are diagnosed under the age of 40. Parkinson's disease was first described by a British physician, James Parkinson, in 1817, as the "shaking palsy", but it wasn't until the 1960's that researchers found the cause of the classic symptoms of the disease, and therapies were developed to treat it. The cause of Parkinson's is the loss of brain cells that produce the chemical dopamine. Dopamine acts as a messenger between parts of the brain to produce smooth, voluntary muscle activity. The loss of dopamine causes nerve cells to fire out of control leaving patients unable to control their movements. When we speak of Parkinson's Disease, we are referring to a set of symptoms, which has no known cause. Parkinsonism refers to the group of disorders with similar symptoms caused by the same mechanism. Other forms of Parkinsonism are components of other known or suspected disorders. Early signs of the disease are subtle and occur gradually. Symptoms include: Fatigue Speaking softly Handwriting that appears cramped and small Lack of facial expression, called a "masked face" Stiffness and slow movement Tremor The major symptoms of Parkinson's are: A tremor in the hands, arms, legs, jaw, and face. "Pill rolling" is a typical tremor of Parkinson's; the thumb and forefinger make a back and forth motion at three beats per second. The tremor usually disappears during sleep or improves with intentional movement, like picking up a glass. Stiffness of the limbs and trunk and rigidity, which means resistance to movement. If another person tries to move the patient's arm, the arm will move like a ratchet; this is known as "cogwheeling". Slow movement, which can be unpredictable, and Difficulty with balance and coordination. Some patients may seem to shuffle with their head leaned forward in order to keep their balance. Other symptoms can include emotional changes, difficulty with swallowing and chewing, speech changes, bladder and bowel problems, and oily or dry skin. There is no cure for Parkinson's at this time. Treatment is aimed at controlling the symptoms and slowing the progression of the disease. Most symptoms can be controlled with medication, used singly or in combination. Surgery may be an option for patients who are not responding to medication or who suffer significant side effects from the medicines. Thalamotomy is a surgical procedure that destroys a specific group of cells in the part of the brain called the thalamus, to reduce tremor. Another surgical procedure called a pallidotomy involves using a tiny electric probe to destroy a small portion of the brain, the globus pallicus, which is believed to be overactive in Parkinson's patients. Deep brain stimulation entails implanting an electrode deep in the brain, which can be controlled by the patient with a magnetic device. The stimulation blocks the brain signals that cause tremor. On-going studies of the factors, which can cause Parkinson's, and alternative treatment modalities offer hope for effectively treating this disease.

	How is the disease diagnosed? There are no specific lab tests to diagnose Parkinson's. Knowing the symptoms and the early signs can help with the diagnosis, so that the right treatment can be given as early as possible. References and Resources: Parkinson's Disease: Hope Through Research National Institute of Neurological Disorders and Stroke www.ninds.nih.gov/patients/Disorder/parkinso/pdhtr.htm Parkinson's Disease: New Treatment Slow Onslaught of Symptoms U.S. Food and Drug Administration www.fda.gov/fdac/features/1998/498_pd.html Parkinson's Disease American Academy of Family Physicians http://familydoctor.org/handouts/187.html Surgical Treatment of Movement Disorders American Association of Neurological Surgeons/Congress of Neurological Surgeons www.neurosurgery.org/pubpages/patres/faq_surgical.html National Parkinson Foundation, Inc. www.parkinson.org