New Telegraph

When the central nervous system degenerates…

The scene

Imagine a banquet with the guests seated, strange bed fellows came to feast. The roll call of invitees was indeed puzzling; Adolf Hitler (1889–1945), German dictator and champion of the Holocaust, Pope John Paul II (1920–2005), Polish cleric, Pope of Roman Catholic Church, Walter Sisulu (1912–2003), South African freedom fighter, Jeremy Thorpe (1930–2014), British politician and leader of the Liberal Party (1967–1976), Muhammad Ali (1942–2016), American boxer, George H. W. Bush (b. 1924), 41st President of the United States, Jesse Jackson (b. 1941), American civil rights activist, Francisco Franco (1892–1975), Spanish dictator, Billy Graham (1918-2018), American evangelist…the list goes on and on. The party organizer strolled in, grinning at his uncommon accomplishment of pooling the high and mighty into a single room. Across the divides of politics, race, religion, age he brought them. The event planner is Parkinson’s disease, he inflicted a common fate on them all, one that binds them into a common destiny. Though in reality, most of them would never have moved near one another.

What it is

Parkinson’s disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor (shaking) in just one hand. But while a tremor may be the most wellknown sign of Parkinson’s disease, the disorder also commonly causes stiffness or slowing of movement.

Historical background

During his years as an operating physician, James Parkinson (also a geologist) whose main work was an essay on what he called “trembling paralysis”. In this paper, Parkinson establishes the disease as a clinical entity. “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects being uninjured,” Parkinson described in 1817 (the exact date is unknown). This description was the first and the most classic recorded about the disease, although in current terms it is considered limited. He wrongly predicted that these tremors could be due to damage to the cervical spinal cord; it is now known to be a chronic neurodegenerative disorder. The doctor had observed throughout his career certain determinants for the paralysis. However, it was due to the observation of three of his patients and three of his neighbours, especially in their hands and arms, that Parkinson would derive the description. It would be almost half a century before the French neurologist Jean-Martin Charcon added robustness to Parkinson’s description and used his name to classify this disease.

What is the cause?

The nerve cells break down but no one yet knows for sure why they do so. In essence the cause remains largely unknown but believed to involve both genetic and environmental factors. Those with a family member affected are more likely to get the disease themselves. There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries,

What may give it out

Symptoms generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease. People with this condition may experience: Tremor (shakiness), mainly at rest (that is, when not moving the affected limb) and described as pill rolling tremor in hands, slowness of movements (bradykinesia), Limb rigidity, Gait and balance problems. In addition to movement-related (“motor”) symptoms, Parkinson’s symptoms may be unrelated to movement (“non-motor”).People with the condition are often more impacted by their non-motor symptoms than motor symptoms. Examples of non-motor symptoms include: apathy, depression, constipation, sleep behavior disorders, loss of sense of smell and inability to cope with daily activities. In the later stages of Parkinson’s disease, the face may show little or no expression, or the arms may not swing when walking. The speech may become soft or slurred. Parkinson’s disease symptoms worsen as the condition progresses over time. More importantly, not everyone with tremor has Parkinson’s disease.

Between Parkinsonism and Parkinson’s disease

Parkinsonism is a term for a group of symptoms that can be seen in someone with Parkinson’s disease such as tremor, stiffness, and slowness of movement. There are several conditions other than Parkinson’s disease which can cause these symptoms. Parkinson disease is a specific disease process leading to these symptoms.

The catch

Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used to rule out other diseases.

Treatment

There is no cure for Parkinson’s disease, treatment is directed only at improving symptoms.

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