Coming to grips with Parkinson's disease

Nearly 70 people out of 100,000 in India have Parkinson’s disease, a degenerative nervous system disorder, according to a 2013 report published in the International Journal Of Nutrition, Pharmacology, Neurological Diseases. Sushma Sharma, consultant neurologist at the Fortis Hospital in Faridabad, near Delhi, says these numbers don’t give a clear picture of the prevalence, for very often the disease is diagnosed rather late.

“We get around two patients in their 40s every week, exhibiting symptoms of Parkinson’s disease. However, generally the average age at which people come to us is 60, by which time the disease has progressed to an advanced stage,” she says.

What exactly is Parkinson’s disease? “It is basically a neurodegenerative disorder that is chronic and progressive and results when the nerve cells in the brain stop producing dopamine, a chemical that helps control movement,” explains Anirban Deep Banerjee, senior consultant, neurosurgeon and functional neurosurgeon at the Apollo Gleneagles Hospitals in Kolkata. Dopamine is needed for the smooth transmission of messages to different parts of the brain, regulating body movements in healthy adults. “In patients suffering from Parkinson’s disease, almost 60-80% of the dopamine-producing cells get damaged,” says Dr Banerjee.

When there isn’t enough dopamine, the delicate balance between millions of nerve and muscle cells gets disrupted, resulting in the classic symptoms of Parkinson’s: tremors in the hands, arms and legs, limb stiffness, loss of balance and slowness of movement. “Plus constipation, low blood pressure, dizziness, erectile and urinary dysfunction, fatigue, depression and anxiety,” lists Joy Desai, a neurophysician at the Bhatia Hospital in Mumbai. “The symptoms can be so subtle in the early stages that they go unnoticed, leaving the disease undiagnosed for years,” adds Dr Sharma.

A study of over 54,000 men and women, published in January 2015 in the British journal Lancet, identified a slew of symptoms that were more likely to have been present in people who were diagnosed with Parkinson’s years later. Basically, the findings suggested that the damage caused by this disease begins long before classic symptoms like tremors, rigidity and an unsteady gait develop. By the time patients develop the characteristic symptoms, the brain has already lost more than half of its dopamine-producing cells. The goal, therefore, should be to identify those at risk of Parkinson’s while their brains are largely intact. The study suggests that if Parkinson’s is diagnosed early, medicines can prevent brain cells’ damage and help control the severity of symptoms.

Early diagnosis

According to researchers, one early symptom to look out for is REM (rapid eye movement) sleep behaviour disorder, characterized by a tendency to move or walk during sleep, along with a lost sense of smell. “Diagnosis of Parkinson is clinical and 99mTc-TRODAT-1 SPECT scan of the brain helps. Early diagnosis and treatment are important to help minimize dopamine loss in the brain and maintain muscle function,” says Dr Desai.

According to him, the cure for Parkinson’s will come from a deeper understanding of what causes the disease and why dopamine neurons begin to degenerate and die. “If the cause of the neurodegeneration can be identified, perhaps a specific treatment can be developed to slow, stop or reverse its process,” he says.

Right now, the treatment is focused on helping people lead a better life with Parkinson’s, and it is the symptoms that are treated. “Dopaminergic drugs such as Levodopa and dopamine receptors are helpful in management and treatment of the disease. Of late, many new drugs have been introduced for treating Parkinson’s. Nonetheless, drugs can have side effects such as drowsiness, excessive lethargy, excessive nausea and vomiting, and stop being effective after a while (the time would vary from person to person). Surgery is the other option then,” says Dr Sharma.

In some cases, it can be an option to treat symptoms. Dr Banerjee recalls the case of a 55-year-old housewife from Howrah, West Bengal, who had been suffering from young-onset Parkinson’s disease since the age of 37. The patient was disabled, with severe stiffness (rigidity and slowness) as well as violent abnormal (dyskinetic) movements, a side effect of excessive medication. The medicines would work on her only for a couple of months before becoming ineffective, and since they made her drowsy or dizzy at all times—she was unable to do any activity—she was taken off them. “When she came to me, she and her husband had already researched about treatments for advanced Parkinson’s disease and learnt about deep brain stimulation (DBS) surgery. After the surgery, there has been a significant improvement in the severity of her symptoms. Both the stiffness as well as the violent abnormal movements have significantly reduced,” says Dr Banerjee.

DBS uses a surgically implanted, battery-operated medical device, called an implantable pulse generator, to deliver electrical stimulation to specific areas in the brain that control movement, thus blocking the abnormal nerve signals that cause the symptoms.

While the treatment is proving effective for patients with advanced Parkinson’s, it may also help people in earlier stages of the disease.

Diet and exercise

If people with symptoms predictive of Parkinson’s, as well as those who are genetically at risk owing to a family history, begin exercising and change dietary habits, they may be able to build up some protection against the disease. All forms of exercise seem to be good, including dancing, aerobics and stretching. Exercising in your 30s and 40s—decades before Parkinson’s typically occurs—may reduce the risk of getting it by about 30%, according to the March 2012 issue of Harvard university’s monthly Harvard Health Letter. A Mediterranean-style diet—rich in fresh fruits and vegetables, whole grains, fish and olive oil—is most closely associated with a reduced risk of Parkinson’s.

Some research also suggests that certain foods, like the (dietary) nicotine in red peppers and the flavonoids in apples, are protective. A study published in May 2013 in the journal Annals Of Neurology reported that eating vegetables that naturally contain (dietary) nicotine, such as peppers and tomatoes, may reduce the risk of developing Parkinson’s disease.

This is perhaps the best bet, at least till we understand the cause and come up with a cure.