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Nov.-Dec. 2011, Vol. XXVI, No. 6
 
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Managing Your Health
Coping with Parkinson's disease

Are you at risk?Growing older comes with physical decline, even if you eat as you should and train like an Olympic athlete. So when Parkinson’s disease appears in later years (most cases occur after 50), early symptoms are easy to explain away as just part of the aging process.

That’s why a definite diagnosis comes as such a shock to most who are told they have Parkinson’s, a disease with four chief signs:
1. Tremors at rest (usually seen first in the hands)
2. Rigidity (muscle stiffness)
3. Bradykinesia (slow movement or difficulty starting to move)
4. Abnormal gait and posture (including shuffling steps and leaning forward).

This is well-known to Ronald Rodrigues, one of many people who share their story of coping with Parkinson’s on the Parkinson’s Disease Foundation website.

Diagnosed in 1996, Rodrigues writes:

“I was determined to absorb the blow; suck up all fear, confusion and doubt, and be grateful that a small group of friends and family were there.”

He notes, “Some people with the disease also experience [difficulty with] concentration,
problem-solving, concept formation.” They may also have depression and memory loss.
But he adds, “Despite all I have lost, I continue to derive pleasure from life. Regular exercise and yoga have been indispensable in helping me achieve some sense of well-being.”

Mayo Clinic’s Demetrius M. Maraganore, M.D., says about a million Americans have the “miserable disorder,” but optimistically notes “halting its progression, restoring function and even preventing Parkinson’s are now considered realistic goals.”

Array of Parkinson’s treatments

There are many options available to help improve the quality of life of Parkinson’s patients. They range from maintaining good nutrition and preserving bone and muscle mass and flexibility to complex treatments like deep brain stimulation surgery. There are many options in between.

  • Skilled therapies. Physical therapy can help minimize symptoms while improving strength, balance and gait. Studies show exercise may prevent or alleviate symptoms related to rigidity and flexed posture such as back, shoulder and hip pain and may also improve function. Typically, Parkinson’s patients speak more slowly and the volume of their voices goes down. Speech therapy may help people improve their speech volume.

  • Drugs. There is no cure yet for Parkinson’s, but some medications help ease the symptoms. A medication commonly used in Parkinson’s is called levodopa, a substance occurring naturally in the body. When taken orally in pill form, it goes to the brain and is converted to dopamine. This is important because dopamine is a “messenger” helping to govern bodily movements. For reasons unclear, dopamine dies off in Parkinson’s patients.

At first, levodopa triggers dramatic improvement in patients. But the improvements gradually wear off, requiring medication adjustments. These, in turn, can allow symptoms the drug is designed to suppress to return to some degree. Other drugs can fool the brain into believing dopamine is present, help prevent the breakdown of dopamine (both naturally occurring and formed from levodopa), block an enzyme that breaks down dopamine and help control tremors associated with Parkinson’s.

What is ‘deep brain stimulation’?

This surgical procedure involves implanting electrodes deep within the parts of your brain that control movement. The amount of stimulation they deliver is controlled by a device, similar to a pacemaker, placed under the skin in the upper chest.

This procedure is used for people with advanced Parkinson’s disease who don’t react well to levodopa.

Risks with deep brain stimulation are rare but do occur: They are brain hemorrhaging,
stroke and infection.

A small but promising U.S. clinical trial indicates gene therapy may someday help people with severe Parkinson’s, but researchers stress more testing is yet to be done to ensure long-term safety. The trial aimed to increase the brain chemical GABA (gamma-Aminobutyric
acid), missing in Parkinson’s patients. When subjects were injected with a gene that increased GABA production, a 23 percent improvement in movement resulted.

The study was reported in the journal Lancet Neurology.

As for Ronald Rodrigues, he uses faith and a constant, upbeat attitude to deal with his diminished physical and mental skills. “It is my hope that those who suffer from similar diseases, and especially those struggling with the disease that steals control of mind and body, will find some comfort if I am able to articulate and thereby validate what they feel and experience – but they may not be able to express,” he writes.

Rodrigues ends his shared story this way. “Hold fast to your dreams. For if dreams die,
life is a broken-winged bird that cannot fly.” (Langston Hughes, 20th-century American
writer, poet, playwright and social activist).

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