PD is a progressive, nervous disorder characterized by a deficiency of dopamine, a biochemical substance in the brain that is important for coordination of body movement. PD is named after Dr James Parkinson, a British general physician who wrote the first comprehensive report on this illness in 1817.
What is the cause of PD?
PD is a mysterious illness – to date the cause of PD is generally unknown. There is also no cure yet. As such the symptoms of PD deteriorate with time despite medications. Despite this, the available treatment (medications and brain surgery) are effective in improving the quality of life of PD patients.
What are the symptoms of PD?
The commonest symptoms are tremor (uncontrollable trembling of hands), slowness of movement and body stiffness. These symptoms result in difficulty in getting out of a chair, starting to walk, writing and turning over in bed.
However, it is important to note that the symptoms of PD start very slowly and can be so subtle that sometimes patients themselves do not realize they have the disease until at least several years after its onset.
Occasionally, the observant spouses and immediate family members are the first ones who notice the early symptoms. Quite often, it is the slowness of movement rather than tremor that brings a patient to see a doctor. This is because tremor by itself is usually not as disabling as slowness of movement especially in carrying out basic daily activities such as bathing, walking and eating.
Who are at risk for getting PD?
PD does not spare any race or ethnic group – it is seen in any country in this world. PD can affect any age group but it is most common in elderly people. It is known to affect even children and teenagers (hereditary parkinsonism) but this is very rare.
Age is an important risk factor for PD, with the incidence rising with age. Thus, PD is generally an illness of elderly people. However, a small percentage of PD patients are relatively young. A study which was carried out at University Malaya Medical Centre, Kuala Lumpur (1998) on 153 PD patients showed that the onset of symptoms was at age 20-45 in 20.9% of patients (one patient had onset of symptoms at age 24).
How is PD diagnosed?
This is carried out based on typical history and bed-side examination. A good response to medications further support the diagnosis of PD. Brain scans and blood tests are generally not necessary.
What are the treatment options for PD?
The mainstay of treatment of PD is medications. At the moment, there is a long list of new and effective medications which helps relief the symptoms of PD and improve the quality of life of Parkinson’s patients. Nevertheless, as the physical disability of PD patients become more severe with time, after 10-15 years of illness, many PD patients have difficulty carrying out daily activities despite taking maximal medications.
At the advanced stage of PD (after 10-15 years), brain surgery is effective in relieving the main symptoms of PD such as slowness of movement and tremor. Currently, surgical treatment is available in Malaysia.
Supportive treatment involves counseling, dietary advice, physiotherapy (exercise) and rehabilitation (social and occupational therapy while specific treatment employs drugs and brain surgery.
Even though there is no cure for PD, it is important to recognize the existence of PD because the rapid improvement in the treatment has resulted in much better quality of life. PD patients should not be made to suffer as they used to be. Generally, PD patients do not require wheelchair anymore. There are so many new and effective medications for PD.
With the increase in the proportion of elderly people in the society, there will be more and more PD patients in the near future. PD will become a major health burden in the near future.
Picture 1. Brain surgery for PD is an effective treatment for those who are in the advanced stage of illness.
Picture 2. Other than medications and brain surgery, physiotherapy helps in improving the coordination of movement.