Dr Mahendra Gonsalkorale

Parkinson’s disease (PD) affects the nervous system and has been known to Medical science for centuries. It has been described in ancient Egyptian Papyrus and Sanskrit texts but it was first described as a medical condition by an English General Practitioner working in Shoreditch, Dr James Parkinson. He published his famous article, “An Essay on the Shaking Palsy” in 1817, in which he described the condition we now recognise as Parkinson’s Disease, in 6 patients based on his personal observations. It was much later, in the 1860s that the French Physician Charcot named it Parkinson’s disease in his honour. Parkinson didn’t get everything right, for example, he said that the intellect remained normal and his view on the cause of it was erroneous. We now know that cells in certain parts of the brain degenerate and die and the brain becomes depleted of chemical “messengers”, chiefly Dopamine, which are essential for normal brain function. Indeed drug treatment is commonly directed directly or indirectly at enhancing Dopamine activity of remaining healthy brain cells.

Parkinson’s disease, or Parkinson’s as those who are afflicted by this condition prefer to call it, is much more than the shaking of limbs. Most lay people associate the name with shaking or tremor affecting the limbs. But the most disabling feature of PD is that it affects the way we perform movements which are a part of our normal life. Movements become difficult to initiate and become slower and slower as the disease progresses. Speech, walking, simple acts like eating, dressing and toileting are affected. The body and limbs also become stiff and rigid. Apart from these movement symptoms PD can have much wider effects on the lives of people. These include depression and other psychological effects, sleep disturbances, body aches and in the later stages, effects on cognitive function with memory problems and difficulties in reasoning.

How common is it? Does it run in families? What can we do to avoid getting it? Will I end up in a wheel chair? Can anybody get this condition? These are some of the questions posed to professionals. It is not inherited (although there is a very rare and unusual form which is), it affects older people more commonly (about 1% of people over the age of 60 have it but about a fifth of all those affected are aged 40 or less).There are some medications that can lead to PD and should either be avoided or taken under strict medical supervision. It can affect any one and among famous people with PD, the late Pope John Paul, the boxer Muhamad Ali, the actor Michael J Fox are a few. A person with PDcan look forward to a virtually normal life span although the last years could be disabling.

PD does not affect all those afflicted in the same way. It can be a very mild and slowly progressive condition with just a slight tremor in the hand or it could be very disabling, making It difficult to lead a normal life producing dependence and even to Institutional care unless they have a supporting partner or family. Fortunately, although it is a progressive condition, it can be managed very well with appropriate drug treatment and supportive treatment. There are even some surgical treatments available for suitable patients. In the early stages, drug treatment is so effective that it is easy for patients to forget that they have PD. A PD person could lead a virtually normal life, gainfully employed and enjoying the benefits of a family life. They become quite adept at managing their condition with the help of a Team dedicated to managing their condition. These Teams consist of specialists from many disciplines and could include professionals such as Physiotherapists, Occupational therapists, Speech and Language therapists, Clinical Psychologists, specialist nurses and is often led by a Neurologist who specialises in PD. Not all Team members are involved with each patient at any one time. They provide their services as and when the patient needs it as he progresses through a life with PD. The GP is an important link between the Team and the patient.

For more on how PD is managed, look for the second Instalment. For those able to access the Internet, a very good source of information is the UK Parkinson’s Society website. MAHENDRA GONSALKORALE .