Parkinson’s Disease
EDP column by Dr Ketan Dhatariya

“My wife has been diagnosed with Parkinson’s disease. What is this?”

James Parkinson was born in London in 1755 and died in 1824. He was a doctor, politician and a fossil collector. He described several medical conditions, but the one for which he is most famously remembered he first described in a paper published in 1817. The paper was called An Essay on the Shaking Palsy.

Modern science has allowed us to find out what causes the condition. The signals between cells in the brain are carried by chemicals known as neurotransmitters. One of these is called dopamine. This is used in part of the brain known as the substantia nigra (“black stuff”) that allows us to carry out fine motor movement enabling an individual to perform smooth, coordinated actions. If these dopamine cells are damaged or destroyed so that the levels of dopamine fall to less than about 20% of normal, then the ability to carry out these fine motor tasks is lost.

About 1 in 500 people in the UK has Parkinson’s disease, and about 10,000 are diagnosed with it every year. It is a progressive long term condition, that most often comes on after the age of 60, although it may start at a much younger age – sometimes even in the 30’s or 40’s. It affects men and women equally.

The symptoms repetitive tremor (shaking) – especially of the arms initially and often when at rest. There may also be slowness of movement (known as bradykinesia) and muscle stiffness. The face may lose much of it’s expression and as the condition progresses, activities such as talking, walking, swallowing and writing become more difficult. As the walking becomes affected, there is often difficulty getting started, but then there are problems slowing down or stopping.

Appropriate care for people with Parkinson’s is vital. They may often need social care and help with many every day activities. Even holding a cup of tea may be hard because of the shaking. The medical treatments are designed to replace the missing neurotransmitter dopamine. They work either by stopping the breakdown of the dopamine that is already being produced, or by giving a drug that mimics the actions of the dopamine. These are usually given as tablets, although in advanced situations, they may be given intravenously. These drugs have several side effects and their use is very carefully monitored. A very few people may be suitable for surgery.

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