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Parkinson's Disease

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Overview
Parkinson’s disease is a progressive neurological disorder. The first signs are problems with movement.

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.

There’s currently no cure for Parkinson’s, a disease which is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinson’s is often misdiagnosed.

It’s reported that Parkinson’s complications are the 14th major cause of death in the United States.

Symptoms of Parkinson’s disease
Some of the early symptoms of Parkinson’s can come before motor problems by several years. These earliest signs include:

decreased ability to smell (anosmia)
constipation
small, cramped handwriting
voice changes
stooped posture
The four major motor problems seen are:

tremor (shaking that occurs at rest)
slow movements
stiffness of arms, legs, and trunk
problems with balance and tendency to fall
Secondary symptoms include:

blank facial expression
a tendency to get stuck when walking
muffled, low-volume speech
decreased blinking and swallowing
the tendency to fall backward
reduced arm swinging when walking
Other, more severe, symptoms may include:

flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis
increased risk of melanoma, a serious type of skin cancer
sleep disturbances including vivid dreams, talking, and movement during sleep
depression
anxiety
hallucinations
psychosis
problems with attention and memory
difficulty with visual-spatial relationships
Early signs of Parkinson’s disease may go unrecognized. Your body may try to alert you to the movement disorder many years before movement difficulties begin with these warning signs.

Causes of Parkinson’s disease
The exact cause of Parkinson’s is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger Parkinson’s as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinson’s.

Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinson’s. Scientists don’t know what role, if any, Lewy bodies play in the development of Parkinson’s.

While there’s no known cause, research has identified groups of people who are more likely to develop the condition. These include:

Sex: Men are one and a half times more likely to get Parkinson’s than women.
Race: Whites are more likely to get Parkinson’s than African Americans or Asians.
Age: Parkinson’s usually appears between the ages of 50 and 60. It only occurs before the age of 40 in 5-10 percent of cases.
Family history: People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease, too.
Toxins: Exposure to certain toxins may increase the risk of Parkinson’s disease.
Head injury: People who experience head injuries may be more likely to develop Parkinson’s disease.
Each year, researchers are trying to understand why people develop Parkinson’s. Learn more about what’s been discovered and what’s known about Parkinson’s risk factors.

Parkinson’s disease stages
Parkinson’s disease is a progressive disease. That means symptoms of the condition typically worsen over time.

Many doctors use the Hoehn and Yahr scale to classify its stages. This scale divides symptoms into five stages, and it helps healthcare providers know how advanced the disease signs and symptoms are.

Stage 1
Stage 1 Parkinson’s is the mildest form. It’s so mild, in fact, you may not experience symptoms that are noticeable. They may not yet interfere with your daily life and tasks.

If you do have symptoms, they may be isolated to one side of your body.

Stage 2
The progression from stage 1 to stage 2 can take months or even years. Each person’s experience will be different.

At this moderate stage, you may experience symptoms such as:

muscle stiffness
tremors
changes in facial expressions
trembling
Muscle stiffness can complicate daily tasks, prolonging how long it takes you to complete them. However, at this stage, you’re unlikely to experience balance problems.

Symptoms may appear on both sides of the body. Changes in posture, gait, and facial expressions may be more noticeable.

Stage 3
At this middle stage, symptoms reach a turning point. While you’re unlikely to experience new symptoms, they may be more noticeable. They may also interfere with all of your daily tasks.

Movements are noticeably slower, which slows down activities. Balance issues become more significant, too, so falls are more common. But people with stage 3 Parkinson’s can usually maintain their independence and complete activities without much assistance.

Stage 4
The progression from stage 3 to stage 4 brings about significant changes. At this point, you will experience great difficulty standing without a walker or assistive device.

Reactions and muscle movements also slow significantly. Living alone can be unsafe, possibly dangerous.

Stage 5
In this most advanced stage, severe symptoms make around-the-clock assistance a necessity. It will be difficult to stand, if not impossible. A wheelchair will likely be required.

Also, at this stage, individuals with Parkinson’s may experience confusion, delusions, and hallucinations. These complications of the disease can begin in the later stages.

This is the most common Parkinson’s disease stage system, but alternative staging systems for Parkinson’s are sometimes used.

Diagnosing Parkinson’s disease
There’s no specific test for diagnosing Parkinson’s. Diagnosis is made based on health history, a physical and neurological exam, as well as a review of signs and symptoms.

Imaging tests, such as a CAT scan or MRI, may be used to rule out other conditions. A dopamine transporter (DAT) scan may also be used. While these tests don’t confirm Parkinson’s, they can help rule out other conditions and support the doctor’s diagnosis.


Treatments for Parkinson’s disease
Treatment for Parkinson’s relies on a combination of lifestyle changes, medications, and therapies.

Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self-care.

In almost all cases, medication will be required to help control the various physical and mental health symptoms associated with the disease.


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Parkinson’s treatment: A new self-tuning brain implant may help treat patients

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Scientists have developed a self-tuning brain implant that can help manage symptoms of Parkinson’s patients by delivering stimulation in real time, in response to neural signals. Deep brain stimulation has been used to treat Parkinson’s disease symptoms for 25 years, but limitations have led researchers to look for ways to improve the technique.

The first fully implanted DBS system that uses feedback from the brain itself to fine-tune its signalling. “The novel approach taken in this small-scale feasibility study may be an important first step in developing a more refined or personalised way for doctors to reduce the problems patients with Parkinson’s disease face every day,” said Nick B Langhals, programme director at the US National Institute of Neurological Disorders and Stroke (NINDS).

Deep brain stimulation is a method of managing Parkinson’s disease symptoms by surgically implanting an electrode, a thin wire, into the brain. Traditional deep brain stimulation delivers constant stimulation to a part of the brain called the basal ganglia to help treat the symptoms of Parkinson’s.

However, this approach can lead to unwanted side effects, requiring reprogramming by a trained clinician. The new method described in this study is adaptive, so that the stimulation delivered is responsive in real time to signals received from the patient’s brain.

“This is the first time a fully implanted device has been used for closed-loop, adaptive deep brain stimulation in human Parkinson’s disease patients,” said Philip Starr, professor at University of California, San Francisco in the US.

Signals from this electrode are then fed into a computer program embedded in the device, which determines whether to stimulate the brain. For this study the researchers taught the programme to recognise a pattern of brain activity associated with dyskinesia, or uncontrolled movements that are a side effect of deep brain stimulation in Parkinson’s disease, as a guide to tailor stimulation.

Doctors saw and patients noticed no differences in the improvement in movement under adaptive stimulation versus constant, open loop stimulation set manually by the researchers. Since adaptive deep brain stimulation did not continuously stimulate the brain, the system saved about 40% of the device’s battery energy used during traditional stimulation.

Many patients with Parkinson’s disease who would benefit from deep brain stimulation are difficult to treat because too much stimulation can cause dyskinesia. Thus, finding the correct level of stimulation is like trying to hit a constantly moving target. An adaptive system could offer an effective alternative and may also limit adverse effects of traditional deep brain stimulation, but considerable testing remains to be done, researchers said.

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पार्किन्सन्स (कंपवात)

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पार्किन्सन्स (कंपवात) :
मेंदूचा जो भाग शरीराच्या हालचालींवर नियंत्रण करतो त्या भागातील चेतापेशींचा हळूहळू नाश जिच्यात होतो ती विकृती म्हणजे कंपवात. हातांना कंप सुटणे, स्नायू ताठर होणे, हालचालींमध्ये शिथिलता येणे आणि शरीराचा तोल सांभाळण्यात अडचण येणे. ही या विकाराची मुख्य लक्षणे आहेत. कंपवात झालेली व्यक्ती स्थिर बसलेली असताना त्या व्यक्ती उभी राहिल्यास तिचे धड पुढे कलालेले दिसते. १८१७ साली ब्रिटीश वैद्यक जेम्स पार्किन्सन याने प्रथम ही स्थिती लोकांच्या नजरेस आणून दिली, म्हणून या विकृतीला 'पार्किन्सन रोग' असेही म्हणतात. पार्किन्सन्स एक असा आजार आहेत, जो 55 वर्ष वयाच्या वरच्या व्यक्तीला होतो. यामुळे अनेक प्रकारच्या आरोग्य समस्या होतात. या आजारावर परमानंट उपचार नाही. परंतु योग्य वेळी यावर ट्रीटमेंट घेतली तर ही समस्या कमी केली जाऊ शकते.

कंपवाताची लक्षणे

कंपवात हा मध्यवर्ती चेतासंस्थेचा विकार आहे. मज्जारज्जूच्या वरच्या टोकाला त्याच्याशी सलग असा मेंदूचा मस्तिष्क स्तंभ (ब्रेन स्टेम) असतो. मस्तिष्क स्तंभातील कृष्णद्रव्य क्षेत्र (सबस्टॅंन्शिया नीग्रा) या भागातील चेतापेशींपासून डोपामाइन हे रसायन स्रवले जाते. कंपवातात या चेतापेशी हळूहळू मृत होत जातात. डोपामाइन हे चेतापारेषक रसायन असून एका चेतापेशीपासून दुस-या चेतापेशीकडे संवेद वाहून नेण्याचे कार्य करते. डोपामाइनमध्ये घट झाल्याने ज्या चेता शरीराच्या हालचालींवर नियंत्रण करण्यास मदत करतात, त्या चेतांच्या संदेशाच्या मार्गात बिघाड होतो. जसजसे या चेतापेशी अधिक प्रमाणात मृत पावतात, तसतसे ठराविक हालाचालींवर नियंत्रण करणे अशक्य होते. कंपवात झालेल्या व्यक्ती ब-याचदा अडखळत चालताना दिसतात. तसेच या व्यक्तींना खाणे, पिणे किंवा लिहिणे कठिण जाते. त्यांच्या चेह-यावरचे स्नायू ताठरल्यामुळे चेहरा मुखवट्याप्रमाणे भासतो. खुर्चीतून एकदम उठताना तोल जाण्याची शक्यता असते. काही वेळा यामुळे रुग्णाला विषण्णता (डिप्रेशन) किंवा विस्मृती असे मानसिक आजार होऊ शकतात व त्यांतून गंभीर स्वरुपाची दुर्बलता उद्भवू शकते.

कारणे
सामान्य स्वरुपाचा कंपवात हा विकार बहुधा ५० ते ७० वयादरम्यान व्यक्तींना होण्याची शक्यता असते. मात्र यामागील निश्चित कारणे अजून माहीत नाहीत. कीटकनाशकांच्या संपर्कातील व्यक्तींमध्ये आणि ग्रामीण व्यक्तींमध्ये कंपवात अधिक प्रमाणात आढळतो. ५० वर्षांखालील व्यक्तींमध्ये कंपवात दिसून आल्यास त्याचे कारण जनुकांमधील दोष असल्याचे मानतात; परंतु बहुतांशी रुग्णांना होणारा कंपवात हा आनुवंशिक विकार नाही, हे संशोधनातून दिसून आले आहे.

उपचार
- मेंदूमधील कमी झालेले डोपामाइनचे प्रमाण पूर्ववत करणे, ही कंपवातावरील मुख्य इलाज मानला जातो. डोपामाइन हे औषधाच्या स्वरुपात देता येत नाही, कारण ते रक्तप्रवाहामधून मेंदूत शिरत नाही; परंतु लेवोडोपा किंवा एल् डोपा ही औषधे मेंदूत शिरतात आणि ज्या चेतापेशी मृत झालेल्या नसतात, त्या चेतापेशींमार्फत या औषधांचे डोपामाइनमध्ये रुपांतर होते. अनेक रुग्णांमध्ये एल् डोपा औषधांमुळे विकाराच्या सुरुवातीच्या काळात रुग्णांच्या लक्षणांमध्ये आश्चर्यकारक बदल दिसून आले आहेत; परंतु जसजसा हा विकार जुना होतो तसे अनेक रुग्णांमध्ये या औषधाचा प्रभाव कमी झाल्याचे दिसून आले आहे. अनेक रुग्णांमध्ये या औषधामुळे दुष्परिणाम घडून आले आहेत. अशा काही रुग्णांना एल् डोपाबरोबर अन्य औषधे घेण्याचा वैद्यकीय सल्ला दिला जातो.

- काही रुग्णांच्या बाबतीत, कंपवाताची स्थिती मेंदूच्या ज्या भागातील चेतापेशीमुळे उद्भवते तेवढा भाग शस्त्रक्रियेने निष्क्रिय केला जातो. मागील काही वर्षांत, रुग्णातील डोपामाइन स्रवणा-या चेतापेशींची कमतरता भरून काढण्यासाठी अन्य स्रोतापासून डोपामाइन स्रवणा-या पेशींचे प्रत्यारोपण मेंदूत करण्याचे प्रयत्न संशोधक करीत आहेत. काही वेळा मेंदूच्या अंतर्भागात मस्तिष्क उद्दीपन यंत्रिका बसवून तिच्यादवारे मेंदूच्या काही भागांना विद्युत् स्पंद देण्याचे तंत्रही वापरले जाते.

Dr. Kshitija Kulkarni
Dr. Kshitija Kulkarni
MS/MD - Ayurveda, Yoga and Ayurveda Panchakarma, 4 yrs, Pune
Dr. Ajita Garud-Shinde
Dr. Ajita Garud-Shinde
MS - Allopathy, Ophthalmologist Eye Specialist, 4 yrs, Pune
Dr. Ganesh Pachkawade
Dr. Ganesh Pachkawade
MS/MD - Ayurveda, Cupping Therapist Dermatologist, 4 yrs, Pune
Dr. Sonal Shendkar
Dr. Sonal Shendkar
MBBS, Dermatologist Medical Cosmetologist, 7 yrs, Pune
Dr. Vrushali Garde
Dr. Vrushali Garde
MBBS, Psychiatrist, 11 yrs, Pune
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