Tuesday, August 25, 2015


Paralysis Agitans

     I finished an examination on a seventy-year old retired sergeant. I was about to reassure him with a clean bill of health. I handed him his refill prescription. His hand tremored. The slip of paper fluttered to the floor.  

      One million people in the US and seven to ten million people worldwide live with Parkinson’s disease (PD). An estimated four percent are diagnosed before age fifty. If a person’s parent has PD, his or her chance of developing it is higher than those in the general population. Those with an affected first-degree relative have a four to nine percent higher chance of developing PD. Men are more likely to have it than women. The cause is unknown.
            
       PD is a chronic and progressive movement disorder. Symptoms such as tremor of the hands, arms, legs, jaw, and face increase over time. Slow movement (bradykinesia), muscle rigidity, stiffness, and impaired balance are characteristic. Activities such as getting out of bed unaided and driving can become challenging. Those affected might stop working due to symptom progression. Though FD is not considered fatal, in some cases, people could die due to complications, such as pneumonia.
        Brain neurons produce dopamine, a neurotransmitter that sends messages to the brain. Dopamine facilitates movement and coordination. Protein alpha-synuclein (Lewy Bodies) are present in the mid-brain stem and Olfactory Bulb. These regions correlate with impaired motor functions, such as disrupted smell and sleep disturbance. As PD progresses, dopamine decreases. There is no accurate diagnostic test. The diagnoses should be made by an experienced neurologist. Physicians rely on a neurological examination and the patient’s descriptions of symptoms to verify the diagnosis.
    
     Though there is no specific treatment, Levodopa is the most prescribed medication. Medication costs for one person with PD average $2,500 per year. Surgical options, such as deep brain stimulation, could alleviate symptoms. Surgery is effective for a small group of those affected and must meet specific criteria. Therapeutic surgery could cost up to $100,000 but is still in experimental stages. Over the last decade, the National Institutes of Health devoted significant resources to clinical trials. 
     Those who are affected who want to participate in clinical trials should log on to http://www.webmd.com/parkinsons-disease/guide/clinical-trials-parkinsons. The website provides a listing of trials that are open for enrollment.

       Those who have PD suffer anger and guilt. However,those affected may have a sense of relief that symptoms were unexplained or misdiagnosed for years. According to one patient, “the worst day of this was the day I was diagnosed. The best was when I understood that I could do something about it. It gave me control.”
       
      A crisis may be looming as the population ages. Combined direct and indirect cost of PD, including treatment, social security payments and lost income from inability to work are estimated at twenty five billion dollars per year.
                
Quote: “involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported, with a propensity to bend the trunk forward, and to pass from a walking to a running pace, the senses and intellects being uninjured.” James Parkinson 1817

 Questions or comments? Contact Dr. Clem at clement.hanson@gmail.com

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