The Shaking Palsy

James Parkinson in his composition, 'An Essay on the Shaking Palsy' first recognized Parkinson’s disease as a medical malady in 1817. He had observed the illness in several patients over a period of years, and clinically defined the symptoms as, “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses, and intellect being uninjured.” Parkinson’s, or ‘the Shaking Palsy’ however, remained rarely diagnosed, treated, or studied over the next 40 years.

It was the work of French neurologist, Jean-Martin Charcot that led other physicians to take notice of the condition. Charcot coined the name ‘Parkinson’s Disease’ in honor of James Parkinson, the first general practitioner to document the ‘Disease’. In addition Charcot further defined the clinical diagnosis of ‘Parkinson’s Disease’. Although Charcot generated an interest in the medical field to treat, and, or cure the disease, an effective treatment was not found until the cause of the symptoms could be identified. In 1960 the cause was identified to be a dopamine deficiency in the central nervous system; an effective treatment option, L-3,4-dihydroxyphenylalanine (L-dopa), a naturally occurring amino acid, became available the following year.

Today, Parkinson’s disease is defined as a ‘movement disorder’ of the central nervous system (brain and spinal cord). It is both chronic and progressive; symptoms last for long periods of time, and become worse over time. The disease arises when cells in the brain that produce the chemical ‘dopamine’ cease to function, either because they die, or are damaged (dopamine as a chemical caries out many functions in the brain, however for the sake of this essay, we will focus only how it affects Parkinson’s patients). Dopamine carries messages to the body’s muscles, nerves, and tendons, when dopamine levels are not high enough it becomes difficult for Parkinson’s patients to move parts of the body at will, or control involuntary movements. The symptoms of the disease and the rate of progression vary from patient to patient.

Parkinson’s is caused by dopamine producing cells ceasing to function. However, we are not entirely sure what causes these cells to die, or become damaged, and stop functioning. Although, there is a strong correlation between Parkinson’s disease patients, and large amounts of damage causing ‘free radicals’, this is one of many factors that patients of the disease often have in common. For instance, 15% to 20% of Parkinson’s patients have a close relative with similar symptoms. This has lead to the belief that Parkinson’s may be a genetic disorder, or that genetics at least allow for a susceptibility to the disease. Other theories suggest that like cancer, environmental agents play a large role in whether, or not a patient develops Parkinson’s. One thing however is clear; It is not contracted. It is developed. Parkinson’s is not contagious, and people should not have any inhibitions about associating with someone who has Parkinson’s.

In the United States alone, 50,000 people are diagnosed with Parkinson’s disease each year, and it is estimated that more than a million Americans have Parkinson’s. The disease does not appear to be any more common in one group of people than any other. Men and women develop the disease at almost equal rates. Individuals of every race, and ethnicity develop the disease, as do individuals of all economic classes. The Human body’s Immune system also does not seem to play any role in developing Parkinson’s; people with all conditions of health develop Parkinson’s. The chance of developing Parkinson’s increases only with age; most patients diagnosed with Parkinson’s are over the age of 50, with the average age of diagnosis being 60. Although less common, there have been cases of individuals with symptoms, diagnosed below the age of 40.

The symptoms of Parkinson’s disease are slight early on, and progress very slowly in the beginning; because of this it’s often difficult for a patient to notice. Friends, and Family members are frequently the first to notice these early symptoms: shaky hands, a constant blank look on the face, a stooped posture, shorter steps or a loss of balance while walking, and being weaker and generally tiring easier. There are four main symptoms of Parkinson’s in more advanced cases are: tremors, slowness and difficulty of movement, inflexible muscles, and poor balance and coordination. Tremors are the rhythmic movements, or shaking most often found in the hands, and, or feet of Parkinson’s patients. Inflexible muscles are constant muscle tenseness with an inability of the patient to relax the muscle, which causes an aching pain, and weakness.

Symptoms of the final stages of the disease often vary greatly from person to person. However they usually include some of the following: deep depression and or anxiety disorders, trouble breathing, problems chewing and swallowing, difficulty speaking or a change in voice, difficulty with urination and bowel movements, difficulty relaxing muscles enough to attain to sleep, and memory loss. Although Parkinson’s it self is rarely defined as a patients cause of death, the patient’s death is often a result of the symptoms of Parkinson’s, usually respiratory failure.

Physicians diagnose patients with Parkinson’s based on symptoms, careful observation, and an accurate in-depth family health history. It is normally difficult to diagnose early on, when the symptoms are mild. Tremors are often the first symptoms noticed by physicians. At this point there are not any tests, or scans that may be performed to determine if someone has Parkinson’s disease or not. The recourse a health care provider can take is to run tests to conclude that the patients’ symptoms are not caused by anything else. Most frequently, when pattern of several symptoms of Parkinson’s disease present in an individual, the final diagnosis is Parkinson’s. There are not many medical conditions that mimic all of the symptoms.

There is no cure for Parkinson’s disease, however with medication, and regular exercise the symptoms can be manageable. Although there are no medications that slow the progression of Parkinson’s, they can help to lessen the effect of symptoms, especially in the earlier stages of the disease. This sometimes requires the patient to try multiple medications at varied dosages to find the right combination that works best for them, with the least side effects. Exercise can help a patient improve muscle strength, and balance. This often lessens the effects of tremors, shaking, involuntarily movement, and falls (do to balance loss). In the past there was a theory that vitamin E could delay, or prevent the onset of Parkinson’s in patients. However, there has been no conclusive study to prove this.

Untreated, the symptoms of Parkinson’s disease can make daily activities difficult, cause discomfort, and lead to more symptom related injuries. Violent tremors, and shaking along with a loss of balance will likely causes difficulty with many activities. More severe muscle tenseness can cause a patient great discomfort and pain. Symptom related injuries may cause a patient great discomfort and pain as well, and can be fatal. Generally, if treatment is an option for a Parkinson’s patient, it is an option they should exercise.