Diseases are sometimes extremely devastating and cruel. Some diseases move very rapidly while others are slow and painful. Treatments are sometimes useful yet other times nothing can stop the silent beasts that lurk in the body. Parkinson’s disease is a slow moving disease that slowly corrupts the brain. Parkinson’s disease (PD) is a chronic motor disorder that causes tremors, rigidity, slowed body movements, unstable posture and abnormal gait. This happens when neurons, nerve cells, in a part or the brain called the substantial nigra gradually die. These cells normally produce dopamine, a chemical that helps relay messages between areas of the brain that control body movement. The death of the cells leads to abnormal low levels of dopamine, and causes difficulty in controlling muscle tension and muscle movement both at rest and during periods of activity. PD as of now affects about 500,000 Americans, with about 50,000 new cases diagnosed each year. It is generally a disease that affects people of late or middle age at about age 60 however about 5 percent of patients have early-onset PD and are younger than 40 years old when symptoms begin. PD is slightly more common in men then women. So far scientists have not determined the reason why some people develop PD and others do not. Some experts blame a process called oxidation. During oxidation unstable molecules that areproduced in the brain as a result of its normal chemical reactions which ultimately damage the brain. Another theory suggests that the effects of toxic affects of drugs may cause PD. Additional evidence suggests that PD may be related to environmental toxins especially because some claim that they havefound rates of PD that are higher in rural areas where farming is intense and residents drink well water. So far PD has not been linked to genetic abnormality. PD usually begins as a slight tremor of a hand arm or leg. The tremors usually affect a limb at rest but it also may occur when it is in use. The tremor may improve when the patient intentionally moves the limb or it may disappear entirely during sleep. In the hand the tremor is often described as “pill-rolling” when it affects the thumb and index finger. As PD progresses the tremor may become widespread eventually affecting limbs on both sides of the body. In addition PD also causes limb rigidity a slowing of intentional body movement unstable posture and gait problems. When bradykinesia affects the facial muscles it may cause drooling, disrupts normal eye blinking interferes with facial expressions. Bradykinesia of the other muscles may affect every day life. The ability to wash or dress him or her self, to use eating utensils becomes very difficult. Also to perform necessary household chores such as washing the dishes or doing laundry also becomes difficult. In many PD patients a problem with balance and unsteady posture occur. This may make it hard for them to lower or raise oneself into a chair. Walking may require small shuffling steps usually without the normal arm swinging motions. Handwriting also becomes shaky and often illegible. Although there is currently no cute for PD its symptoms can be treated with several different types of medication. Antioxidents slow down the progression of existing PD. Dr. Stanley Fahn of ColumbiaUniversity has found that PD patients given large doses of oral vitamin C and synthetic vitamin and delayed the progression of their disease to the point where they delayed the need for 1-dopa by 2.5 years. The most common conventional treatment for PD is the use of drugs such as l-dopa medications,selegiline (deprenyl and eldepryl) which blocks the breakdown of dopamine in the brain, and anticholinergenic drugs which reduce the amount of acetylcholine produced in the brain which corrects the imbalance between dopamine and acetylcholine. Surgical procedures such as pallidotomy are proving successful in the treatment of PD. Pallidotomy is a procedure in which a small portion of theglobus pallidus, a structure deep within the brain, is surgically destroyed resulting in improved motor functioning. Doctors are also finding great success in eliminating tremors by implanting electrodes in the brain. Currently, testing only allows the electrode to be implanted on one side of the brain so ifpatients have tremors on both sides of the body, they must choose which side they wanted treated. Complementary/alternative therapies for the treatment of Parkinson's are becoming more common because they are proving to slow the progression of the disease in its early stages. Some of these treatments include supplementation with vitamins C, B and E, co-enzyme Q-10; controlled diet, relaxtion therapy to alleviate stress which aggravates PD; and detoxification to eliminate as much metal toxicity as possible. A well designed program of rest, exercise, and physiotherapy can also significantly ameliorate the symptoms of PD. In conclusion, PD is a frightening disease. There is no true cure for thedisease but it can be slowed down and controlled. Doctors and scientists are continuing to try and find a cure. Hopefully a cure will be found to end the pain and suffering of PD patients.

Parkinson’s disease usually affects people of late middle age. Most runbetween the age of 50-60. The symptoms of Parkinson’s disease are usuallysubtle and occur gradually. Some examples of symptoms a person may have, arefeeling shaky or having trouble getting up from a chair or a couch. Others maynotice that their speaking is softer or quieter. They will lose track of athought or feel irritable or even depressed for no reason. These are earlysymptoms that may last a long time before the more classic and obvious symptomsappear. For now there is no way to cure or prevent Parkinson’s disease fromhappening., but there has been new research looking at (PET) Position EmissionTopography. This will allow scientists to scan the brain, which see chemicalchange that occurs in the brain. Using PET scientists can study the brain’snerve cells that are affected by disease. IF you are in the major stages ofParkinson’s disease the major symptoms are tremors, problems walking,bradykinesia, and rigidity. Rigidity is an increase of stiffness in the muscles.If it is eased by medications, rigidity is always present. It’s alsoresponsible for a mask like expression. In some patients it leads to sensationsof pain in the arms and shoulders. Secondly, victims with experiencebradykinesia, which means slowness of movement. It causes the brains to reactslower in its transmission of instructions to parts of the body thereforecausing the body to act slowly in carrying them out. Poor balance is often truewhen victims move abruptly. Some patients experience falls due to poor balance.Last are tremors, they will affect three out of four patients. Tremors mayaffect only one part or side of the body. For the most part they don’t disablepeople and it disappears during sleep. Some minor symptoms are depression,emotional changes, memory loss, difficulty swallowing, and chewing. At thispoint there is no cure for Parkinson’s disease but there are a wide variety ofmedications that provide relief for the symptoms. Treatments are determined byhow much the symptoms affect the person by a physician. Most of the medicationswill have to be adjusted to a countable dosage for the patients. In the earlystage the physicians begin with one or two less powerful drugs. They saved themost powerful medicines for the time when patients need it the most. One of themost common medicines is Levodopa. Levodopa allows the nerve cells to use it tomake dopamine with which the brain can use. It prevents or delays some symptomsin most patients. It also extends the time in which some patients can lead somenormal lives. There are some side effects that could happen like nausea,vomiting, low-blood pressure, and restlessness. Symmevel which is used as ananti flu medication but it is also used with Parkinson’s patients too. Itreduces the symptoms of rigidity. Some other is anthicholinergics, selegiline,and deprehyl. A physician will also strongly suggest that to remain active inthe early stages they will tell you to perform daily activities as much aspossible. Taking supplements of vitamin E is showed to help somewhat. For thetremors, medication or anything relaxing will sooth them down too. WhenParkinson’s disease gets in the later stages physicians will help designexercise programs to help meet your specific needs. Last, they will also suggestfor you to get a cane or a walker because the patient will be more prone tofall.

Afflicting over one million Americans, Parkinson’s disease is one of the most devastating neuro-degenerative diseases in the world. A British physician, James Parkinson, first discovered this disease while observing people on the streets of London. He noted that certain individuals suffered from a tremor, which, along with muscle weakness, became worse with time. Even with standardized neurological examination by doctors today, Parkinson’s disease is still only detectible through careful observation of the patient. It was not until the late nineteenth century in which physicians finally began to understand the anatomy and physiology of Parkinson’s disease. Throughout the past decade the knowledge base for Parkinson’s disease has increased tremendously. Parkinson’s disease has now been identified and cataloged by the medical community as a serious and potentially fatal neuro-degenerative disease. The disease’s symptoms, possible causes, mechanisms, and cures have been researched and studied by innumerable scientists and organizations.Parkinson’s disease occurs when certain nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become i

INTRODUCTION In 1817, a London physician, named James Parkinson, wrote the first information of Parkinson’s disease in his “Essay of the Shaking Palsy.” Little research was done throughout the years. However, researchers at the University of Vienna brought hope in 1960, that restoring low dopamine levels might effectively treat the disease. Investigators soon learned that dopamine by itself was useless; it would be metabolized before reaching the brain. So, in 1970, levodopa was approved for prescription sale and in 1975, Sinemet became available on prescription. What exactly is Parkinson’s? Are there effective treatments? Soon, we will find out the answers to these questions and many others. Not many people know what Parkinson’s disease is. Others may have misconceptions about the disease. I wrote this paper to inform the reader and to expand on my own general interest. Also, this topic is important to me because my grandmother has this disease, and I wanted to know more about it. I would like to thank the writers and publishers for writing and printing the necessary material. This paper is incomplete due to unobtainable sources, because this is an ever-changing field, and limited resources for obtaining some information. PARKINSON’S DISEASE Parkinson’s disease is a degenerative neurological disorder characterized by tremor, stiffness, and slowness of movement. Patients diagnosed with Parkinson’s disease become hunched over, tend to lose their balance, and have slurred speech (Sinha & Zang, pp. 77-81). There are many other symptoms which will be described briefly. Between one and one-and-a-half million Americans have Parkinson’s disease. It can affect men and women; men have a greater chance of getting it; living anywhere in the world. It is uncommon in people under thirty years old and eighty percent of all cases are diagnosed after the age of fifty. As with many other diseases, the risk of developing Parkinson’s disease increases with age. “Before the current best treatments, the mortality rate was three times higher than for the average person. Currently it’s one-and-a-half times as high. The saying now is that you don’t die from Parkinson’s disease; you die with it,” (Meadows, pp.117). It has been approximately 183 years since James Parkinson, who the disease is named after respectively, wrote his “Essay of the Shaking Palsy,” (www.coyotewebart.com/parkinsons_news/curve.html). Little was known then, and still, 183 years later, researchers are looking for the cure which is basically like looking for a needle in a hay stack. A daunting task, yes, but when the needle is found, all the hard work and dedication will be embellished with success. Some of the first signs or symptoms of Parkinson’s disease could be shorter strides, lack of arm swing, and possibly a tremor on one side of the body. The cause of these symptoms is from the slow degeneration of specific brain cells that make dopamine (Sinha & Zang, pp. 77-81). Dopamine is an important neurotransmitter that acts as the go signal between the brain with the rest of the body, initiating thought page 2 into motion. Primary symptoms include rigidity, tremor, Bradykinesia, poor balance, & walking problems. Rigidity is an increased tone or stiffness in the muscles which is often responsible for a mask-like expression of the face. Unless it is temporarily eased by anti-Parkinson’s medications, rigidity is always present. In some patients, rigidity leads to sensations of pain, especially in the arms and shoulders. Tremor is the symptom the public most identifies with Parkinson’s disease, but in fact, only twenty-five percent of patients experience a very slight tremor or none at all. When a tremor is present, it may be worse on one side of the body (www.pdf.org, December 2000). Bradykinesia is characterized by a delay in initiating movements. Poor balance leads to repeated falls and walking problems which include a decreased or nonexistent arm swing; short, shuffling steps; difficulty in negotiating turns; and sudden freezing spells. Everyday dilemmas patients with Parkinson’s encounter, include difficulty with fine hand movements like writing or tying shoelaces, to other movements, such as getting out of a chair or turning in bed. It is important to note that not all patients experience the full range of symptoms. In fact, most do not. People with Parkinson’s disease may also suffer from any of a long list of secondary symptoms. Depression, sleep disturbances, dizziness, dementia, and swallowing are merely a few of these. Once again, all patients experience different symptoms. The actual cause of Parkinson’s is not known. A defective gene was recently found in a few families with a high incidence of Parkinson’s disease, but most researchers believe in the vast majority of cases, genetics alone are not the cause. Instead, it is suspected that Parkinson’s usually results from the combination of a genetic predisposition and an as yet unidentified environmental trigger (www.pdf.org, December page 3 2000). For early treatments of Parkinson’s disease, extracts from the belladonna plant were found to help relax stiffened muscles and to quiet tremors and were used in therapy until after World War II, when a number of similarly acting drugs came into use. Discovery of the brain dopamine deficiency in parkinsonian patients - reported in 1960 by researchers at the University of Vienna - brought hope that restoring the dopamine level might effectively treat the disease. Investigators soon found, however, that giving dopamine by itself was completely useless: the substance did not reach the brain because it could not cross the blood-brain barrier, a protective biochemical mechanism by which the body screens agents passing from the blood into the central nervous system. Scientists then turned to levodopa, the substance that is dopamine’s metabolic precursor. Levodopa did cross the blood-brain barrier and could be quickly metabolized into dopamine. In 1970, levodopa was approved for prescription sale. It was the first major breakthrough, but side effects are severe nausea and vomiting because the drug is broken very rapidly in the body, requiring large doses if the substance is to penetrate the brain. According to the NINCDS Research Program pamphlet, some patients experienced toxic side effects from these dose levels that were so severe that the drug had to be discontinued. Researchers soon learned, however , that they could greatly reduce dose levels - and thus cut down on side effects - by giving levodopa in conjunction with a substance that slows its breakdown in the body. Sinemet, a combination of levodopa and the inhibiting substance carbidopa, has been available since 1975. Treatments must be fine-tuned to suit individual patients depending on their symptoms and stage of disease (Tackacs, Toronto Star). For most Parkinson’s disease patients, the levodopa/carbidopa page 4 cocktail still stands as the single , most effective therapy available. Most patients benefit from it: some moderately and some with striking relief from their symptoms - at least for several years. There are a few other drugs available that are also prescribed. Symmetrel, which was originally an anti-flu medication, is thought to block or reuptake dopamine by neurons, or it increases the release of dopamine by neurons, thereby increasing the supply of dopamine in the synapses. When its benefits seem to lessen, stopping the drug for a short time and then reintroducing it seems to provide help once again, according to some clinicians. Tremors can be controlled by prescribing anticholinergics, which act to decrease the activity of the balancing neurotransmitter, acetylcholine. Older patients may not be able to take these drugs because they tend to cause confusion and hallucination. Selegiline or deprenyl have been shown to delay the need for sinemet when prescribed in the earliest stages of Parkinson’s disease, and they have also been approved for use in later stages to boost the effects of Sinemet. COMT inhibitors such as tolcapone and entacapone, represent a new class of Parkinson’s medications. These drugs must be taken with levodopa so they prolong the duration of symptom relief by blocking the action of an enzyme which can break down levodopa before it reaches the brain. Like the symptoms of Parkinson’s disease itself, the side effects of drugs vary from patient to patient. They may include dry mouth, nausea, dizziness, confusion, hallucinations, drowsiness, insomnia, and other unwelcome symptoms. Some patients experience no side effects from a drug, while others have to discontinue its use because of them. When drugs aren’t working, there’s still surgery. The most common procedures page 5 are palliodotomys, in which the surgeon drills through the skull and destroys selected brain cells, and deep brain stimulation, in which electrodes are implanted in the thalamus and connected to a pacemaker-like device. In a palliodotomy, there is a possibility of stroke, partial loss of vision, speech and swallowing difficulties, and confusion. There aren’t many risks with deep brain stimulation. New, controversial forms of surgery, called brain tissue implants, are still in experimental , however, promising results leave researchers hopeful that this surgery will provide a long-lasting treatment for the disease. Jim Finn, a recipient of the disease, has had Parkinson’s disease for twenty years. Three years ago, at age fifty-one, doctors diagnosed him as “end stage” - they could do nothing more for him. That’s when Finn’s doctor approached him about an experimental new treatment in which surgeons would implant millions of fetal pig cells into the brains of Parkinson’s patients. Without hesitation, Finn agreed to the surgery (Sinha & Zang, pp. 77-81). Finn describes the procedure as going through a drive-thru: “Buy some burgers, get some surgery.” The whole surgery actually takes only two-and-a-half hours. Also, patients can be awake the whole time from the use of local anesthesia. The doctors inject the fetal pig cells through an injection syringe guided by a halo-shaped frame bolted to the head. Originally, surgeons used aborted human fetuses to harvest the cells which are needed, but many considered this unethical. Researchers realized these obstacles early on, and so focused on using fetal pig cells instead. The results have been amazing: Finn can now walk with out his cane, write his name, and cut his pork chops into bite-size pieces. Nowadays, he gives speeches to medical professionals and support groups about his successful surgery. “I’m a commodity now. Pork bellies, I think they call it,” he jokes. CONCLUSION In reality, Parkinson’s disease may not be such a burden as we think. The Medicine being prescribed is getting better. There are even surgeries to help out those who are at “end stage” like Finn. Many people think soon we will find the real cause for this dreadful disease, thus finding a cure. We should all care about this disease, because it could affect you or someone you know. Unfortunately, there are still only a small amount of resources available. I think this is due in part that little is known still, however more is known than the past. Lack of research funds and grants to facilities also plays a major factor. I wish I could have written more about the history of Parkinson’s, but it was very difficult finding what I have. Also, I would have liked to have written more about Jim Finn and his results from the surgery. It is truly amazing what we can do today with technology. Maybe since geneticists have mapped the human genome this past year, researcher will be able to use that information to help find a cure. Michael J. Fox, who has been in hit TV shows “Family Ties” and “Spin City”, has recently been lobbying congress to fund more money for researchers. He has been battling Parkinson’s for many years. This disease affects about one-and-a-half million Americans, but currently gets a pitiful amount of funding compared to what other causes get. We should be fighting for a cure since it affects so many people. But we must remember, there is life after Parkinson’s; patients will go one with their lives with a cure or not. It just would be nice to find that needle in the hay stack. (please e-mail me, ashley_b83@hotmail.com, to give me your opinion on my term paper. This paper recieved a 97/A+.) | |