In light of World Parkinson’s Month in April – the month of Dr J Parkinson’s birthday – Executive: Medical Standards and Services at PPS, Dr Dominique Stott, talks about the efforts being made to increase awareness and understanding of Parkinson’s disease (PD) and how it impacts the patients’ lives.
PD is a chronic and progressive neurological disorder where cells in the brain, called the substantia nigra, start to die off and stop producing dopamine. As dopamine is responsible for movement and coordination, when the production ceases it causes problems with the muscles resulting in resting tremors, stiffness or rigidity, and abnormal and slowed movement.
The disease occurs in about 1% of the population among people over the age of 60 years, but it can less commonly occur in much younger people. Although there is no cure for PD, the condition can be managed with medicine and the patient will require skilled medical intervention to balance the medications used versus side effects experienced.
Diagnosing Parkinson’s disease
The first symptom of PD is often a resting tremor in one arm, which may be present in 70% of patients initially. Progressively there may be reduced ability of facial expression and stiff arm movement when the person is walking. The inability to walk normally and balancing problems usually develop at a later stage.
If a patient has any visible symptoms of a tremor, it is important to note the particular location of the tremor, the position in which it occurs and the frequency in order to report the information to a medical doctor as these can be possible signs of PD.
The diagnosis of the disease must be made by clinical examination which is conducted by a neurologist or physician. There are no blood tests that can diagnose PD so the diagnosis is made purely on the clinical picture. Magnetic Resonance Imaging (MRI) brain scans are normal practice in the diagnosis, but are mostly done to exclude other conditions, such as a stroke.
Treating Parkinson’s disease
In some instances medication does not work indefinitely and various different forms of treatment will need to be used eventually. Surgery in the form of Deep Brain Stimulation (DBS) is a treatment option for some types of PD. This involves electronic stimulation of specific sites in the brain. This is not a cure, but the outcome of managing the disease with this technique has been good for some patients.
There are studies underway regarding gene therapy to improve dopamine availability in the brain. Lifestyle and exercise therapy may also play a role in improving gait, balance and flexibility. Research is also being done into the neuroprotective effects of vigorous exercise on preventing this disease but there is no evidence to support this as yet.
There is a genetic link in approximately 10% of PD cases, however, the majority of the cases are assumed to be caused by environmental factors. These environmental factors include exposure to solvents, herbicides and pesticides and proximity to industrial plants or quarries. Most of these substances are not used in developed countries any longer, but may very well be used in developing countries.
It is therefore also important to disclose whether a family member has PD when applying for life insurance. Due to the underwriting of genetic disorders it is important to disclose family history, hence the reason why this question is asked on application forms. Depending on the frequency of PD in the family it may or may not pose a risk for that specific person.
Due to the high prevalence of PD, medical research is very active in this field. New developments are being made all the time in an effort to bring about a cure for the disease and not just symptom control, but these are all still being investigated. As with any movement disorder, the impact of such a condition on the ability to earn a living can be severely impacted. PPS sees cases where the PD causes problems among professionals who use fine motor skills, like dentists and surgeons. It is therefore important to ensure that proper insurance is in place before health issues develop. Once they are diagnosed, it may be impossible to get insurance to cover one’s financial losses caused by such conditions.