Dear Dr. Pat:

I am just 59 years old and have recently been diagnosed with early Parkinson’s disease.  I had been having unusual muscle stiffness over the last year and noticed some unsteadiness.  My husband and children told me that I should “pick up my feet” when I walked, but I wasn’t aware of much else. I am a teacher and I am finding it a little harder to stay organized now.  My GP prescribed a medicine at a low dose “so I could get used to it.”  I don’t feel any better.   I thought that only older people had this disease in most cases and I thought it ran in families.  I never had any head injury and I don’t take any medicines; I don’t smoke or drink alcohol.  What caused this, and what can I do about it?  The nearest big university hospital is 100 miles away.  Should I see a regular neurologist or a specialist in Parkinson’s?  Could I have some other disease?

Elizabeth

 

Dear Elizabeth:

For expert advice to pass on to you, I turned to Joseph Safdieh, M.D.,  medical director of the Neurology Clinic at Manhattan’s NewYork–Presbyterian Hospital. He  also serves as Director of Outpatient Training for the Neurology Residency Training Program ar Weill Cornell Medical Center.  Well respected as an innovative medical educator, Dr. Safdieh  has developed numerous curricula for the teaching of neurology to both medical students and other physicians. He was glad to answer your question. Here’s his response:

—Dr. Pat

 

Parkinson’s disease is the second most common degenerative disease of the  brain. There is a misconception that it is a disease of older people,  but the median age of onset is actually 60 years old, which means that  50 percent of patients are diagnosed before age 60.

Although there are some  known genetic causes of Parkinson’s disease, the vast majority of cases  are not known to be genetic, and often there is no history in the family  of this disease. In Parkinson’s disease, an essential brain chemical  known as dopamine gradually becomes deficient, which leads to the major  symptoms of tremor, stiffness, slowness, and changes in walking— usually  a lack of swinging one arm followed by the development of stiffness of  gait and shuffling.

A cross-section of a brain affected by Parkinson's disease. © Copyright 2011 Net Resources International, a trading division of Progressive Media Group Limited.

The earliest symptoms are usually present on one  side of the body before spreading over a period of a few years. The exact cause of  this disease is a mystery; some studies have suggested a possible role  of oxidative stress, but this is very unclear. It is important that you  mention that you do not take any medications, because there are some  medications that can cause symptoms that mimic Parkinson’s disease. It  is also a good thing for your overall  health that you don’t smoke or drink, although a very fascinating fact is that smoking seems to  reduce the risk of development of Parkinson’s disease! (By no means  am I suggesting that you start smoking—there are dozens of reasons not to  smoke.)

The good news about Parkinson’s disease is that, unlike most  degenerative diseases of the brain, the symptoms are very treatable, and  in fact patients who are well treated can have an excellent quality of  life. Treatment focuses on replacing dopamine. There are a number of  medications that are FDA-approved for treating Parkinson’s disease. The  doses need to be carefully adjusted over time, because the disease  progresses over time, so it is in essence a moving target. A dose that  works well today may no longer work well in one year.

Other beneficial  therapies include tai chi and aerobic exercise.

As the disease  progresses over five years or so, the effect of the medications tends to  become very unpredictable, but recently an exciting new development has  been the advent of a neurosurgical procedure called “Deep Brain  Stimulation.” It is very beneficial in carefully selected patients. I  think you definitely should see a regular neurologist to confirm the  diagnosis. A number of conditions can mimic some of the symptoms of  Parkinson’s disease; they need to be excluded. The neurologist can also  recommend an effective treatment plan. If seeing the neurologist  regularly is a burden, then you can work with your primary care doctor  to enact the neurologist’s recommendations and perhaps follow up  annually with the neurologist for dose adjustments. Seeing a movement  disorders specialist (a neurologist who specializes on Parkinson  disease) is also an option, but is not necessary unless there is  something that the regular neurologist thinks is atypical about your  case.

I want to reiterate that you should not be scared to face this  disease, if you indeed have it, since it is eminently treatable, and many  patients, when properly diagnosed and  cared for, have an excellent quality of life.