Parkinson's Disease

Also known as shaking palsy, Parkinson's disease is one of North America's most common debilitating illnesses. It is often thought of as a disease of old age—one person in a hundred will develop it by retirement age, but half of them may have it by age 4o. Parkinson's disease develops progressively. Nerve cells slowly degenerate in the part of the mid-brain that controls movement (the substantia nigra layer of the basal ganglia). In normal health, messages from the motor cortex to the reticular formation initiate free movement, and neurotransmitters released from the basal ganglia in response to the same messages slow or dampen movement, providing the suppleness and dexterity we take for granted. These two neurotransmitters are dopamine, which stimulates the damping effect, and acetylcholine, which inhibits it

Its exact cause is usually unknown, but Parkinson's disease is characterized by cell damage in the basal ganglia. Production of dopamine slows down and the characteristic symptoms appear. It begins with weakness or stiffness accompanied by a slight tremor of the hands or head. Over time the shaking increases, muscles stiffen further and there is a visible deterioration in balance and coordination. In advanced stages, symptoms include generalized rigidity, drooling, loss of appetite, stooped posture, a shuffling walk and a fixed facial expression. Eventually, communication skills may be impaired. Dementia, depression and other emotional problems are common.

Genetic factors play a role too, but there are other contributing causes including certain medications, pesticides, carbon monoxide, cyanide, manganese, street heroin, specific viruses and the type of repetitive head trauma suffered by boxer Mohammed Ali (dementia pugilistica). Researchers at the National Institute of Health in Bethesda have recently identified a gene programmed for the production of a protein called alpha synuclein. There is hope that this clue will open the door to further discoveries about Parkinson's disease and innovative ways to treat it.

There is so far no definitive cure for Parkinson's disease but it is treatable—most effectively at its outset. Therefore, early diagnosis is best. For the time being, conventional treatments include medication that attempts to restore neurochemical balance by replacing or supplementing the body's production of dopamine. Neurosurgical techniques and fetal tissue implants have had some success. Some scientists are developing implantable electrodes into the brain to stimulate specific neural pathways. Drugs such as selegiline have shown promise. A team headed by researchers P Jenner and C.W. Olanow from the Neurodegenerative Disease Research Centre in London have shown that selegiline may increase GSH activity. Recently, newer drugs like pramipexole and ropenerole have emerged as more effective treatments.

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