What is Parkinson’s…
The overall prevalence in the world is estimated at 6.5 million at present and expected to double in the next 10-20 years. In Pakistan alone there are estimated to be 450,000 persons afflicted from the disease.
It was nice cloudy evening with cool Karachi breeze blowing when I arrived at my family physicians clinic dot on time. My doctor is a ‘gora sahib’ who is a stickler for time. At exactly 5.45 PM , the doctors clinic door opens and he comes out immaculately dressed and ushers me in. I spot a new writing instrument on his desk. We share a passion for collecting writing instruments and Doctor Sahib proudly shows his latest acquisition - a sterling silver Caran D”Ache. What a beauty
I start to narrate some problems that I am becoming aware of and ramble a laundry list of issues like my left hand dangles when I walk, my handwriting of which I have been so proud of, tends to become smaller and at times unreadable, being a senior banking executive I travel a lot but I have a problem lifting the computer case to the overhead compartment in the plane. I self diagnose and comment that I think I may have suffered a minor stroke. Doctor sahib does the usual checks, looks at my medical file and makes me walk up and down like a model on a catwalk. His face turns serious and he remarks, Haroon Sahib you are showing sings of Parkinson’s. Let me refer you to a neurologist and promises to have a medical history and introduction ready by next day.
I consult a prominent neurologist who comes from a family of goldsmiths. The whole story is repeated, I am checked for balance and made to walk. The neurologist’s prognosis is the same and he calmly says it is the early onset of Parkinson’s, but that he will prescribe no medicine and asks me to lead a normal life and return for consultation in two years. Feeling relieved I thank Allah and stop on the way from the hospital for a bite.
Life goes on and the symptoms don’t go away and I learn to cope. On one of my trips to London I am meeting up with my son who is posted in Singapore and also attending a company meeting in London. On the families insistence we agree to consult a leading Harley Street Neurologist who also confirms the earlier doctor’s diagnoses and puts me on medication and assures me that I can look at at least another 12 to15 years of normal life.
Little did I know this would be a turning point in my life but with faith in Allah I continue with my career and started reading about the disease and its management and realize there is little awareness about the disease even among GPs and family doctors and was considered an untreatable old man’s disease. Perhaps Allah has given me the responsibility and opportunity to do community service.. The thought of starting a Parkinson’s Society is born as a community service. Supported and encouraged by friends and the Society is launched in April 2008 on “World Parkinson’s Day”
What is Parkinson’s ?
Parkinson’s Disease - PD for short - is a progressive degenerative disorder which features globally effecting all cultures without any ethnic, social or geographical boundaries. While the conditions usually manifests itself after 60 it is now being observed that 15-20 per cent diagnosed are below age 50 (Young Onset Parkinson’s). PD effects both men and women in almost equal numbers The overall prevalence in the world is estimated at 6.5 million at present and expected to double in the next 10-20 years. In Pakistan alone there are estimated to be 450,000 persons afflicted from the disease.
PD targets a specific area of the human brain that is a collection of nerve cells, the substantia nigra. The damage to these nerve cells affects a circuit of cells in the brain called the basal ganglia. which controls movement in the body. PD causes brain cells in the basal ganglia to die gradually, thereby decreasing dopamine in the basal ganglia and causing Parkinson's disease and the symptoms of tremor, rigidity, difficulty walking, and postural imbalance.
Scientists don't know for certain what causes Parkinson's disease, but some believe that a combination of environmental and genetic factors may be responsible. Treatment options for the management of Parkinson's disease, are available and the disease can be managed (but not yet treated) through a comprehensive treatment program which includes medication and physical therapy.
Early-stage symptoms of Parkinson’s disease may include the mild tremor of a limb or limbs at rest such as shaking of the hands and arms, trembling legs and feet, etc slowness of movement, masked facial expression, body/limb stiffness, or mild postural imbalance.
As PD progresses, a person may notice increasingly severe resting tremor of a limb or limbs, slowness of movement, body/limb stiffness, or significant loss of balance. During the advanced stage of Parkinson’s disease, a patient may require significant assistance from a caregiver and support from friends and family. Be aware that there are various Parkinson's disease treatment options that can help lessen these symptoms.
In general, someone with Parkinson’s disease will experience one or more of the following symptoms in differing degree of severity:
- Shaking at rest ( resting tremor)
A symptom of involuntary trembling that may occur in the hands, arms, and legs of a patient. This shaking is usually evident when the patient is either standing still, seated, or lying down.
- Slow movement ( bradykinesia)
Slower-than-normal movement can occur in patients with Parkinson’s disease.
- Stiffness (rigidity)
A symptom of body or limb inflexibility present in a patient with Parkinson’s disease.
- Balance problems (postural imbalance)
A symptom that manifests itself in the inability of a patient to balance or remain steady.
- Change in volume of speaking voice ( hyperkinetic dysarthia)
A symptom that may be noticeable in some patients is the low volume of their speaking voice. As a result, some Parkinson’s disease patients need to raise their voices in order to be heard.
- Change in handwriting style ( micrographia)
A symptom that produces a noticeable change in a patient’s handwriting style, as well as a shrinking in the size of the script. One place to measure this change in handwriting is to review documents that require an annual signature, such as tax returns. Other changes in handwriting in Parkinson's disease may result from shaking at rest, slow movement, or stiffness.
- Masked face (hypomimia)
A symptom where there is a reduced degree of facial expression, or rigidity, caused by decreased facial muscle movement.
If you notice any of the above symptoms in yourself of your friends or family it is recommended you consult your family physician who can guide you. Treatment options besides specific medication include physical therapy, voice therapy, occupational therapy and music therapy.
It is important to note that medicines alone do not form the full gambit of treatment. It needs to be pointed out the PD manifests itself in differing degrees and symptoms vary from person to person and worsen over a varying length of time. As a result medication has to be fine tuned by doctor after regular clinical examinations to allowed for the continued management of the disease.
Besides medication each patient needs to be motivated to take charge and make the disease “their friend”. They need to attempt to be as independent as possible for as long as possible and not be allowed to fall into a depressive state mind. Alongside the patient, their primary caregiver has a key role to play in this aspect of the management of the disease and they too should be encouraged to understand as much as possible about PD.
A significant amount of information on the steps to manage PD is available on the internet generally and specifically some key items are available and regularly updated on on the website of the Pakistan Parkinson’s Society on www.parkinsons.org.pk. One can also also contact them on