Parkinson´s Disease

Parkinson's ( or Parkinson´s disease or PD ) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech, as well as other functions. It is a progressive disease whose effects get worse over time.

PD is the most common cause of chronic progressive parkinsonism, a term which refers to the syndrome of tremor, rigidity, bradykinesia ( slow movement ) and postural instability. While many forms of parkinsonism are "idiopathic" meaning that they are not caused by any other agent, secondary cases may result from toxicity most notably of drugs, head trauma, or other medical disorders


Symptoms of Parkinson's disease

People who have Parkinson's disease experience the following symptoms:

1. Tremor. The characteristic shaking associated with Parkinson's disease often begins in a hand. However, many people with Parkinson's disease do not experience substantial tremor.

2. Slowed motion (bradykinesia). Over time, Parkinson's disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and time-consuming. When you walk, your steps may become short and shuffling.

3. Rigid muscles. Muscle stiffness often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain.

4. Impaired posture and balance. Your posture may become stooped as a result of Parkinson's disease. Imbalance also is common, although this is usually mild until the later stages of the disease.

5. Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be diminished and even lost.

6. Speech changes. Many people with Parkinson's disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking.

7. Dementia. In the later stages of Parkinson's disease, some people develop problems with memory and mental clarity. Alzheimer's drugs appear to alleviate some of these symptoms to a mild degree.


Diagnosis

A doctor may diagnose a person with Parkinson's disease based on the patient's symptoms and medical history. The disease can be difficult to diagnose accurately. The Unified Parkinson's Disease Rating Scale is the primary clinical tool used to assist in diagnosis and determine severity of PD. It consists of the following sections:

Mentation, behavior, and mood;
Activities of daily living;
Motor;
Complications of therapy;
Hoehn and Yahr Stage;
Schwab and England Activities of Daily Living Scale
These are evaluated by interview and clinical observation. Some sections require multiple grades assigned to each extremity.


What causes Parkinson's disease?

Many symptoms of Parkinson's disease result from the lack of a chemical messenger, called dopamine, in the brain. This occurs when the specific brain cells that produce dopamine die or become impaired. But researchers still aren't certain about what sets this chain of events in motion. Some theorize that genetic mutations or environmental toxins may play a role in Parkinson's disease.


Treatment

Parkinson's disease is a chronic disorder that requires broad-based management including patient and family education, support group services, general wellness maintenance, physiotherapy, exercise, and nutrition. At present, there is no cure for PD, but medications or surgery can provide relief from the symptoms.

Some of the medicines used to treat Parkinson's disease include carbidopa-levodopa (one brand name: Sinemet), bromocriptine (brand name: Parlodel), selegiline (one brand name: Eldepryl), pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), and tolcapone (brand name: Tasmar). Your doctor can recommend the best treatment for you.

Alternative Medicine

Diet

The choices we make about food – what we consume, its quality and quantity – arecrucial to our health and well-being. There is some agreement that it is generally wise to consume a varied diet high in fruits and vegetables and to avoid excessive saturated fats, especially trans-fats. For example, Mediterranean diet, a diet high in monounsaturated fats, such as olive oil, may be beneficial in reducing blood pressure and cardiovascular disease. The diet also emphasizes fish, especially those high in Omega-3 fatty acids, such as salmon, and foods containing antioxidants.

Antioxidants

Antioxidants are substances that can detoxify free radicals, which are reactive particles involved in certain types of cell death. Coenzime Q10 is one antioxidant that lately has appeared to have some effect on disease progression at doses of 1200mg/day. This is a much larger dose than most people were taking prior to the release of the study data, a deliberate choice designed to avoid the risk of missing a significant effect by giving too low a dose. Another medications with far less research include IV Gluthathione and very high dose Vitamin C.

Ayurvedic Medicine

The initial step is to determine the metabolic type of an individual. Then the practitioner looks at environmental factors, such as season and time of day. Diseases are diagnosed by assessing various pulse points and their relationship to internal organs.

Treatment of disease consists of detoxification through various cleansing therapies, then restoring balance through palliation with such modalities as yoga and meditation. Finally, a process of tonification, called rasayana, is initiated. Interestingly, one of the medications used in Ayurveda was derived from a legume, Mucuna pruriens, which has been found to contain levodopa. The condition for which it was used, as described many centuries ago, most likely was Parkinson disease.

Yoga

A complete practice of yoga integrates mind, body and spirit in a process involving one’s complete lifestyle. The most popular form of yoga is asana or Hatha yoga, which involves execution of a series of postures with attention to breathing (pranayama), meditation and proper execution of the poses. Like Tai Chi, the practice of yoga has been shown to improve various aspects of health such as blood pressure, digestion and asthma. Most yoga centers offer a range of classes and list them as to level of experience required.

Since exercise is so important in the treatment of PD, patients are seeking to improve their strength, balance and flexibility. Yoga and Tai Chi are both excellent for this. In addition to more traditional fitness programs such as walking and weight lifting, classes in yoga and Tai Chi have become standard offerings in senior centers, gyms and park districts.

Traditional Chinese Medicine (TCM)

Like Ayurveda, Chinese or Oriental Medicine has been in practice for thousands of years and also is concerned with maintaining health instead of just reacting to disease. Much emphasis is placed on maintaining a balance between opposites within the body as well as with the natural world.

Tai Chi

Tai Chi, both a form of martial arts and a system of meditation, is part of an ancient Chinese system of healing called Qigong. In Tai Chi classes, participants follow a teacher in performing a choreographed series of movements. There are various styles and levels of difficulty, including some classes performed while practitioners are seated. Tai Chi has been shown in several studies to improve balance in older patients as well as persons with PD.

Acupuncture

One of the methods used to help restore the balance of yin and yang is acupuncture, a technique developed over 2,500 years ago in China. The treatment involves inserting hair-like needles into certain points on the body. This is done to restore the flow of Qi to the organ system associated with that acupoint. Some patients with PD describe temporary relief from symptoms such as tremor and rigidity. Variants of acupuncture include cranial acupuncture and seem to be effective in helping PD patients.

Body Work/Massage Therapy

Body work comprises a group of “touch therapies” such as reflexology, and therapeutic massage. Massage therapy in particular has become very popular because of its beneficial effects on the muscle stiffness and aching that may accompany PD. Massage may also help with associated conditions such as arthritis, and sleep and digestive disorders. In addition, a well-executed massage can be an extremely relaxing and enjoyable experience.

Of the many different styles of massage therapy, two in particular may be useful in PD. Shiatsu, or acupressure, uses touch rather than needles to treat the same pressure points as acupuncture.

Please look at the following video

Seasonal Affective Disorder

Seasonal affective disorder (also called SAD) is a type of depression that follows the seasons and is usually called winter depression. It usually begins in late fall or early winter and goes away by summer. SAD may be related to changes in the amount of daylight during different times of the year.

With respect to prevalence, about half a million people in the United States may have winter depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. For adults, the risk of SAD decreases as they get older. SAD is more common in northern geographic regions, where the exposure to bright light is obviously reduced during winter season.

Why does seasonal affective disorder occur?

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%. Cloud cover may also contribute to the negative effects of SAD.

SAD can be a serious disorder and may require hospitalization. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness. The symptoms of SAD mimic those of clinical depression. At times, patients may not feel depressed, but rather have depression equivalent symptoms such as a lack energy to perform everyday activities. Norman Rosenthal, a pioneer in SAD research, has estimated that the prevalence of SAD in the adult United States population is between about 1.5 percent in Florida and about 9 percent in the northern US.

Various causes have been suggested. One possibility is that SAD is related to a lack of serotonin, although this theory has not been widely accepted.

How does my doctor know I have SAD?

1. Appetite changes, especially a craving for sweet or starchy foods
2. Weight gain
3. Heavyness in the arms or legs
4. Decreased energy and fatigue
5. Oversleep need
6. Difficulty concentrating
7. Irritability or excessive passiveness
8. Increased sensitivity to social rejection

According to the American Psychiatric Association, for a diagnosis to qualify as SAD, it must meet four criteria:

I. Depressive episodes at a particular time of the year

II. Remissions or mania/hypomania also at a characteristic time of year

III. These patterns must have lasted two years with no nonseasonal major depressive episodes during that same period

IV. The seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime.

Treatment for SAD

Winter depression is probably caused by your body's reaction to a lack of sunlight. Light therapy is one option for treating winter depression. You will need to sit in front of the light box or wear the light visor for a certain length of time each day. Generally, light therapy takes about 30 minutes each day throughout the fall and winter, when you're most likely to be depressed. The sufferer sits a prescribed distance, commonly 30-60 cm, in front of the box with her/his eyes open but not staring at the light source. Many patients use the light box in the morning, however it has not been proven any more effective than any other time of day. Discovering the best schedule is essential because up to 69% of patients find it inconvenient. Dawn simulation has also proven to be more effective in some studies, there is an 83% better response when compared to other bright light therapy

When used properly, light therapy seems to have very few side effects. Side effects may include eyestrain, headache, fatigue, irritability and inability to sleep (if light therapy is used too late in the day).

Tanning beds shouldn't be used to treat SAD. The light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin.

In addition to the light box your doctor may also want you to try a medicine or behavior therapy to treat your SAD. If light therapy or medicine alone doesn't work, your doctor may want you to use them together.

Please view the following video related to SAD