Parkinson’s is usually thought of as a disease that affects the elderly but that’s not true. In fact there far more to it than meets the eye…
We’ve heard about celebrities such as the late Muhammad Ali who battled with Parkinson’s disease and Michael J. Fox who has been fighting Parkinson’s for 25 years. He was diagnosed in 1991. Fox also lends his celebrity status to looking for a cure. The fact is there is a lot of research being done into looking for a cure for Parkinson’s disease and it is hoped that a cure will be found soon. Gleneagles Kuala Lumpur’s Consultant Neurologist, Dr. Ooi Phaik Yee, provides her expert insights on this neurological disorder.
Urban Health: What exactly is Parkinson’s disease?
Dr. Ooi Phaik Yee: Parkinson’s disease is a neurodegenerative disease which means it’s a neurological disorder that keeps getting worse across 15 to 20 years on average. In general, Parkinson’s disease tends to be a condition that affects the elderly, who are usually diagnosed in their 50s to 60s. However, it can also manifest at a fairly early age such as in the 40s.
UH: What causes Parkinson’s disease?
Dr. Ooi: It is caused by the lack of a chemical in the brain called dopamine. This is due to the death of neurons that produce it. Parkinson’s disease affects more than just the brain. Usually, patients start to seek medical attention when they begin to notice problems with their movements. This is called motor symptoms, whereas other symptoms not related to movement are called non-motor symptoms.
Non-motor symptoms include pain in any part of the body, numbness, a loss of the ability to smell and taste, low blood pressure when standing which can cause fainting spells. Patients also experience memory problems, hallucinations, constipation, erectile dysfunction, difficulty passing urine and sleep problems such as insomnia.
UH: What are key symptoms of this disease?
Dr. Ooi: Symptoms are the same in men and women and typically, symptoms begin from one side of the body, either the right or left side, then slowly spread to the other side. Typical symptoms include, shaking in any body part such as the hands, legs, head, jaw or lips, stiffness, pain and loss of dexterity in the limbs, slowness in movements, thought and response as well as problems walking. The patient may also find it hard find their balance and may fall, often.
UH: Who are at high risk of developing Parkinson’s disease?
Dr. Ooi: In most cases, it happens randomly and without a known cause. Less than 10 percent of the cases have a family history, some are genetic with predicted mode of inheritance but this is rare.
Risk factors include older age, being male and environmental factors such as drinking pesticide contaminated water from a well , or living in rural areas where high amounts of pesticides are used on crops.
UH: How is Parkinson’s diagnosed?
Dr. Ooi: Diagnosis is done clinically, by observing the patient’s movement by an experienced doctor or neurologist, and diagnosis is made based on the typical signs and symptoms. Generally, a brain scan is not needed, unless there is suspicion of other diseases which may mimic Parkinson’s disease.
UH: What should carers look out for, as a sign of Parkinson’s disease?
Dr. Ooi: They should look out for:
- Shaking or tremors in any body part
- Slowness in movement, thought and response
- Stiffness of one side of the limb, which may be painful. When they walk, patients tend to show less of arm swing, or dragging the leg on one side
- Problem with walking like getting stuck when walking, imbalance, tendency to fall
- Soft voice without much change in intonation
- Lack of facial expression
UH: How is Parkinson’s treated?
Dr. Ooi: Treatment focuses on easing the symptoms because there is no cure for Parkinson’s disease. Current treatments aim to restore the level of dopamine in the brain, namely, dopaminergic therapy.
The typical drug used for Parkinson’s disease is levodopa or L-dopa. Patients are usually highly responsive to this medication and symptoms may improve to a point where they become almost imperceptible. Another drug is dopamine agonist which mimics the actions of naturally produced dopamine.
Non-motor symptoms can also be treated but the medication used will have to be tailored to the symptoms. Treatment of Parkinson’s disease is very dynamic as the disease pattern and complications changes with time.
It is very common for Parkinson patients to be on four to five types of medication in order to achieve optimum treatment. It must be said that after a few years, some patients may start to develop complications from the treatments. For instance, the effects of the medications last a shorter amount of time, effects became unpredictable, or patients may develop excessive involuntary body movements. These patients have to get their medications carefully adjusted, and be considered for advanced therapy.
Advanced therapy for Parkinson’s disease include apomorphine and deep brain stimulation. These are available in hospitals in Malaysia. These treatments are very effective and can significantly improve their symptoms and quality of life.
UH: What kind of diet can help prevent Parkinson’s disease?
Dr. Ooi: A healthy and balanced diet cannot prevent the disease, but can improve the general wellbeing of Parkinson’s patients. They should consume adequate fluids and stay hydrated especially for patients who have low blood pressure. Additionally, a diet rich in fibre like vegetables and fruit is also good for these patients as they commonly suffer from constipation.
UH: What should be done if Parkinson’s is suspected?
Dr. Ooi: A general practitioner or GP will be the first contact for most patients who suspect they may have Parkinson’s disease. Seeing a GP is very helpful as they can help to make the diagnosis, or at least consider Parkinson’s disease if many of the symptoms point towards it. Usually, the general practitioner will then refer the patient to a neurologist for further confirmation, work-up and treatment.
Alternatively, the patient can see a neurologist to have their suspicion confirmed or ruled out. Confusion may arise if some patients present with very atypical features and initial diagnosis may not be easy. There are many conditions which mimic Parkinson’s disease. These have to be ruled out as the course of these diseases and response to treatment are different. For treatment, these patients see a neurologist, particularly those who are trained to handle Parkinson’s, as the treatment regimes are usually complex.
UH: What is your advice for the carers and also individuals suffering from Parkinson’s?
Dr. Ooi: Though it is not curable, with good treatment, the patient can continue to enjoy a reasonable quality of life for many years. It is not uncommon to see an early stage Parkinson’s disease patient to continue working and earning a living.
Patients should get the diagnosis confirmed early so they can plan ahead, and improve their quality of life with the right medication. It is important for them to follow the treatment regime prescribed by the doctors, while living a healthy lifestyle.
Carers should encourage the patient to continue living an active life. Physical activity should be tailored to their capability, while taking safety precautions to prevent secondary complications like falls. Do take part in support groups such as MPDA (Malaysian Parkinson’s Disease Association) to get more information on Parkinson’s disease.
Malaysian Parkinson’s Disease Association (MPDA)
If you’re feeling a little lost or alone while dealing with or caring for someone with Parkinson’s disease, do contact MPDA at: http://www.mpda.org.my or find them on Facebook at: www.facebook.com/Malaysian-Parkinsons-Disease-Association-207738475948217/