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<TITLE>About the Disease</TITLE>
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<TD><I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Parkinson's
disease: An Overview</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times">Parkinson's disease (PD) is a disorder
of the central nervous system that affects between one and one-and-a-half
million Americans. Because it is not contagious and does not have to
be reported by physicians, the incidence of the disease is often underestimated.</FONT>
<P><FONT FACE="Times New Roman,Times">PD may appear at any age, but it
is uncommon in people younger than 30, and the risk of developing it increases
with age. It occurs in all parts of the world, and men are affected
slightly more often than women.</FONT>
<P><I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Primary
Symptoms:</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">Following
is a list of the primary symptoms of Parkinson's disease. It is important
to note that not all patients experience the full range of symptoms;
in fact, most do not.</FONT></FONT>
<UL>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Rigidity
</FONT></FONT><FONT COLOR="#000000">is
an increased tone or stiffness in the muscles. Unless it is temporarily
eased by anti-Parkinson's medications, rigidity is always present.
However, it increases during movement. It is often responsible for a
mask-like expression of the face. In some patients, rigidity leads
to sensations of pain, especially in the arms and shoulders.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Tremor<B>
</B></FONT></FONT><FONT COLOR="#000000">is
the symptom the public most often identifies with PD, but in fact, up to
25% of patients experience very slight tremor or none at all. When
it is present, the tremor may be worse on one side of the body. Besides
affecting the limbs, it sometimes involves the head, neck, face, and jaw.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Bradykinesia<B>
</B></FONT></FONT><FONT COLOR="#000000">means
slowness of movement. This symptom is characterized by a delay in
initiating movements, caused by the brain's slowness in transmitting the
necessary instructions to the appropriate parts of the body. When
the instructions have been received, the body responds slowly in carrying
them out.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Poor
balance<B> </B></FONT></FONT><FONT COLOR="#000000">tends to affect people
with PD. This is particularly true when they move abruptly, causing a sudden
change in the position of their bodies. Some patients experience repeated
falls due to poor balance.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Walking
problems</FONT></FONT><FONT COLOR="#000000"> commonly include a decreased
or non-existent arm swing; short, shuffling steps (festination); difficulty
in negotiating turns; and sudden freezing spells (inability to take the
next step).</FONT></FONT></LI>
</UL>
<I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Secondary
Symptoms</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">People with
Parkinson's may also suffer from any of a long list of secondary symptoms.
These include depression, sleep disturbances, dizziness, stooped posture,
constipation, dementia, and problems with speech, breathing, swallowing,
and sexual function. Again, it is important to note that different
patients experience different symptoms.</FONT></FONT>
<P><I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>What
causes these symptoms?</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">The actual
cause of PD is not known. Although a defective gene was recently
found in a few families with extraordinarily high incidences of PD, most
researchers believe that in the vast majority of cases, genetic factors
alone are not responsible for causing the disease. Instead, it is
suspected that Parkinson's usually results from the combination of a genetic
predisposition and an environmental trigger.</FONT></FONT>
<P><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">When PD occurs,
degenerative changes are found in an area of the brain known as the <I>substantia
nigra</I>, which produces <I>dopamine</I>, a chemical substance that enables
people to move normally and smoothly. Parkinson's disease is
characterized by a severe shortage of dopamine. It is this deficiency
that causes the symptoms of PD.</FONT></FONT>
<P><I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Commonly
prescribed medications:</FONT></FONT></FONT></I>
<UL>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Levodopa
</FONT></FONT><FONT COLOR="#000000">is
a <I>dopamine precursor</I>, a substance that is transformed into dopamine
by the brain. The prescription of high dosages of levodopa was the
first dramatic breakthrough in the treatment of PD. Unfortunately,
patients experienced debilitating side effects, including severe nausea
and vomiting.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Levodopa/carbidopa</FONT></FONT><FONT COLOR="#000000">
(Sinemet) represented a significant improvement. The addition of
carbidopa prevents levodopa from being metabolized in the gut, liver and
other tisues, and allows more of it to get to the brain. Therefore,
a smaller dose of levodopa is needed to treat symptoms, and the unpleasant
side effects are greatly reduced.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Anticholinergics</FONT></FONT><FONT COLOR="#000000">
such as amantadine (Symmetrel) are drugs which cause the release of dopamine
from nerve terminals. These drugs are often used when symptoms are
mild and before Sinemet is prescribed, although they may also be taken
along with Sinemet in later stages.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Selegiline
</FONT></FONT><FONT COLOR="#000000">or</FONT><FONT COLOR="#000099"><FONT SIZE=+1>
deprenyl</FONT></FONT><FONT COLOR="#000000"> (Eldepryl) has been shown
to delay the need for Sinemet when prescribed in the earliest stage of
PD, and has also been approved for use in later stages to boost the effects
of Sinemet.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Dopamine
agonists</FONT></FONT><FONT COLOR="#000000"> are drugs that activate the
dopamine receptor directly, and can be taken alone or in combination with
Sinemet. Agonists available in the United States include bromocriptine
(Parlodel), pergolide (Permax), pramipexole (Mirapex) andropinirole (Requip).</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>COMT
inhibitors</FONT></FONT><FONT COLOR="#000000"> such as tolcapone (Tasmar)
and entacapone, represent a new class of Parkinson's medications.
These drugs must be taken with levodopa. They prolong the duration
of symptom relief by blocking the action of an enzyme which breaks down
levodopa before it reaches the brain.</FONT></FONT></LI>
</UL>
<I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Side
effects from medications</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">Like the symptoms
of PD itself, the side effects caused by Parkinson's medications vary from
patient to patient. They may include dry mouth, nausea, dizziness,
confusion, hallucinations, drowsiness, insomnia, and other unwelcome symptoms.
Some patients experience no side effects from a drug, while others have
to discontinue its use because of them.</FONT></FONT>
<P><I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>Surgical
interventions</FONT></FONT></FONT></I>
<UL>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Pallidotomy:</FONT></FONT><FONT COLOR="#000000">
This procedure has a long history in the treatment of Parkinson's disease,
but it fell out of favor with the advent of levodopa. In recent years
it has gained new popularity, mainly because magnetic imaging now allows
it to be performed with far greater precision. Pallidotomy is indicated
for patients who have developed dyskinetic movements in reaction to their
medications. It targets the source of these unwanted movements, the
<I>globus
pallidus</I>, and uses an electrode to destroy the trouble-causing cells.
As with any surgical procedure, there are risks involved. The most
serious is the possibility of stroke; other risks include partial loss
of vision, speech and swallowing difficulties, and confusion.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Brain
tissue transplants:</FONT></FONT><FONT COLOR="#000000"> Although
they have produced encouraging results, transplantation surgeries are still
in the experimental stage. The experiments began with fetal tissue,
but now scientists are also working with genetically engineered cells and
a variety of animal cells that can be made to produce dopamine.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Deep
brain stimulation:</FONT></FONT><FONT COLOR="#000000"> Like pallidotomy,
this technique also seeks to stop uncontrollable movements. It is
based on the technology of cardiac pacemakers. Electrodes are implanted
in the thalamus or globus pallidus and connected to a pacemaker-like device,
which the patient can switch on or off as symptoms dictate.</FONT></FONT></LI>
</UL>
<I><FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+2>The
role of the patient</FONT></FONT></FONT></I>
<BR><FONT FACE="Times New Roman,Times"><FONT COLOR="#000000">Treating Parkinson's
disease is not exclusively the doctor's job; there is much a patient
can do to stay as well as possible for as long as possible.</FONT></FONT>
<UL>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Exercise:</FONT></FONT><FONT COLOR="#000000">
For people with Parkinson's, regular exercise and/or physical therapy are
essential for maintaining and improving mobility, flexibility, balance
and a range of motion, and for warding off many of the secondary symptoms
mentioned above. Exercise is as important as medication for the management
of PD.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Support
groups:</FONT></FONT><FONT COLOR="#000000"> These groups play an
important role in the emotional well-being of patients and families.
They provide a caring environment for asking questions about Parkinson's,
for laughing and crying and sharing stories and getting advice from other
sufferers, and for forging friendships with people who understand each
other's problems.</FONT></FONT></LI>
<LI>
<FONT FACE="Times New Roman,Times"><FONT COLOR="#000099"><FONT SIZE=+1>Staying
active:</FONT></FONT><FONT COLOR="#000000"> PD seems to advance more
slowly in people who remain involved in their pre-Parkinson's activities,
or who find new activities to amuse them and engage their interest.
In a word, getting joy out of life has proved to be good for the health.</FONT></FONT></LI>
</UL>
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