Understanding Parkinson’s Disease

‘I am doing good,” Manny Pacquiao told Bulletin Sports when asked whether he is suffering from Parkinson’s disease a couple of years ago.  “God is good.” He added: “I am the one who knows and feels what my body is telling me.”

The question was asked because physician Rustico Jimenez, president of the Private Hospitals Association of the Philippines, told a television channel that the boxing champion was supposedly already exhibiting early signs of Parkinson’s disease.

In a separate interview that was aired on Unang Hirit, Pacquiao again dismissed the notion outright. “Comment lang ‘yun,” the multi-millionaire pugilist, actor, TV host, philanthropist and lawmaker said, “Lahat naman may karapatan mag-comment.” 

More often than not, boxers are susceptible to Parkinson’s disease. Both legendary boxer Muhammad Ali and Pacquaio’s own trainer and Coach Freddie Roach (also a former boxer) have been battling the disease.

“It’s slight [that boxers have somewhat higher risk of developing Parkinson’s disease], but it is there,” says neurologist Zoltan Mari, director of the National Parkinson Foundation Center of Excellence at Johns Hopkins University in Baltimore. “However, it is not risky enough to dissuade potential boxers.” 

“It is only one of many, many factors, and more research is needed,” Mari further states.  “If a kid does not have the genes that predict Parkinson’s disease—and chances are he doesn’t—there’s more of a downside from not letting him pursue a career he wants to pursue.” 

Parkinson’s disease, also called “shaking palsy,” is a slowly progressing, degenerative disorder of the nervous system. It usually attacks people between the ages 50 and 69. However, it may occur in younger persons, especially following brain inflammation (encephalitis) or poisoning by carbon monoxide, metals or some drugs.

“I was pinning my hopes on the fact that the disease usually begins after age 50,” Canadian actor Michael J. Fox wrote in his autobiography, “Lucky Man.” “My symptoms showed up in my late 20s. How could I possibly have this old person’s disease?”

Ali was only 42 when he announced that he had Parkinson’s disease. Both Ali and Fox belong to 10 percent of those who are struck by the disease. “In such cases, the disease is referred to as early-onset Parkinson’s,” wrote Dr. Michael W. Smith in an article, which appeared in WebMD Health News. 

The earlier the disease is diagnosed, the better the prognosis, Mari says. “Younger patients who have had the disease for 10 years do better than older patients who have had the disease for 10 years. We don’t know why,” he admits.

No one knows also how many people are suffering from Parkinson’s disease. But according to the Geneva-based World Health Organization (WHO), there are an estimated 4 million people suffering from the disease around the world.

Historical records showed Parkinson’s disease to have existed since Biblical times, but it was only in the 19th century that it was clinically recognized. Because the prevalence of Parkinson’s disease increases with age, the shorter life expectancy in previous centuries probably meant that it was not as noticeable as it is today.

The condition was first established as a clinical entry in 1817 by a British doctor, James Parkinson, in his “Essay on the Shaking Palsy.” Later, in the 1860s, the French neurologist Pierre Marie Charcott called the condition “Parkinson’s disease,” in honor of the essay author. Almost 200 years after it was first published, Parkinson’s essay continues to be recognized throughout the world as the classic description of the disease. 

“Parkinson’s disease symptoms and signs may vary from person to person,” the Mayo Clinic points out. “Early signs may be mild and may go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.”

Symptoms of Parkinson’s disease include tremors that occur while at rest, “pill rolling” movements of the fingers and a mask-like face. Other symptoms are a shuffling gait, a slightly bent-over posture, rigid muscles and weakness.

“People suffering from the disease may drool, have a heavy appetite, be unable to stand heat, have oily skin, be emotionally unstable and have judgment problems,” the UN health agency says. “The symptoms are made worse by tiredness, excitement and frustration. It rarely damages the ability to think and reason.” 

Loss of communication skills is particularly common. “Speech often becomes soft, mumbling and monotonous in tone,” the WHO notes. “There is often reduced facial expression, resulting in a typical ‘mask-like face’ and limited body language. Many people also have problems with their handwriting, which becomes small and cramped, making it very difficult to read.”

These communication problems can seriously affect the social and emotional life of both the person with Parkinson’s disease and his or her family. Research has shown that the loss of non-verbal skills has a negative impact on people’s perception of an individual’s abilities. Because of reduced body language, people with Parkinson’s disease are often erroneously labeled unintelligent, uncooperative and difficult.

Recent studies have discovered that the symptoms of Parkinson’s disease appear when about 80 percent of dopamine is lost. Deep within the brain is an area known as the basal ganglia, of which the main neurotransmitter is dopamine. 

Although some people with Parkinson’s disease in the later stages may become mentally confused or demented, most retain their intellectual facilities while living in a body, which is becoming increasingly disabled. “This, in itself, can contribute to the boredom, social isolation and depression commonly experienced by sufferers,” the UN health agency says.

Like many other brain disorders, Parkinson’s disease is—at the moment—incurable. But there are medications that can help.

“Drugs like levodopa and carbidopa can help improve the patient’s movement and lessen tremors by increasing the amount of dopamine in the brain,” coauthor Dr. Willie T. Ong writes in the book, Doctors’ Health Tips and Home Remedies. “These drugs, however, need to be adjusted regularly depending on the patient’s condition.” 

There’s another class of drugs called “dopamine agonists,” which mimic the effects of dopamine. Examples include pramipexole and bromocriptine. “They are not as effective as levodopa but may still improve the person’s symptoms,” Ong says. 

Other medications that neurologists can prescribe are selegiline and amantadine. “Consult your doctor about these options,” Ong suggests.

In certain cases, the doctor may recommend a surgical procedure called deep brain stimulation. “This procedure is often used for patients who do not respond to oral medicines,” Ong explains. 

Because of the complex nature of Parkinson’s disease, management requires a holistic approach that takes into account the affected person’s whole life. These include accurate diagnosis, individual approach, multidisciplinary support and involving the patient and caregiver.

Good management of the disease starts with an accurate diagnosis that can be made by a doctor with special knowledge on Parkinson’s disease, usually a neurosurgeon or a geriatrician.

The diagnosis of Parkinson’s disease is often a shattering experience both for those diagnosed and their families. It needs to be given in a sensitive way, allowing people to come to terms with the diagnosis and encouraging them to seek further information and advice.

Fox was reportedly shooting a movie called Doc Hollywood in 1991 when he noticed a twitch in his left little finger. “How long this had been going I wasn’t sure,” he wrote in his autobiography. “But now that I noticed it, I was surprised to discover I couldn’t stop it.” 

Feeling uneasy, he went to see a doctor who suggested a series of tests. The diagnosis was terse and devastating. “Even the most paranoid fantasy I could think of would not have prepared me for the two words the neurologist bludgeoned me with: Parkinson’s disease,” the actor recalled.

Except to a tight circle of family and friends, Fox kept his condition a secret before finally going public in an exclusive interview with People magazine in November 1998. “It was incomprehensible,” People quoted him as saying of the diagnosis. “The doctor said I would be able to function for years and years. But even taking in those terms was strange.” 

Here’s a final thought from Ong: “A person with Parkinson’s disease needs a lot of support and understanding.  It’s easy for the patient to get frustrated because he or she cannot do the usual activities.”

Image Credits: EMSL on Visual Hunt / CC BY-NC-SA

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Turning Points 2018