THE treatment of Parkinson's disease has improved beyond belief in
the past 30 years. However, the trick of a happy relationship
between patient and doctor is still to find a neurologist who has a
special interest in the disease, and to keep regular contact with
the relevant patient groups (there is one in each Australian state).
Parkinson's disease doesn't usually shorten life, but it is one that
we all hope not to suffer and pray that our family and friends will
be spared its difficulties.

In normal brains, neurons, or nerve cells, produce a chemical called
dopamine, which helps relay messages, including messages that
control body movements. In Parkinson's patients the neurons that
produce dopamine gradually die, leading to abnormally low levels of
dopamine, which in turn causes difficulty in controlling the tension
and movement of muscles.

Parkinson's disease currently affects about 40,000 Australians,
according to the Brain Foundation website. The disorder affects
about one to two people per 1000, but over the age of 60 the rate
increases to one in 100.

It is slightly more common in men than in women. But so far,
scientists have not determined why some people develop Parkinson's
disease and others do not.

The suggestion that there could be a relationship to allergic
rhinitis, a common condition that induces a runny nose and watery
eyes without having a cold, is only one of many suggestions. As the
prevalence of the disease is still a point of dispute in some
countries, statistics that suggest a specific increase in
vulnerability to Parkinson's must be viewed with caution.

There are also anecdotal suggestions that Parkinson's is more common
in rural areas than urban; this has been attributed to diverse
factors such as keeping a dog or exposure to pesticides.

The premise about the dogs is that they may give their owners gut
infections that can set up antigen reactions and interfere with
antibodies. The truth is that the causes of Parkinson's are still
unknown and more research is needed.

Medical journals occasionally publish mea culpa columns in which
doctors acknowledge mistakes that have left them with a sense of
regret, or even guilt.

I missed one diagnosis that I have always regretted.

The person involved was a former colleague rather than a patient.
This bright young man had come to England to escape the consequences
of his opposition to apartheid in South Africa. He was highly
intelligent and, as would be expected, politically conscious.

After completing his medical studies he found it difficult to find a
hospital job. I was able to arrange for him to meet my old boss, a
respected cardiologist, who shared the South African's political
opinions.

Thereafter the young man flourished.

Ten years later, when I started a brief spell in Parliament and was
back in London, I invited him to dinner at the House of Commons. The
quick, amusing, friendly faced smiling man had gone.

He was now apparently slow, surly, quiet, withdrawn and had so lost
his joie de vivre that he couldn't even summon up a smile when it
was socially appropriate.

I assumed at the end of dinner that not all friendships survive, and
that perhaps the intellectual excitements of his new life had left
him with little in common with a rural GP.

I had made one of the commonest mistakes and missed an occasional
initial sign of early Parkinson's that sometimes precedes the more
obvious shake, gait and muscle and joint stiffness.

Although the doctor was still in his early 30s, one person in 200
develops the disease under the age of 40, whereas at 65 it is
already affecting 1 per cent of the population. The mean age when
Parkinson's develops is 57, but there is a form of it that can even
involve children or adolescents.

Although the most common initial sign of Parkinson's is the
characteristic slow, pronounced tremor, which is worse when at rest
but disappears during sleep, sometimes the patient first notices
changes in their muscles and joints.

There is rigidity and slowness of movement. If the first muscles to
be involved are those of the face, the eyelids, forehead, tongue and
jaw, as occasionally happens, the facial movements are lost.

My former colleague's face had already acquired the early signs of
the mask-like expression of the disease.

He didn't smile because the muscles with which he should have been
smiling reacted too slowly and inefficiently to give a timely
greeting, or make the appropriate facial gestures when pleased or
amused or that customarily accompany conversation. His withdrawn
silence was a result of muscle rigidity; by the time he had managed
to summon his powers to make a contribution to a conversation it was
too late, the chatter had already moved on.

He had learnt to keep quiet because his muscular rigidity prevented
the right social responses.

Other signs and symptoms of Parkinson's often missed are a gradually
shrinking size of handwriting (this was one feature of the infamous
Hitler diaries that the forger accurately represented).

Other early symptoms that may cause confusion include severe and
persistent constipation, because of the loss of muscle tone and
movement in the gut, and difficulty in swallowing as slow gastric
emptying gives a feeling of fullness and of being satiated while
others are still enjoying their beef Wellington. Another early
symptom is sleeplessness that may precede the muscular signs, and is
often not related to the depressed state that many people with
Parkinson's suffer.

Parkinson's is characterised by the tremor, muscle rigidity, slow
movements and the loss of normal muscular tone and responsiveness
(akinesia), but less common early indications need to be noted as
the sooner treatment starts the better these can be controlled.

September 30, 2006(The Australian Health) -