Reason for Pause

Reason For Pause

One night while watching television he first noticed it. His hand was trembling. He didn't think

too much about it. He hadn't been ill. Other than the usual slowing down a bit for any man of

seventy-four he was generally good health. Gradually; however, over the next few weeks, both

hands had started a shaking he couldn't control. Also, he wasn't sleeping as well, and felt stiff and

awkward in all of his muscles. Finally, it was the spilling of his coffee all over himself, and tripping

over his own feet that sent him to the doctor for some investigation. His family practice doctor

suspected Parkinson's disease.

Parkinson's disease is usually diagnosed by a neurologist who can evaluate symptoms and their

severity for their is no test that can clearly identify the disease. Parkinson's is a disease of the

central nervous system that primarily occurs in older adults and is slightly more common in men

that in women.

Its cause is usually unknown. What is known is that is results from degeneration of nerve cells or

neurons in region of the brain, the cerebellum, that controls voluntary muscle movement and

posture. This degeneration creates a shortage of the brain signaling chemical or neurotransmitter

known as dopamine. In 1817, a London physician named James Parkinson was the first to publish

a description of this disease; however, it probably existed for many thousands of years. Its

symptoms and potential therapies were a part of India's system of medicine as early as 5000 B.C. ,

and in the first Chinese medical text appearing 2500 years ago.

Today, in the United States, about a million are believed to be afflicted, with about 50,000 new

cases having been reported every year. As this disorder usually strikes people in their seventies and

eighties, and the average age of the population increases over the next several decades, these figures

are expected to grow significantly.

Today there are many theories about causes of Parkinson's disease. Until recently the prevailing

theory was held that one or more environmental factors, such as toxins that twist the body's

mechanism for breaking down protein was a cause. Others say that an infection, such as a virus

might alter the body's normal cell mechanisms that would then lead to the accumulation of debris

that clogs brain cells, eventually becoming severely disabling and ultimately deadly to these cells.

Recently, the National Institute of Neurological Disorders and Stroke at the National Institute of

Health reported strong evidence of a particular gene on chromosome 4 that can lead to Parkinson's.

This genetic link is where much research is now being done, not only for Parkinson's disease but

additionally for other common brain disorders such as Alzheimer's disease.

Microscopically, brain structures called Lewy bodies, which can only be seen during an autopsy,

are classically regarded as the hallmark of Parkinson's disease. Otherwise, this disease is

characterized by tremors of a limb, often beginning on only one side of the body; as well as other

common symptoms. People with Parkinson's show reduced facial expression and speak in a soft

voice. There may be other speech impairments as voice changes and difficulty in swallowing. Often,

bradykinesia or slow movement, akinesia, an inability to move, rigid limbs, a shuffling gait, and a

stooped posture are common. Intellectual ability is unchanged until very advanced stages, which

may increase the incidence of depression and personality changes as the frustrations and limitations

of the afflicted person increases.

When symptoms grow severe doctors classically prescribe levadopa (L-dopa), which helps replace

the brain's dopamine. A drug called Selegiline is often prescribed to maintain maximal effectiveness

of the L-dopa. Antis-tremor drugs may be prescribed to reduce muscle rigidity, but they often have

significant side effects including a tolerance level at which time they lose their effectiveness. In some

patients a kind of brain surgery known as thalamotomy has reportedly been effective in reducing

tremors. Another type of brain surgery involving