User:71.3.21.241/sandbox

The Parkinson’s Disease Foundation, or PDF, defines Parkinson’s disease as “a chronic and progressive movement disorder” of which the symptoms worsen over the course of time. A recent study reveals that an estimated one million people in the US today are suffering from Parkinson’s with an additional 60,000 people diagnosed annually, not including the large number of cases that go unreported and undetected. Parkinson’s disease entails “the malfunction and death of vital nerve cells in the brain, called neurons (“PDF”).” These neurons are responsible for producing dopamine, a chemical that sends messages to the brain, which results in coordination and movement. However, as Parkinson’s progresses, an inadequate amount of dopamine is produced, prohibiting the individual from functioning normally. There are references to Parkinson’s Diseases as far back as ancient times. It was referred to as Kampavata (“Kampa” meaning tremor in Sanskrit) in the ancient Indian medical system. It wasn’t until 1817, however, that Parkinson’s Disease was officially discovered by a London Doctor by the name of James Parkinson, hence the name, published a detailed medical essay regarding the disease. The essay, “An Essay on the Shaking Palsy”, established Parkinson’s as a real, recognised medical condition based on Dr. Parkinson’s own six case studies. Six decades later, a French neurologist, Dr. Jean Martin Charcot, began his own work on Parkinson’s disease. Through their extensive studies, they found that there was two stages of the disease- the tremor stage and the rigidity stage. In the 1880’s, William Gowers wrote of his personal experiences with 80 patients in his work, “Manual of Diseases of the Nervous System,” which described the typical joint deformities of the disease. Despite the extensive research regarding Parkinson’s disease, the cause is still unknown. Many experts believe that the cause is a combination of genetic and environmental factors, so the severity of the symptoms can vary from person to person. While genetics are thought to play a part in the acquisition of Parkinson’s, most cases are not directly inherited. In fact, only 15- 25 percent of people suffering from Parkinson’s have a relative with the disease (“PDF”). Further research discovered that people with a “first-degree relative,” a parent or sibling, who suffered from Parkinson’s had a 4-9 percent higher chance of developing the disease, compared to the 1-2 percent of the general population (Mandal). In addition to genetics playing a role in Parkinson’s disease, scientists believe that exposure to an “environmental toxin or injury” (“PDF”) may increase the risk of having it. Several examples of factors that may be linked are: rural living, well water, pesticides, and manganese. While no one exposure to any environmental toxins were enough to cause Parkinson’s, scientists consider it important to continue study these clues in hopes that it will lead to further information. Diagnosis of Parkinson’s disease begins when one or more of the most common motor symptoms of the disease becomes apparent. The four most common motor symptoms are: resting tremor- “consists of a shaking or oscillating movement, and usually appears when a person's muscles are relaxed,” bradykinesia- “describes a general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressivity,” rigidity- “stiffness and inflexibility of the limbs, neck and trunk,” and postural instability- “a tendency to be unstable when standing upright (“Causes”).”Since each individual suffering from Parkinson’s will experience it differently, diagnosing Parkinson’s is very difficult. This often forces doctors to rely on what they call “secondary motor symptoms” to make their diagnosis as accurate as possible. These include: freezing of gait- hesitating before continuing in their movement, micrographia- the shrinking of handwriting as the writing progresses, a mask-like expression, unwanted accelerations- unwanted, quick movements, stooped posture, decreased arm movements, impaired fine motor dexterity, speech problems, difficulty swallowing, sexual dysfunction, and cramping (“Causes”). As a final way of predicting Parkinson’s, doctors may evaluate a person’s nonmotor symptoms. Nonmotor symptoms are: loss of sense of smell, REM behavior disorder, mood swings, low blood pressure, bladder problems, and sudden weight loss or gain. Once a doctor diagnoses a patient with Parkinson’s disease, they then have to determine to what extent the disease has progressed. Since Parkinson’s occurs in everyone differently, it makes sense that the progressional rates vary as well. Some people can live with mild Parkinson’s symptoms for years while some develop severe symptoms much faster. Most commonly, the rating scales are based off of primary motor symptoms. The first, more widely used, scale is called Hoehn and Yahr (“Progression”). This scale rates the person’s symptoms on a scale from one to five: one to two representing early-stage, two to three being mid-stage, and four and five late-stage or advanced Parkinson’s. The other scale is known as the United Parkinson’s Disease Rating Scale, or UPDRS. The UPDRS offers a more specific, tailored progressional scale by evaluating primary motor skills, cognitive abilities, ability to carry out daily skills, and treatment complications. After a doctor or medical professional has rated their patient on one of the two scales, they are then able to determine the severity of Parkinson’s the person is suffering from. The assessment ranges from mild to moderate to advanced. Mild generally entails movement symptoms being described as “inconvenient” and tremors occuring on one side of the body, but the individual is able to function normally on Parkinson’s medication(“Progression”). As the disease progresses, it is considered moderate. This entails movements symptoms regulary occuring on both sides of the body, trouble moving, and “freezing” periods; while Parkinson’s medicine is still helpful to the individual it frequently “wears off” between doses. A step up from that would be advanced Parkinson’s. This entails great difficulty walking, the inability to live alone, and often hallucination and delusions. Luckily, to combat the horridity of Parkinson’s disease, many medications have been developed to treat the symptoms. In order to best treat a patient’s specific needs, often a combination of drugs, taken at different times of day, are used. The five most common prescription medications are: Carbidopa/Levodopa therapy, Dopamine Agonists, Anticholinergics, MAO-B Inhibitors, and COMT Inhibitors (“Medications and Treatments”). To most accurately prescribe the patient the appropriate narcotics, they must take into account: present symptoms, other health issues, and a person’s age, height, and weight. From there the start with a standard dose and tweak the dosage until it fits the patient’s individual, specific needs.

In some special cases, the side effects create more problems than they alleviate. This is when surgical treatments become an option. The two surgical treatments currently available for those suffering from Parkinson’s disease are: deep brain stimulation, or DBS, and a surgery to insert a tube into the small intestine (“Surgical Treatments”). In deep brain stimulation, the surgery implants electrodes into the targeted area of the brain and then an impulse generator under the collarbone or in the abdomen. The impulse generator then provides an electrical impulse to the brain through the implanted electrodes, which is controlled by a controller given to the patient. Though is very effective for those suffering with tremors or spells, it is not effective at slowing down the progression of Parkinson’s and doesn’t function as a cure. The other surgical option is the implantation of a tube into the small intestine, which is responsible for releasing DUOPA. As with any surgery, there is always some risk; as well as the risk carried by both the drug and the device used to administer the drug.