Parkinson’s Disease Busra Berika Yucel Columbia University Medical Center / Neurological Institute

History of Parkinson’s Disease Parkinson’s disease was first described by James Parkinson in his Essay on the Shaking Palsy in 1817. James Parkinson was a physician and surgeon practicing in London. In his words, “shaking palsy”, which we call Parkinson’s now, was described as:

Shaking Palsy “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to running pace; the senses and intellect being injured.” James Parkinson

Symptoms By looking at his article; we can clearly say that the main symptoms of the disease are: - Tremor - Stiffness (rigidity) - Bradykinesia (slowness of bodily movement)

Tremor It is the symptom which usually first comes to patient’s attention. Typically, tremor occurs when the affected hand or foot is at rest. It disappears during sleep or when the patient is resting quietly. Nervousness and being ‘under stress’ enhances the tremor.

Bradykinesia Muscular rigidity slows movement. Loss of automatic movements: - swinging arms while walking - eye blinking - expressive movements of the face and hands

Stiffness (rigidity) There is often a regular, jerky quality to the resistance as if there was a ratchet gear or cogged wheel in the joint being manipulated. Physicians call this as “cogwheel rigidity”

Symptoms (cont.) Other symptoms of disease include: - tendency to stand in a stooped posture - walking with short, shuffling steps - change in tone - decrease in facial expressions - memory problems

Other signs While they are writing, their writing goes upwards instead of straight. Lose their face expression Decreased tone while talking They have difficulty with swallowing. Their food might accidentally go to trachea Personality changes There is difficulty with turning in bed There is drooling – day & night Stoop position, not swinging arms while walking While driving, they might make a big swipe turn to left, and small turn to right (which may cause an accident) Eyes – may stare at one point

Cause There is not a clear answer for the cause of the disease, but it’s known to be related to a chemical substance called ‘dopamine’.

Dopamine Dopamine is a chemical naturally produced in the body. In the brain, dopamine functions as a neurotransmitter, activating dopamine receptors. Since dopamine cannot cross the blood-brain barrier, dopamine given as a drug does not directly affect the central nervous system. Shortage of dopamine, particularly the death of dopamine neurons in the nigrostriatal pathway, causes Parkinson's disease, in which a person loses the ability to execute smooth, controlled movements.

Michael J. Fox Michael J. Fox was diagnosed with Parkinson’s in 1991, when he was 30. He has the biggest foundation of Parkinson’s disease research, which is “Michael J. Fox Foundation for Parkinson's Research “

Muhammad Ali He had signs of decreasing motor skills during a fight against Larry Holmes in 1980. It was noted that his illness was probably brought on by repetitive head trauma. There is a Muhammad Ali Parkinson Research Center at Barrow Neurological Institute

Treatments Surgery: Surgery may be used to control symptoms of Parkinson's disease and improve the quality of life when medication ceases to be effective or when medication side effects, such as jerking and dyskinesias, become intolerable. Only about 10% of Parkinson's patients are estimated to be suitable candidates for surgery.

Treatments (cont.) Medication: Medication could also be used as a treatment of Parkinson’s Disease. The main medicine to treat Parkinson’s is Sinemet. Sinemet is a combination of Carbidopa and Levadopa. (Levodopa is a prodrug that is converted to dopamine by DOPA decarboxylase and can cross the blood-brain barrier) But there are some side effects of Sinemet: it might have reactions with proteins, such as milk and milk products; might lead to some involuntary activities when it is not used in the right dose; and it also causes tendency to sleep.

Current Research about Parkinson’s Disease There is a research being done about stem cell therapy, where you inject dopamine to stem cells. Since stem cells are part of the nervous system, it is suppose to effect directly to brain. Doing exercise is also being research; it seems, it helps Parkinson’s patients to lose some of their symptoms.

References http://www.3dchem.com/molecules.asp?ID=289 Parkinson’s Disease – Roger C. Duvoisin, M.D www.parkinson.org http://menshealth.about.com/od/diseases/f/parkinson_nine.htm http://neurologicalillness.suite101.com/article.cfm/muhammad_alis_fight http://www.maprc.com http://www.neurologychannel.com/parkinsonsdisease/surgery.shtml http://www.3dchem.com/molecules.asp?ID=289

Acknowledgements Dr. Karen Bell Dr. Lucien Cote CUMC HCS staff Dr. Sat Audience

Any questions ?