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

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

3. 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

4. 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)

5. 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.

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

7. 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”

8. 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

9. 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

10. 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’.

11. 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.

12. 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 “

13. 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

14. 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.

15. 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.

16. 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.

17. References http://www.3dchem.com/molecules.asp?ID=289
Parkinson’s Disease – Roger C. Duvoisin, M.D

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

19. Any questions ?