Parkinson’s Disease (PD) – A New Journey Begins

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Listen to their story…..

It started with my hands trembling. It went on for almost a year. Then I started coughing each time I ate. I could feel the gas pushing up the food and I would start coughing until it became very stressful to take my meals.
I consulted a specialist and focused on the cough and the reflux problem. I was put on antibiotics and allergy medicine as well as reflux medicine. But they didn’t help. After a while I decided to go for a full blood test. That was my turning point!
The doctor told me to see a neurologist specialising in Parkinson’s disease because the cough could be related to it. Because of the fear of inconvenience of having to go through an MRI or scan, it took me a while to decide to seek the specialist for help. However, the procedure was so comforting and the examination was simple.
After consulting the PD specialist and taking the medication the doctor prescribed, my life is almost back to normal! I can eat and drink anything. My cough has stopped just after a few days after taking PD medication! I realised how important an early diagnosis is and that Parkinson’s disease is treatable.
Mr A, who suffered from PD

What is PD?
Parkinson’s disease is a neurodegenerative disease, affecting the nerve cells in the brain (substantia nigra) that produces dopamine resulting in dopamine deficiency. Dopamine is a chemical that is needed in order to send messages to part of the brain that controls movements and coordination. When the amount of dopamine produced in the brain decreases, a person will experience difficulty in controlling his or her movements.

, most PD cases develop other symptoms not related to movement (non-motor symptoms), years before the movement symptoms.

Motor symptoms of PD

 

 

 

 

 

 

 

 

 

 

 

 

Non-motor symptoms of PD

What are the symptoms of PD?
PD is generally thought of as a disease that only involves movement such as slowness of movement, tremor and stiffness. However

Is it affecting only older people?
No, PD can also affect younger adults (less than 40 years old) or even teenagers, although it mostly affects older people. The average age of onset is 60 years, and the incidence rises significantly with increasing age.

How to diagnose PD?
PD is diagnosed clinically based on the history and physical examination. The presentation varies among patients. Some patients might come to a doctor because of trembling and some might be presented with “weakness” which is actually attributed to slowness or clumsiness. Some patients might even come in with joint pain due to stiffness. Most of these patients will have non-motor symptoms of PD at this point of time.

Fear of being diagnosed as PD?
PD is a treatable disease. There are various medication available and the option is tailored specifically towards individual patients. The treating doctor will discuss with the patient and come to an agreed plan of management, with the aim of treatment to improve a patient’s function and quality of life.

Do I need a scan of the brain to diagnose PD?
DaT scan; a ‘dopamine transporter (DAT) single photon emission computerised tomography’ (SPECT) imaging can give your doctor more information regarding the cells function and support the diagnosis of Parkinsonism. However, DaT scan is not widely available and it does not confirm the diagnosis of PD. A CT brain or MRI brain scans basically gives your doctor information regarding secondary causes of Parkinsonism.

What is the treatment available for PD?
Generally, the treatment of PD is to restore the dopamine. This is usually done with medications either by oral or patch. Medication will help to relieve or reduce the symptoms of PD. With the progression of PD, some patients might benefit from apomorphine infusion or deep brain stimulation when the symptoms cannot be adequately controlled with oral medications.

Apomorphine Infusion
Apomorphine is a medication used to stimulate dopamine receptor in the treatment of PD. This medication is delivered continuously via injection below the skin (subcutaneous) using a device during waking hours (12-16 hours) in order to provide the brain with uninterrupted stimulation.

Deep Brain Stimulation (DBS)
DBS is a neurosurgical procedure involving the implantation of a medical device called pulse generator, which sends electrical impulses, through implanted electrodes, to specific targets in the brain for the treatment of PD.

What is the support and resources for PD patients?
Fortunately, nobody has to deal with PD all by themselves. It would be beneficial for PD patients to seek help from physician or neurologist with specialist interest in PD. Patients may also seek advice from Malaysian Parkinson’s Disease Association (MPDA).