Dr Irengbam Mohendra Singh
Science has useless bits of information most people never really need to know. Richard Feynman, Nobel Prize-winning American physicist, an “avowed atheist”, once said: “Science is the belief in the ignorance of experts.” Parkinson’s disease (PD) or Parkinson’s is such a bit of diseasethat Manipurisdidn’t really need to know. Not anymore. Manipuris are living longer. Parkinson’s is age-related.I knew only someone in Imphal, who I admired from my childhood, havedeveloped this disease in his ripe old age.
There is no cure for PD. Current treatments are focussed on reliving symptoms to improve the patient’s quality of life.Current drugs are helpful only in reducing stiffness and tremor. Rarely do they have side effects, and stopping the drugs, only returned them to pre-treatment conditions. Alternative drugs have the same problems.
When I was studying in Edinburgh in 1967-68, they showed a brain surgery on a patient with Parkinson’s at Edinburgh Royal Infirmary. I think it was called stereotactic brain surgery. The patient on the operating table was aware of what was going on. When the surgeon dissected the right area of his brain, the patient’s hand tremor suddenly stopped. That was all the benefit.
More recently, DBS (deep brain stimulation) or non-destructive surgical treatment for Parkinson’s disease has been attempted. This involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator. It blocks nerve signals that cause PD. It does not cure the disease, but significantly improves symptoms especially rigidity and tremor.
Now, the long-awaited cure of PDis expected to come in the next 5-6 years. It isthus important to be aware of this disease by the lay public in Manipur and not just consign it to senile dementia(SD)or known in Manipuri, ahaloibageesono-phono touba and in Hindi, vrddhaavavasthakamanobhransh. Both are long-winded words.
Parkinson’s isvery rare all over India though it is one of the most common neurodegenerative diseases after Alzheimer’s (similar to senile dementia) in the West. It’s a progressive damage to the nerve cells of our body due to an unknown cause. It’s quite common in the West and sometimes associated with SD.It’s uncommon before the age of 60. However, an English doctor colleague of mine, developed Parkinson’s when he was 53. After 3 years he had to retire. After 10 years he is now wheel-chair-bound for outdoor mobility.
I never saw a patient with PD in India. Even in my long practice in the UK, I’ve treated about 4 patients including a Pakistani. In India recently, someneurologists claimed that ‘due to lack of awareness and understanding, neurological disorders like Parkinson’s, are often subject to various taboos, which heavily impact the lives of patients, hindering the treatment and in some cases even aggravating the problem’.
Parkinson’sis most noticeable by the shakes of fingers that are often confused with ‘senile tremor’ (even for doctors in its early phase). It’s associated withclumsiness in walking and often speaking some unintelligible words, which would let relatives think to be the beginning of senile dementia.There are no positive blood tests, or brain scan to make a definitive diagnosis as it can in Alzheimer’s disease.
Surfing the net, there is a record of only 458 people ‘related to PD’ (not frank PD) in 2002-2011in India. There is no record for Manipur that I can find. Symptoms of Parkinson’s include tremors of hands (resembling like someone’s thumb and fingers rolling a pill, unlike fine finger tremors in senile dementia), muscle stiffness all over, and balance problems that make them walk in a shuffling gait as they feel they are about to fall forward because of a forward shift in body gravity. Their face is expression-less, masklike.They have problems with sleep andmemory. Speech that may be slurred or soft, is difficult for people to understand. They have difficulty finding the right word and cannot participate in a conversation. PD does not directly cause death but it makes the body vulnerable to complications because of difficulty in swallowing, and susceptibility to various infections.They may also experience loss of smell, mental problems, digestive problems, and low blood pressure. When associated with high blood pressure, it’s difficult to treat.
The disease is named after an English surgeon James Parkinson. Who was born and brought up in London’s East End. East End is London’s most notorious slum with tough guys and historic Roman walls, towards the Tower of London, where Crown Jewels are stored and where English kings and queens were beheaded. It’s the poorest part of London, previously with Jewish immigrants and now with a concentration of Bangladeshi immigrants.Parkinson established PD as a recognised medical condition and called it ‘shaking palsy’. He was born on April 11 1755. And so, April 11 is now ‘World’s Parkinson Day’.
PD is due to decay of nerve cells in the brain that die off overtime, leading to a loss of the chemical dopamine, which is vital for controlling muscle movements and lack of which causes slowness of motion, tremor of fingers and body stiffness. It progresses relentlessly and leads to severe disability. They experience hallucinations or delusions (20-50%) that cause problems. A hallucination is when you see, hear or feel things that aren’t there. Delusions are unusual thoughts, beliefs or worries that aren’t based on reality. In the later stages, they develop dementia, depression, sleep disorders and impaired vision. In late September 2018, an article in The Lancet,quoted that patients with PD worldwide, had reached 6.1 million in 2016, almost two and a half times the 1990 figure of 2.5 million. In the UK, PD affects one in 350 people, but they predict, by 2025, the number will have increased by around 18% to more than 168,000. According to Charity Parkinson’s UK, this figure is almost set to double within 50 years, as population ages and improvements in medical advances mean more people survive other diseases, such as cancer and heart diseases.
Renewed public interest in finding a cure only began in the UK from charities, after a well-known English actor Michael J Fox, who was just 29 whendiagnosed with early onset of Parkinson’s in 1991. Research charities received around £40 million in donations last year, a well-known British habit.
Until then, the focus of investment was on other serious conditions, such as dementia and cancer. Scientists are optimistic that at least, current researches could hold the key to understanding what triggers the disease and its treatment.Several clinical trials exploring potential treatments was launched late this year (1918). Dr David Dexter, deputy director of Research at Parkinson’s says: “it’s a positive time for research because we can see so much of jigsaw coming together.” Dr Dexter continues: “The research world is positive about the potential of new therapies. Thirty years ago, we knew which cells died in Parkinson’s, but we had no idea why. Now we have got to the point where we know so much more about the mechanisms, how they work, how they interact with each other. The exciting thing is that now we’re actually developing the drugs to stop these mechanisms. Within the next five years or so, we should know which ones are the key drivers in the disease.”
Dr Simon Scott, deputy director of research at the ‘CureParkinson’s Trust’, explains: “In order to find a cure for the disease, scientists must discover how to stop its progression, rejuvenate any remaining brain cells and replace those which have died.” He adds: “The bad news is that we don’t have any one single treatment on the horizon that will do all three things. But the most exciting part of Parkinson’s research at the moment is that we have clinical trials ongoing for different techniques dealing with each of these three components.”
Dr Scott believes a cure may be found using a combination of treatments for the three targets. When it comes to stopping the disease, scientists are focused on halting the spread of a ‘rogue’ protein called alpha-synuclein. At least six trials in patients are underway worldwide to explore whether anti-protein vaccines could help, including some funded by the Michael Fox Foundation. The area of research which has caused the most excitement is ‘Cell Replacement Therapy’ (CRT), where dopamine cells grown from stem cells are transplanted into the brain. The treatment should help relieve the physical symptoms of Parkinson’s. Human trial of CRT have been launched in the last few months of 1918 in Japan, the US and Australia, while a European trial co-led by Cambridge University and Lund University, in Sweden, is expected to start in 2019.
Prof Roger Barker, Consultant neurologist, who is leading the European project says: “The idea behind cell replacement therapies is to literally transplant the cell into the brain to replace those which have been lost. If dopamine-based therapies work in the way we expect, they would be standard therapy in the next five to 10 years’ time. Though it’s not a cure, it would transform the treatment of Parkinson’s.”Dr Baker warns: “though If the trials do not work, they will still further our understanding. But if they do… it’s Christmas Day.”
The writer is based in the UK. Email: firstname.lastname@example.org, Website:www.drimsingh.co.uk
Dr Irengbam Mohendra Singh