Parkinson's Disease

Hi,

I am Dr. Namit Gupta. Aaj hum baat karenge disease of elderly, Parkinson's disease, ye disease ek neurodegenerative disorder hai and mostly elder patient mein paya jata hai, as the patient grows old the incidence increases. Most of the patients jo hote hain wo usually 55 ya 60 years ke above hote hain, rarely hi parkinson ke patient young onset hote hain jinme family history bhi hoti hai. To abhi hum classical parkinson disease ke baare mein baat karte hain. Ye disease ek neurological disorder hai which happens due to neurotransmitter imbalance, specifically dopamine deficiency in substantia nigra and basal ganglia. Most common jo iske symptoms dekhe jaate hain, jo family members notice karte hain wo hota hai ki shareer ke kisi bhi aang mein kampan hona jaise ki haath kampanta rehta hai ya koi bhi ek taang kammpti rehti hai without any stress and all.

To kampan hona ek initial lakshan dekha jaata hai. Iske alawa dusre symptom jo dekhe jaate hain wo hai body slowness, body bohot slow ho jaati hai, stiff ho jaati hai, in fact attendants usually give the history like my dad or my mother has become very slow over a period of last 6 months or a year, bohot slow ho gye hain, bohot dheere chaltein hain, sab kam dheere dheere karte hain. In fact, jo routine activity hoti hai jaise ki bathing, brushing, eating sab kuch slow hota rehta hai and this slowness thinking ko bhi affect karti hai that we call it as bradyphrenia, isme patient ko jyada time lagta hai respond karne mein. Even if they are alert, conscious or understand the thing, but kisi bhi cheez ko respond karne mein they take more time. 

Thinking slow ho jaana, body movement slow ho jaana, haath ya paon mein kampan hona ye sab symptoms parkinson ke dekhe jaate hain and agar timely detect nhi hote hain ya untreated rehte hain to dheere dheere karke ye symptoms badhte hain. Aksar ye symptom shareer ke kisi aang se shuru hote hain wo koi bhi haath ya paair ho sakta hai lekin jaise time badhta hai to isme baaki aang bhi involve ho jaate hain aur patient fir bohot slow hota rehta hai. Apart from kampan or slowness jo dusre associate symptoms dekhe jaate hain jisme patient ka arm swing chala jata hai, they walk like a robot, facial expression decrease ho jaate hain, they smile less frequently, they blink less frequently jise hum kehte hain ki mask-like face ho jaat hai. Iske alawa kuch know motor symptoms hote hain parkinson me like constipation hoan common hota hai, sexual dysfunction common hota hai and excessive sweating aur seborrheic dermatitis ye sab symptoms hote hai parkinson disease ke. Parkinson disease ki hum baat isliye kar rahe hain kyunki it is one of the easily controllable if not treatable disorder as compared to other neurological disorders.

To isko timely diagnose karna important hai because if we diagnose it timely and properly and you give the adequate treatment to quality of life improves dramatically aisa karne se patient ki life next 10-15 years tak bohot achi change ho jati hai. To mostly jo hume parkinson disorder ko diagnose aur eliminate aur baaki ke disorders se differentiate karne ki jarurat padti hai wo hoti hai parkinson plus syndrome and these 2 terms are similar. Idiopathic parkinson disease aur parkinson plus syndrome alag hai, dono ke symptoms milte julte ho sakte hain jo differentiating feature hota hai wo rehta hai ki jo parkinson plus syndrome jyada aggressive hote hain, aggressive means jyada disabiliting hote hain, jabki parkinson disease ke patients usually 5 saal,10 saal, 15 saal bohot aaram se rehte hain, bohot slow progression hota hai lekin parkinson plus syndrome me progression rapid hota hai, the moment parkison plus sets in most of the patients 4-5 saal ke andar wheelchair ya bedbound ho jaate hain, chalna phirna bilkul band ho jaata hai which is very unlikely in parkinson disease, parkinson disease ke patient 10 saal tak usually chalte-firte rehte hain. Parkinson's disease me kampan hoti hai, parkinson plus me usually kampan nhi hoti hai. Parkinson's disease mein shuruaat kisi ek aang se hoti hai lekin parkinson plus ke symptom shareer me dono side symmetrically rehte hain, dono haathon, paaon me ek sath chalu hota hai.

Parkinson patients usually early disease me fall nhi karte hain, isme patients 5-6 saal nhi girte hain you will rarely get a history ki baar baar mere father, mother gir jaate hain lekin parkinson plus me frequent fall ki history jyada hoti hai. Parkinson plus syndrome jo 2 hum commonly dekhte hain Progressive supranuclear palsy (PSP) aur Multiple System Atrophy (MSA), hum in dono ke baare mein baat na karke sirf parkinson ke baare me baat karenge. In recap, parkinson disease usually elderly mein dekhi jaati hai(above 60), 90% to 95 % genetic nhi hote hain they are acquired or idiopathic and without any reason can happen to anyone. Jin logon ko family history hoti hai un logon ko parkinson thoda jaldi chalu hota hai maybe at the age of 30 or 40 years jisko hum young onset parkinson kehte hain. Classical parkinson 60 saal ke upar chalu hota hai usually shareer ke ek aang se shuru hota hai kampan se, body stiffness se, arm swing reduce hona, facial expression kam hona.

 Classical parkinson is diagnosed clinically matlab any good neurologist can diagnose the parkinson as soon as the patient walks into his room, this is the standard dictum in our neurology, but to rule out other disorders we do certain tests including any kind of CT scan, MRI. Usually a CT scan, MRI does not show anything. Kabhi doubt hota hai ki ye parkinson hain ya parkinson plus to hum dusre nuclear scan karte hain like TRODAT scan, jo differentiate karne me help karte hain. Otherwise, parkinson disease is very easy to diagnose and we can use other scans to rule out any other structural pathology. Management is disease ka usually oral medications se start hota hai jise hum kehte hain dopa-agonist like levodopa, carbidopa rehta hai aur specific dopa agonist rehte hain like pramipexole, ropinirole and along with that dusre symptomatic management rehte hain jaise kampan hota hai to we use trihexyphenidyl and other symptomatic management. 

Usually jo dosage hoti hain we use low and slow, it is a standard approach in parkinson because we don’t want to treat parkinson very aggressively in the early stages because it is a long disease jaise age badega patient ke symptoms badhte hain, To you keep the reserve of your drugs and you release it slowly over a period of time. Jaise age badhta hai, jaise disease badhti hai to humko doses modify karne ki jarurat padti hai, dose increase karne ki jarurat padhti hai and majority of patients they do well on medications for at least 10 to 12 years, iske baad me medicine ki kuch efficacy kam hone lagti hai, medicine ke kuch issues aane lagte hain jisko dyskinesia bolte hain to phir hume other approach lene ki jarurat padti hai. Jisme ek approach rehta hai surgical option, deep brain stimulation that helps some patients. Otherwise, there is a new drug in news now apomorphine, but these are the drugs to be used in advanced cases or refractory cases. Reason being, first it is costly the per day costs around 1500 to 2000 and monthly cost is 50,000 to 60,000 jo hum mass apply nahi kar sakte and general public can not afford it and that is the reason ye first line drug bhi nahi hai and it has to use on those cases jisme syndopa, levodopa, carbidopa  aur baaki cheezein kaam nahi kar rahi hain.

So it is easy to treat but the only thing is, from a patient's point of view thoda sa patience rakhna padta hai because drugs almost life-long chalti hai aur isme gume rapid result ki asha ke liye overtreat nahi karna chahiye, we have to treat adequately. The purpose of the treatment is to make patients comfortable and to make his quality of life good and to make him independent of his activities of his daily living. So these are the things jo hume parkinson ke baare mein pta hona chahiye. This disease usually medicines ko bohot accha respond karta hai aur most of the patient me 10 to 12 saal tak koi issues nhi aate like if someone is diagnosed at 60 years to 70 to 75 years tak koi problem nahi aati hain and later stage me we do have options and hopefully if, in the recent time agar koi further research aati hai jo advanced disease me kam karti hai, that thing is always open to patient.

Thank you!