New Delhi: Most patients of Parkinson’s, a neurodegenerative disease that generally affects the elderly, experience tremors at some point in the disease. It can occur in other parts of the body — in a patient’s lower lip, jaw, or legs — but tends to affect the hands.
With their shaking hands often making routine tasks difficult, patients sometimes look for ways to ease their day. For example, patients often use straws and sippers to drink liquids without spilling them.
It’s for this reason that Stan Swamy, the 83-year-old Jharkhand-based Jesuit priest and tribal rights activist under arrest for his alleged role in the Bhima-Koregaon violence, carried a sipper around, and why it became news when he had to wait to get one in jail.
Swamy, a Parkinson’s patient who experiences extreme tremors in his hands, was finally provided a sipper Saturday by the authorities of the Taloja jail, where he is lodged, nearly two months after his arrest.
Speaking to ThePrint, doctors said sippers and similar aides aren’t something all patients use. It is used by patients sometimes because the tremors can get “quite disabling”.
What causes Parkinson’s?
Parkinson’s inhibits patients’ control over their body balance and movements. It was first discovered by James Parkinson, an English apothecary, in early 19th century. In a work titled An Essay on the Shaking Palsy, Parkinson described six individuals bearing the symptoms of the disease.
Dr P.N. Renjen, a senior consultant in the neurology department at Indraprastha Apollo Hospitals, Delhi, said Parkinson’s “is caused by the degeneration of a specific part of the brain”.
“Predominantly, this part produces a neurotransmitter that is called dopamine. So, basically symptoms of Parkinson’s disease (specifically the type known as ‘idiopathic’) is caused by the deficiency of dopamine,” Renjen added.
Neurotransmitters are chemical messengers that transmit messages from a cell of the nervous system to the target cell. The neurotransmitter dopamine plays several important roles, including motor control.
Along with the deficiency of dopamine, those with idiopathic Parkinson’s also have an excessive amount of acetylcholine, a neurotransmitter that plays a role in contracting smooth muscles, dilating blood vessels and slowing the heart rate.
“So the interplay between dopamine and acetylcholine” is what gives rise to “the classical idiopathic Parkinson’s disease”, said Renjen.
The other kinds include Parkinson’s plus, where the disease manifests as a symptom of another underlying degenerative disorder, and drug-induced Parkinson’s, where symptoms of the disease are produced due to certain drugs.
Among the most noteworthy people to have been diagnosed with Parkinson’s are boxing champion Muhammad Ali, singer-songwriter Neil Diamond, actor Robin Williams, and the “the First Lady of Rock” Linda Ronstadt.
Research has shown that Parkinson’s is more common in men than women, but there is no conclusive explanation as to why.
About Parkinson’s tremors
Tremors are among the three “cardinal” motor symptoms of Parkinson’s, the others being stiffness and bradykinesia, or slowness.
A senior AIIMS doctor who didn’t wish to be named said tremors can either manifest as a “rest tremor”, when the muscles are at rest, or an “action tremor”, when the body part is performing some function.
“Typically, this tremor is a rest tremor. When one is at rest and not doing any activity, then this tremor comes up. In many patients, it may also happen during some action, or when during certain postures like when one is trying to hold a pen, a cup or a mobile phone,” she said.
Unlike other symptoms of Parkinson’s, tremors may not respond to the dopamine replacement therapies that are commonly used to treat the disease. “There are these theories that tremors are not only due to dopamine degenerations, they are also a result of (a degeneration in the) other tracts in the brain like the cerebellum to the thalamus.”
These tracts typically oversee the modification of routine motor programs in light of changes to the environment.
A tremor, the doctor added, can be quite disabling. “For that, there maybe things that can help. You get around your daily activities using a sipper cup or spoons with a (special) handle. These are things that individual patients may use sometimes to help them do their activities,” the doctor said.
“Sometimes, in advanced Parkinson’s disease, patients can also get swallowing difficulties. So, if you have difficulty in swallowing from a cup or a glass, then you use a sipper.”
Is there a cure?
Currently, there is no cure for Parkinson’s disease, given that it is caused by the degeneration of nerve cells.
There are, however, a few treatments that can offer short-term relief from symptoms. Among them are therapies where certain medications are administered to increase the dopamine levels in the brain. The gold standard of such treatments involves levodopa, a natural chemical that gets converted into dopamine as it passes into one’s brain.
This is usually administered in combination with carbidopa, a drug that ensures levodopa doesn’t convert into dopamine before reaching the brain.
According to Renjen, the response to dopamine intake is good in the initial stages. But, over time, as the disease progresses, the symptoms either increase or the patients suffer from side-effects of the drugs, he said.
Asked whether any headway has been made in finding a cure, he said, “Basically we don’t know what initiates the process of degeneration. So, you don’t know what the degeneration process is centred around… if it is chemical or environmental, we don’t know.”