Professor Sola Ogunniyi, a neurologist says that when an individual is slowing down with age and experiencing shaky hands and with an unclear voice, such should be suspected to be Parkinson’s disease. SADE OGUNTOLA reports.
W HAT is Parkinson’s disease?
It is simply described as shaking palsy; it is a condition characterized by tremulousness of the body, stiffness of the body, slowness in walking and in doing things. It is common in old age.
Its first usual symptom is a tremor at rest, even when the person is sitting down, you would still notice that the hands would be shaking. This might progress to include the lips and the legs shaking. Subsequently, the whole body will also be tremulous. Also, you notice that the person is bent forward and slow when walking.
And as they are walking, they seem to be running because they are tilted forward; what is called a shuffling gait and there is loss of arm swinging, so the arms are held by the side. As a result, they have the tendency to fall and sometimes they have a slowing of their mental faculty so that it can also be accompanied by dementia.
Are there tests to help detect Parkinson’s disease early?
The diagnosis of Parkinson’s disease is purely clinical. So, once you see somebody who is slowing down with age, whose voice is not too clear and who experiences shaking of the hands, then you must think about Parkinson’s disease. There are sophisticated tests that can be done to detect changes in the brain due to the disease. The problem is due to a reduction in the quantity of a chemical in the brain called dopamine. The disease manifest when there is less than 80 per cent of the normal dopamine content in the brain.
How common is Parkinson’s disease in Nigeria?
It is regarded as the second most common neurodegenerative disease that affects individuals as they get older, second after Alzheimer’s Disease, which is dementia. Because people are getting older now, the number of cases is increasing. But, compared with Western World, the cases are still fewer.
Essentially, what is not known about Parkinson’s disease in Nigeria is similar to what is known elsewhere. But it’s not everybody that has shaking of the hand or of the body that has Parkinson’s disease. There are other things that can mimic that. For instance, in individuals with essential tremors, there is only the tremor in the hands, it is not accompanied by other things like the stiffness of the body, the tendency to run when walking and also the arm swings that go with Parkinson’s disease.
Also, some diseases that affect the cerebellum, another part of the brain that controls coordination may also cause shaking or tremors in the hands only the hand is used in carrying out an activity. That’s when the shaking is obvious, but at rest, they don’t have it. But when you have shaking at rest, think of Parkinson’s disease, especially in elderly people.
What are some of the things studies tell about Parkinson’s disease in Nigerians?
Well, there are a few things that are common. Parkinson’s disease affects both individuals in rural and urban areas. It has been described in all regions of Nigeria. In one study that we carried out many years ago, it appeared to be common among welders. We couldn’t figure out why that was so. But it’s something that we found. These have not been proven with other occupations, but it’s something worth noting. Some of the people who have Parkinson’s disease may have other members of the family who suffer from the same condition. So, it could be familiar, but the proportion is very small.
I’ve seen a few patients who had Parkinson’s disease following trauma to the head. I’ve seen one or two boxers that ended up with Parkinson’s disease. Mohammed Ali, the famous boxer, had Parkinson’s disease and it was due to frequent punches that hit his head that lead to damage to the part of the brain that controls this condition.
Are there diseases that Parkinson’s disease on its own predisposes individuals later to or diseases that predispose to Parkinson disease?
Infections of the brain can result in Parkinson’s disease. Some who suffer from von economo virus infection a century ago ended up with Parkinson’s disease. Similarly, diseases of the brain like stroke when it involves that part of the brain can also result in Parkinson’s disease. They say smoking is not associated with Parkinson’s disease; we are not sure, but it’s something to also think about.
Are there diets? I’m not sure of any that can predispose individuals to develop Parkinson’s disease or protective of individuals from Parkinson’s’ disease. But any disease of the brain, especially with old age, can result in some clinical manifestations that may mimic Parkinson’s disease so one should think about it in general.
Can it be cured?
It can be cured in some ways because it is due to a deficiency of dopamine. So if the loss of dopamine in the brain is replaced, it might be possible to overcome the disease. When we give people dopamine replacement therapy, it controls the symptoms but it doesn’t cure the disease.
Experimental treatments, including brain surgery, transplantation of chemicals into the brain and stem cell treatment had been tried to cure Parkinson’s disease, but, again, results have been quite disappointing.
So what we do is to control the symptoms and reduce neurodegeneration in the brain with drugs. In some ways, this seems to help individuals to control the symptoms, including ensuring a reduction in the tremor. But with time, the drugs tend to lose their effectiveness and require that the dosage be increased.
The drugs work for some time and then they appear non-effective for some time, an on-and-off effect. The longer you use medications, the more you experience some of these side effects, including the on and off effects. So somebody who has this condition needs to see a specialist in neurology for appropriate treatment and follow up.
How does Parkinson’s disease contribute to an individual’s Disability Adjusted Life Year (DALY)?
It’s a major contributor to disability in old age but it is not the number one. There are many other things that contribute to an increase in an individual’s Disability Adjusted Life Year, including depression, stroke and epilepsy.
Are there support groups for people with this condition in Nigeria?
At the moment, I’m not aware of any support group for persons with Parkinson’s disease, but I know that in Lagos, some of my colleagues have put together a cohort of patients who have Parkinson’s disease so that they can assist them to function together. But there is no collective group for Parkinson’s disease that is established and has government support at the moment in Nigeria.
A support group brings individuals who suffer from the same disease together as well as their care providers so that they can think about their various challenges and collectively resolve them together. They can also form a united force for advocacy with the government and for NGOs to assist them for funding so that they can then get better. They can also assist them to get needed medications for their care.
What can families and society do to ensure that individuals with Parkinson’s disease can function properly in society?
They need to support the individuals with the disease. First, they need to know about the disease. They need to provide money for drugs and ensure that individuals with Parkinson’s disease do not hurt themselves in any way. They may be prone to falling down and sustaining injuries, and so they are not to be left alone or neglected or allowed to do things beyond their capability.
They must bring them to the hospital for medical check-ups, when necessary, and look out for other conditions that might make their plight worse. Fever, for instance, may make their condition worse. Any illness can make a chronic condition worse.
A lot of these diseases come together and add to problems in old age. So it may not be unusual for a person who has Parkinson’s disease to also have hypertension or diabetes. And peradventure they have complications of hypertension like stroke that will worsen their Parkinson’s disease. That will also worsen their ability to reason, which we call dementia. So, no aspect of their health should be neglected. Early discovery and treatment, prevent a disease from becoming chronic.
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