Getting the Facts on Parkinson's Disease

This week we debut Medical Minute, an occasional column providing updates on various medical conditions and research advances.

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Parkinson's disease affects 500,000 to 1 million people in the United States, including U.S. Atty. Gen. Janet Reno and actor Michael J. Fox. Although many people associate the disease with advancing age, Parkinson's can strike early. Fox, for instance, was diagnosed in his 30s. The actor, who grew up on the screen and, to many people, epitomizes the vitality of youth, recently announced he is leaving his TV show "Spin City" to spend more time with his family and promote awareness of Parkinson's. We spoke to Dr. Abraham Lieberman, medical director of the National Parkinson Foundation at the University of Miami, to learn more about Parkinson's.

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Question: What is Parkinson's disease?

Answer: Parkinson's disease is a chronic neurological condition that is slowly progressive and affects a small area of cells in the midbrain known as the substantia nigra. You lose these cells from the time you're born, and if we all lived to 120, we'd all have Parkinson's. But for reasons that are not clear, Parkinson's accelerates this loss, and you lose cells at a more rapid rate, which causes a reduction in a vital chemical known as dopamine that helps control movement.

The disease is named after Dr. James Parkinson, a London physician who first described the syndrome in 1817.

Q: What are the symptoms?

A: The main symptom is a tremor on one side of the body. But 30% of Parkinson sufferers don't exhibit this symptom. There can also be generalized slowness and irregularity of movement. People shuffle, they take tiny steps, they have trouble turning and tend to fall, they're stiff in their arms and legs, they develop a poker-like, mask-like face and their handwriting becomes very tiny.

Q: When should people see a doctor?

A: When the symptoms become worrisome enough. About half the sufferers are aware of their symptoms and see a doctor on their own. For the other half, it's usually a spouse or another family member who says, "Hey, there's something wrong." It's not like cancer, where if you get in there early, it may turn out better. There isn't a cure, and drugs can only treat the symptoms. The standard medicine is sinemit, in which the drug L-Dopa is combined with another medicine that cuts back on side effects such as vomiting and nausea.

There is also another class of drugs that shows promise, although there is controversy over which you should use first. Because of this, you want to go where the doctor is aware of all these arguments, understands it fully and can give you a best opinion of what's current at that moment.

Q: Are there any known risk factors?

A: Men have a slightly higher risk than women and account for 55% of sufferers. We don't know why. It may have something to do with estrogen. Caucasians have a higher risk than blacks. The older you are, the higher the risk. Peak incidence of the disease is age 60, although 15% of Parkinson's appears earlier, such as with Michael J. Fox. Also, 15% of patients have a family member who has it, although whether it's genetic, or the environment they shared when they were younger, no one knows.

Q: What's the prognosis?

A: We have drugs that treat the symptoms, but there's no cure yet. People get worse over a 10- to 20-year span. Twenty years into the disease, most people have significant disabilities due to the disease. But they do well the first five to 15 years.

Q: What is being done in the medical community?

A: There are companies working on ways to arrest the disease and regenerate the nerve cells. Amgen Corp. in Thousand Oaks and the Salk Institute are doing work on regenerating some of the lost cells. The University of Southern California, too. If I was in L.A. and was diagnosed, I'd want to go to a place like USC's Movement Disorder Center that is doing cutting-edge research. There are two types of surgery too. One replaces some of the lost cells with fetal cells. This is controversial. A second type is called deep brain stimulation. It's a type of surgery in which electrodes are implanted in the brain.

For more information, go to http://www.parkinson.org. Lieberman says patients with Parkinson's should also seek a referral to a neurologist.

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