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Parkinson’s Disease

Dr. K. Y. Iyer

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Cause:
There are many theories about the cause of Parkinson’s disease. Until recently, the prevailing theory held that one or more environmental factors caused the disease. Some people have an inherited susceptibility to the disease that may be influenced by environmental factors. Strong familial inheritance of the chromosome - 4 gene is the first evidence that a gene alteration alone may lead to Parkinson’s disease in some people.

As we age, particularly into our later years, apana vayu accumulates (sanchaya) and may become aggravated (prakopa). This leads to the constipation so commonly seen in the elderly. When this is combined with a vata increasing lifestyle and constitutional tendencies, the stage is set for vata to overflow (prasara) into circulation. Overflow causes vyana vayu to become disturbed within the rasa dhatu. Systemic signs of vata disturbance occur, such as dryness of the membranes of the body. Vata may relocate (sthana samsraya) to any dhatus that are weak. When a preexisting weakness resides in the tissue of the brain, this becomes the site of relocation and thus we have a condition of vata (prana, samana and vyana) in the majja dhatu, damaging portions of the brain stem and causing altered coordination and tremors. Additional components of the pathology which are commonly present include vata (vyana) entering mamsa dhatu causing muscle rigidty and prana kshaya (diminished prana) in the manovaha srota causing dpression.

In addition, kapha appears to be diminished in the majja dhatu in these patients. An increase in vata dries out kapha (cellular structure) in the susceptible region of the majj dhatu (brain stem). This creates an open space inviting vata to become vitiated. While the condition has a predominantly vata pathology, pitta can also play an important role in the samprapti (pathology) as its heat can burn out the celluar structure causing kapha kshaya (diminished kapha) in the majja dhatu, creating the original weakness in the brain stem. Hence personalities based in fear (vata) and intensity (pitta) are most predisposed to this condition and those of kapha nature are the most naturally protected.

Medical Pathology
Medical research has determined the cause of the condition to be a loss of function of specialized cells in the brain stem which stimulate the production of the neurotransmitter, dopamine. The cause of the functional disturbance is not known. It is known that Parkinson’s disease can occur secondarily to several known causes including the ingestion of anti-psychotic drugs such as reserpine. (Reserpine is a plant alkaloid derivative of the Indian herb Sarpagandha or Rauwolfia Serpentina.

These drugs block the action of dopamine on the brain even though normal levels are present. In addition, carbon monoxide and maganese poisoning can instigate the condition as well as other brain tissue abnormalities such as tumors and infarcts. Finally, drug abusers injecting N-MPTP or Meperidine (1-menthyl-4-phenyl-1,2,5,6-tetra hydropyridine (1,3,7).), can cause a form of the disease which has a sudden onset and is irreversible.

Signs and Symptoms
The first symptom of Parkinson’s disease is tremor (trembling or shaking) of a limb, especially when the body is at rest. Tremor often begins on one side of the body, frequently in one hand. Other symptoms include slow movement (bradykinesia), an inability to move (akinesia), rigid limbs, a shuffling gait, and a stooped posture. People with Parkinson’s disease often show reduced facial expressions and speak in a soft voice. The disease also causes depression, personality changes, dementia, sleep disturbances, speech impairments, or sexual difficulties. Severity of Parkinson’s symptoms tends to worsen over time.

The most common recognizable symptom of Parkinson’s disease is known as a “pill rolling tremor.” In this condition, the thumb and fingers move uncontrollably in a manner resembling the rolling of a pill between the fingers. Tremors most commonly appear in the hands, arms and legs, though other areas may be affected.

Small movements of the hands and fingers may eventually be difficult. This condition called micrographia, can make ordinary daily activities such as buttoning a shirt very difficult.

Another symptom is stambha (rigidity), in which movement becomes slow and difficult to initiate. Patients usually have to look at their feet to begin, shuffle forward to and occasionally, inadvertently break into a trot (festination). The arms do not swing in coordination with the usual stride. The face may appear without expression (mask face), dull or depressed, though no depression may be present. Reduced blinking is an early symptom. The voice becomes monotone and expressionless, further causing some to mistake this as depression. Fifty percent of patients will develop dementia- (1)Vishada (depression), can accompany the disease but the symptoms of mask face and monotone voice occur as a part of Parkinson’s disease and should not be confused with depression.

Upon examination, passive movements of the limbs, produces what is commonly called, “cogwheel rigidity.” This is an unconscious resistance to passive motion causing the limb to move with irregular starts and stops or a ratchet type motion. Sensory examination and reflexes are usually normal. Other signs of autonomic nervous system dysfunction may or may not be present, including orthostatic hypotension, constipation and urinary hesitancy.

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