Early Consultation with a Neurologist can go a Long Way in Mitigating The Effects of Parkinson’s Disease

Mr Ramesh Bhatia (Name Changed), a 54-year-old senior corporate professional, led a very active life and often reflected on his achievements with quiet satisfaction. Happiness also stemmed from the fact that he had struck a perfect work-life balance. He shared his passion for wildlife photography and an outdoor lifestyle with his wife.

Then, two years back, his life changed forever. He noticed he was a little clumsy as he was taking his wallet out of his pocket. He didn’t pay much attention to this, thinking of it as ‘one of those things which happen’. Over the next month, he noticed that the diminished dexterity in his right hand not only persisted but was more pronounced. He also developed an unfamiliar pain and stiffness in the right shoulder and noticed that he was taking longer than usual to shave, wear his clothes and get ready for work. Over time he also seemed to have developed a tremor in his right hand that he tried to conceal by keeping the hand in his pocket when interacting with colleagues.

Work-life balance took a hit. He became less interested in routine things such as going out to restaurants. He could not appreciate the flavours of different cuisines that he loved so much earlier. A general sense of fatigue was overpowering him. His wife began to wonder if he was depressed.

One day, his wife noticed that his gait had become a little peculiar. He was walking with short steps and not swinging his right hand. When asked by his wife, Mr Bhatia shared the other symptoms with her. Collectively, they decided to consult a neurologist.

The Neurologist heard all the Parkinson’s disease symptoms Mr Bhatia had to share and after a thorough examination, suggested that he might be having early Parkinson’s disease. While there are no conclusive tests, the doctor said that the combination of his symptoms and findings on physical examination made the diagnosis very likely and that he would order a few investigations that would make the diagnosis more secure.

He explained that Parkinson’s disease is a chronic neurological illness caused by damage to brain cells that produce a chemical messenger called dopamine. 

While it seemed the world had fallen apart when the doctor uttered those words, Mr Bhatia soon came to terms with it. On the advice of his doctor, he started taking the prescribed medications along with a regimen of exercise and also modified his lifestyle. He could feel himself slowly regaining his energy and also a zest for leading a full and active life again.

Mr Bhatia is not alone. While Parkinson’s disease is more common in those who are above 50 years of age, it can also sometimes affect younger persons. It may also be inherited sometimes. Typically people with Parkinson’s disease experience tremor, slowness of movements, limb rigidity, along with gait and balance problems. These are called motor symptoms. Patients may also have several non-motor symptoms such as mood disorders, difficulty in planning and organizing, sleep difficulty, constipation, lack of ability to smell, and sexual dysfunction. The severity of symptoms and pace of progression of symptoms often varies from one person to another.

Treatment of Parkinson’s disease includes a combination of medications, some designed to replenish the amount of dopamine in the brain and others to arrest the progression of the disease are often prescribed. They are very effective in the early stages but the neurologist may adjust the doses and introduce new drugs as the disease progresses. If the medications become less effective over time or if side-effects become bothersome, advanced approaches to management such as deep brain stimulation (DBS) and surgery are considered. With DBS, electrodes are surgically implanted in the brain. They send electrical impulses to stimulate the parts of the brain that control movement. Evidence suggests that patients with Parkinson’s disease also benefit from a multidisciplinary approach to care. 

Parkinson’s disease can be managed with proper attention and medical consultation. Mr Bhatia is a case in point and it is proved that early consultation and close interaction with a neurologist thereafter can go a long way in mitigating the effects of Parkinson’s disease. By knowing the nature of the disease and the various effective ways of managing it, patients with Parkinson’s disease can pursue their work, hobbies, and go on to lead a life full of joy. 

 

Dr. (Lt Gen) CS Narayanan

HOD, Department of Neurology

Manipal Hospitals, Dwarka

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