Diagnosis and treatment for a progressive disease
Any discussion about Parkinson’s disease should begin with the good news first. While there is no cure for the degenerative disease at the present time, the prognosis is not necessarily grim. Patients on Cape Cod can be assured they have access to the latest testing and treatment available, according to Hyannis neurologist Ahmad Abokhamis, MD.
“The progression varies widely among patients,” he said. “We still see bad cases, but on the other hand we also see very slow cases. We can follow people even for a decade or longer and they still haven’t progressed badly and they are fully functional. So, patients should not compare themselves to the worst cases that they see.”
This is especially true for people who are diagnosed in their 70s or 80s, said Dr. Abokhamis, who practices at Neurologists of Cape Cod on North Street, because it is not considered a terminal illness. Someone who is first diagnosed at an advanced age is much more likely to die of something other than Parkinson’s disease.
Parkinson’s disease typically starts with a tremor, according to Dr. Abokhamis. The tremor is most noticeable when the person is at rest and it disappears when the patient tries to move or thinks of moving. For instance, if the tremor is in the right hand, it will go away when the patient is trying to do activities with that hand or even thinks of performing activities like writing.
”Patients literally tell me I feel like I can control the tremor,” he said.
The tremor is so subtle at first that the patient might not even notice it. Often it is family members or people around the patient who first notice something is going on.
While the diagnosis is mainly clinical, a nuclear brain imaging test, known as DaTscan, is available at Cape Cod Hospital, Dr. Abokhamis said. The scan measures the presynaptic dopamine activity in the brain and has a high sensitivity and specificity in making the diagnosis earlier.
Treatments and Progression
The treatment for Parkinson’s disease is designed to address symptoms. Doctors use medications to cover up the symptoms to a certain degree, but the drugs do not slow the progression of the disease.The longer a person has Parkinson’s, the more medication they need.
“Parkinson’s disease is a progressive disease that results from the deterioration of the cells in the brain that produce a chemical called dopamine,” Dr. Abokhamis said. “The treatment is mainly medications that can enhance the dopamine activity or, in other words, replace the dopamine.”
Physical therapy also helps, as do activities like dancing and non-contact boxing with a punching bag.
Classic Parkinson’s disease tends to strike people when they are older, Dr. Abokhamis said. It has a much better prognosis, better response to medication and a slower progression than the less common Parkinsonian syndromes. People with the rarer forms often do not respond as well to treatment and progress more quickly. Eventually, all patients will worsen over time and need more medication for the same relief.
“The tremor for the most part is the presenting symptom, but it’s not the worst symptom,” Dr. Abokhamis said. “The worst symptom is basically stiffening and slower body control, so people tend to shuffle when walking.”
More concentration is needed to initiate the steps, they are slower to change direction, and they tend to fall, he added. Classically, Parkinson’s patients have a stooped posture when they stand up, and they have a shuffling gait. Their voice becomes hypophonic, or softer. In the advance stages basically people suffer from almost near complete body freezing as soon as the medication wears off, so they require the medication Carbidopa/Levodopa much more frequently, he said
There is hope for the future. Recent studies on animals focused on injecting stem cells into the substantia nigra area of the brain with positive results. It’s too soon to know if such therapies would translate to human trials, according to Dr. Abokhamis, but he and his colleagues at Neurologists at Cape Cod are monitoring it closely.