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Much is still unknown about Parkinson's disease

Mikael Häggström

While Michael J. Fox may best be known for his acting, many know him as one of the leading figures in taking away the stigma against Parkinson’s disease. Fox, along with former U.S. Attorney General Janet Reno, boxer Muhammad Ali and singer Linda Ronstadt have all been open and frank about their diagnosis of the disease. But as more and more of the public are aware of the disease though, there is still much that is unknown about Parkinson’s disease.

This week on Take Care, Dr. Kelvin Chou discusses the uncertainties involved with Parkinson’s disease, as well as cutting edge ways to treat it. Dr. Chou is associate professor of neurology and neurosurgery at the University of Michigan Medical School, and is one of the country’s leading authorities on Parkinson’s disease. He has recently published a book for patients and families called Deep Brain Stimulation: A New Life for People with Parkinson’s, Dystonia and Essential Tremor.

Click 'Read More' to hear our interview with Dr. Chou.

According to Dr. Chou, Parkinson’s disease is a neurodegenerative disorder that is characterized by tremor, slowed movements and rigidity. The combination of these symptoms can cause things such as walking difficulties, handwriting issues, and problems in everyday fine motor skills such as dressing, cutting food and combing hair.

The symptoms of Parkinson’s disease take a long period of time to fully appear and are often mistaken as common changes people go under as they age. “Someone may notice a very mild tremor at first, and then over the next year or two it becomes a little more severe, and then over the next few years, it spreads to the other side of the body,” says Dr. Chou.

Because of its slow development, diagnosing Parkinson’s disease can be difficult. “We don’t really have a test that allows us to tell you whether you have Parkinson’s. We also don’t have a test that rules out Parkinson’s for sure,” says Dr. Chou.

History is the key to a Parkinson’s diagnosis, meaning not only do the number and types of symptoms matter, but how long those symptoms have been present is important as well.

“In the hands of even an experienced neurologist, it can be difficult to tell, especially when someone doesn’t really have tremor and they’re just really slow,” he says. “You have to make the judgment, if they’re slow enough, where you think Parkinson’s disease might be possible. Or, are these symptoms just explainable by someone getting a little bit older with a little bit of arthritis?”

There is also no medication or treatment plan that can slow the progression of Parkinson’s disease, so treatment often focuses on “calming the symptoms,” says Dr. Chou.

Credit Jean-Martin Charcot
Example of writing by a patient with Parkinson's disease; possibly showing micrographia in addition to other abnormal characteristics.

One cutting edge treatment in particular that Dr. Chou has been researching is called deep brain stimulation (DBS), which can be compared to using a pacemaker for the brain. DBS involves surgically placing an electrode into the part of the brain that controls movements in the body. Wires are then tunneled under the skin and connected to a battery in the chest where a pacemaker would normally sit

“When you turn on the stimulation, it actually helps the symptoms of Parkinson’s disease. It can help tremor, it can help improve slowness, it can help improve stiffness,” says Dr. Chou.

Just like other forms of Parkinson’s disease treatment, DBS does not slow the progression of the disease. The results of DBS though, according to Dr. Chou, have been very positive.

“People who have had it will say that it feels like the clock has been turned back a few years, ‘I feel like I was four or five years ago instead of the way I am now.’ And so it can actually help symptoms for longer periods of time.”