PV Rai MD FANP
Consultant Neurophysician and Epileptologist Nord 28, 9428 Walzenhausen, Switzerland
Formerly Medical Chief Polyclinic Swiss Epilepsy Centre, Zürich, Switzerland
7Preface
Jitendar P Vij
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Step by Step® Treatment of Parkinson Disease
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
9789380704876
Typeset at JPBMP typesetting unit
Printed at Ajanta
To
A long time friend, a great psychiatrist and philosopher
Prof Dr Christian Scharfetter Professor Emeritus
Psychiatric University Hospital Zürich, Switzerland
6Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects being uninjured.
James Parkinson, 1817
Almost two centuries after the original description of cardinal symptoms by James Parkinson, the idiopathic Parkinson disease remains even today a challenging problem in the clinical neurology. The neurology, however, as a specialized discipline has made great advances over the last 6–7 decades, not only in the field of diagnosis but also in the treatment of chronic and intractable diseases. Several major neurological diseases such as multiple sclerosis, epilepsy, myasthenia gravis and giant cell artheritis can be treated with specific drugs and corticosteroids, thus reducing the suffering of patients. The idiopathic Parkinson disease can be treated to a considerable extent through such drugs as Levodopa, Dopamine-receptor agonists and other drugs. A series of factors which are responsible for the neuronal degeneration and cell death in the region of basal ganglia have been identified. Because of this, a fund of knowledge is available from the basic brain research regarding the pathophysiology of basal ganglia. As in the case of many other progressive neurological diseases, definite etiological factors which are responsible for the occurrence of Parkinson disease are not known. Accordingly, the medical profession is not in a position to advise the population at risk regarding the preventive measures. It is now more or less settled that Parkinson disease is preceded by a long preclinical phase consisting of nonmotoric phenomena characterized by neurovegetative disturbances and mood changes. However, it is almost impossible at this stage to make even a suspected diagnosis of future Parkinson disease, as the changes are far too unspecific. By the time 8the disease is clinically manifested with the known cardinal symptoms, there is almost 60 percent loss of melanized nigronal neurons.
Hence, the diagnosis and treatment of idiopathic Parkinson disease (IPD) remains still a clinical procedure without being able to arrest the further process of this neurological disorder. However, with the development of potential drugs such as Levodopa and Dopamine-receptor agonists, the physician is in a position to reduce the symptoms to improve the quality of life for the patient. With the introduction of further new drugs, perhaps, one has the possibility to improve the general condition of the patient also in view of prevention of late cognitive disturbances leading to dementia. For the diagnosis of IPD, being predominantly a clinical method, every attempt must be made to arrive at an early diagnosis also for the purpose of initiating early drug treatment. One has the possibility today to take help of such methods as cerebrocranial MRI and PET in the event of difficulties in clinical diagnosis.
This book is the result of over 35 years of neurological practice involving also patients of Parkinson disease and gives practical hints for the general medical practitioners and students of neurology. Attempts have been made to give details regarding the interrogation of patients and the management of various clinical aspects of the disease. As there is no proper standardization in the drug treatment of IPD, other than the use of Levodopa, suggestions are made for the proper combination of drugs during different phases of the illness. Management of such problems as late dyskinesias, akinesia crisis and late phase of Parkinson disease have been referred to. Short mention has been made regarding the supplementary treatment and deep-brain stimulation.9
I would like to thank my long-range patients of Parkinson disease, who have given me an opportunity to treat them for years. For any physician, who is attached to the profession, the patients are the real living libraries. My special thanks are due and hereby offered to my part-time secretary Mrs Silvia Kürsteiner, who has taken great pains to write this manuscript in spite of repeated corrections. I am thankful to my wife Nirmala, my sons Vijay, Vinay and Anil as well as for my daughters-in-law Rekha, Sheela and Bhavana for their tremendous moral support during my medical and my non-medical publications. Finally, I am highly thankful to the publishers M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi and Bengaluru for their cooperation and help.
PV Rai
10Acknowledgments
My hearty thanks are offered to the following friends for their professional and moral support:
Dr Erwin Stenzel
Dr Jutta Dambacher
Prof Maximilian Dambacher
Mrs Helga Steiner
Mrs Isabelle Kürsteiner
Mrs Romy Zuberbühler
Dr Luzius Knöpfli
Prof N Sridhar Shetty
Dr Karl Scheidegger
Mr Armin Benz