The New Straits Times, June 18, 2000
By Prof Dzulkifli Abdul Razak
COME June 29, a nationwide roadshow to spread awareness about Parkinson's disease is scheduled to begin in Penang, thanks to the National Parkinson Foundation of Malaysia. One of the target groups is schoolchildren so that "the students would be able to identify its symptoms (if any) in their loved ones," according to the foundation (NST, May 26).
Through the efforts of the foundation, Parkinson's disease has been given a wide publicity and Malaysians have benefited a great deal from it.
According to the foundation, there are about 70,000 Malaysians known to suffer from the disease. Each year about 60 new cases are being discovered, and perhaps many more will be detected as awareness among the public increased.
In the US roughly a million Americans fall victims to the disease including prominent officials such as the Attorney-General Janet Reno.
For those who are living with victims of the disease, they would be able to cope with the situation better. This is especially so since the disease can also be associated with cognition difficulties.
Among legendary figures who have been stricken by this debilitating condition are the "greatest" Muhammad Ali and the late Chairman Mao Zedong.
More recently, the sitcom "Spin City" actor, Michael J. Fox, was reported to suffer from the condition too. But unlike the former, Fox, aged 38, is thought to be rather young for the disease.
Parkinson's disease is better known to hobble the older age group; it being a type of degenerative disease of the brain generally thought to be more prevalent as the population ages.
But the disease profile seems to be changing. As pointed out by the foundation president, contrary to popular belief, the disease do affect young people as well. About 20 per cent of all Parkinson's disease patients are between a 20 and 40 years old (NST, May 26).
What is generally accepted as the underlying factor is the degeneration of certain types of cells in some parts of the brain. These cells are mainly associated with the release of a brain chemical or neurotransmitter called dopamine.
This substance is vital for the brain to modulate some functions related to the movement of the body. As the number of the cells diminishs, so too are the related brain functions. If the number drops below a critical threshold, the part of the brain involved is "starved" of dopamine, which then manifests into some symptoms.
Among these are movement impairment usually observed are a progressive loss of muscle control, leading eventually to some form of muscular rigidity. Other symptoms include shaking or tremors of the hands, even while a person is resting, and loss of fine manipulative skills causing difficulty in activities such as eating, writing, speaking, and even breathing.
What causes the destruction of the brain cells are many and varied, and not all of them are well identified. In theory however, any causal factor that can result in the relevant brain functions to deteriorate can manifest in Parkinson-like symptoms. This includes certain type of medicines that may induce Parkinson-like symptoms as side-effects. Such "drug-induced parkinsonism" however are usually reversible, for example on cessation of the usage of the medicine, or by reducing the dose used.
More worrying though are substances that can cause a more "irreversible" type of Parkinson's disease.
In launching educational posters about the disease, the Deputy Minister of Education has called for youngsters to stay away from substance abuse. Indeed one of the early causes documented for the condition has been traced to the use of a synthetic heroin product.
Much less understood are the roles of various environmental poisons, especially the ones that can potentially destroy the brain cells. They can act as external triggers making it easier to reach the critical threshold levels required for the disease to manifest. More alarming still is that some of these poisons leave us with little or no cushion against age-related attrition.
This possibility has been demonstrated by a number of poisons, such as MPTP (1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine). MPTP is a neurotoxin shown to produce a neurological syndrome in humans, monkeys, and mice that is very similar to that of Parkinson's disease. Since the brain cell loss produced by MPTP in the monkeys is identical to that observed in humans with the disease, it is suggested the cell loss in patient with Parkinson's disease may be similarly caused by such a toxin.
In other words, intense exposure to environmental and industrial chemicals could also be associated with the development of the disease. Even environmental risk factor involving toxins in the food chain could hypothetically cause the disease. In fact, one postulation suggests that just by triggering excessive production of oxygen free-radicals (unstable and potentially damaging molecules generated by normal chemical reactions in the body) the toxins may contribute to death of the brain cells thereby leading to the disease.
More recently, researchers from Stanford University found that the disease could be linked to the use insecticides and herbicides in the home. They discovered there was as "much as a 70 per cent increase chance of developing the disease as compared to someone who did not use the poisons".
The study, reported at the annual meeting of the American Academy of Neurology last month, suggests that "insecticide exposure at home showed the strongest association but herbicide exposure in the garden was also associated with an increased risk of Parkinson's disease".
One of the authors of the study was quoted as saying, "Certain chemicals that an individual is exposed to in the environment may cause selective death of brain cells or neurons".
All these show that the triggering factor for the disease could be more widespread than what is currently recognised. Hence by knowing about the disease the public could be made aware as how to avoid getting the disease or when to seek advice on treatment. Because if left unattended the disease will worsen and can result in early death.
Unlike the other major brain diseases such as Alzheimer's, Parkinson's is highly treatable, even at fairly advanced stages. Thus initiative taken by National Parkinson Foundation Malaysia is not only commendable, but must be whole-heartedly supported in the interest of public health.
Recommended site: http://my.webmd.com/content/dmk/dmk_article_40066
