Case Study
Dara Cris, a sixty-three-year-old European American woman, came into the emergency room accompanied by her son. She complained of uncontrollable shaking. Tremors in her right hand made routine activities, such as dressing up and eating, more complicated. Dara could not write properly also. She even had problems with reading if the book was not placed on the table or another stable surface that allowed her not to hold it in her hands.
It was difficult for her to use the telephone, as her muscles became weak rather fast. Still, this symptom was mostly obvious at rest. Except for that, the conversation partners could hardly understand her low and indistinct voice. That is why Dara felt rather confused when being alone in the public places. She also suffered from hypertension for more than five years. The physician examined her and noticed that Dara used to start doing some things and then made pauses as she seemed to get tired in a minute and not be able to continue.
For example, she stopped when walking and getting up from a chair and continued only when her son assisted. The physician asked if someone in her family suffered from Parkinson’s disease and hypertension. It turned out that her parents had high blood pressure, and her father started to reveal first symptoms of Parkinson’s disease when he was thirty-five years old. The examination focused on muscle efficiency, deep tendon reflexes, and coordination, which turned out to be diminished.
On the basis of the received information, the physician diagnosed Dara with Parkinson’s disease and also advised to take carbidopa-levodopa and get a follow-up appointment to make sure. He explained that it was a degenerative condition that affected her ability to control and coordinate movement, underlying that the treatment existed even though there was no cure. The physician advised taking carbidopa-levodopa, neural nutrition, traditional Chinese medicine, physical therapy, and consultations with a speech-language pathologist. He also presupposed the possibility of stem cells injection, which is a new but promising kind of treatment.
Normal Physiology
Parkinson’s disease is known as “a progressive, idiopathic, neurodegenerative disease associated with four cardinal motoric signs: akinesia/ bradykinesia, rest tremor, cogwheel rigidity and postural instability” (Mandir & Vaughan, 2000, p. 270). It has a negative influence on the nervous system and the brain. Normally, the substantia nigra produces dopamine molecules that fit into receptors on the nerve cells so that they stimulate it to communicate the message and make the body move.
If a person is healthy, one’s nerve cells transmit impulses due to the slender they have and release the dopamine molecules after this procedure. Being back in the synapse, molecules are recycled so that the next message can be transferred again. However, if a person has Parkinson’s disease, one’s nerve cells cannot maintain such functions decently. Deep in the brain, they start dying off, which leads to the loss of the dopamine (Mori, Nishie, Kakita, & Yoshimoto, 2006).
After that, the symptoms of Parkinson’s disease occur. A person notices a tremor, stiffness, poor coordination, and bradykinesia. The amount of glutamate increases, trying to compensate the shortfall. Unfortunately, healthcare professionals and scientists have not found out yet why such things happen to some people. Still, they believe it can be caused by sporadic genetic factors, developed due to the environmental peculiarities or senescence (Calì, Ottolini, & Brini, 2014). Secondary forms of the disease can be caused by some medications as well (López-Sendón, Mena, & Yébenes, 2012).
Clinical Manifestations
Parkinson’s disease is rather difficult to diagnose because it entails a wide variety of symptoms that tend to differ from one patient to another. Except for that, people often overlook them because the first signs can be rather mild (Rodriguez-Oroz, Jahanshahi, Krack, Litvan, & Macias, 2009). As a rule, the symptoms are noticed on the one side of the body from the very beginning. With the course of time, they affect the whole boy but tend to remain more severe on the side where they occurred from the inception (Jankovic, 2008).
Uncontrolled shaking and tremor are observed by the majority of the patients with such disease. It starts with fingers and moves to hands soon. Mainly, the tremor gains momentum when a person is relaxed and decreases during some activities. Some patients have bradykinesia. They start to move slowly and feel that simple actions that used to be routines now cause difficulties or cannot be maintained at all (Moroney, Heida, & Geelen, 2008).
This symptom often reveals through shorter steps and dragging feet. Muscles become rigid, which limits motion and causes pain. Problems with coordination are also frequent among the patients who have Parkinson’s disease. They may become stooped. Unconscious smiling and swinging of the arms may be also affected so that the person becomes expressionless (Burch & Sheerin, 2005). The frequency of blinking decreases, which can have negative effects on one’s sense of vision. The speech also can alter.
It becomes slower or quicker and more indistinct. Finally, patients may face difficulties when writing and reading due to the previously discussed symptoms. In some cases, professionals notice emotional and cognition problems; they consider insomnia, depression, hallucinations, dementia, etc. (Lees, 2010; Lees, Hardy, & Revesz, 2009).
Treatment Plan
As it was mentioned earlier, there is yet no cure for Parkinson’s disease that could help all patients. Still, professionals are able to treat the symptoms that cause difficulties.
Tremor and issues with movement are usually treated with the help of medication that increases the level of dopamine. Carbidopa-levodopa is often used as a drug that can ensure the correctness of the diagnosis and as a treatment. It is the most effective medication for now, but impressive changes require large doses and time. It consists of a chemical that turns into dopamine and fills the occurred gap (Arankalle & Nair, 2013).
Constipation is a frequent problem for such patients, and it can be treated with the help of neural nutrition. Healthy eating as a lifestyle provides them with the opportunity to receive more omega-3 fatty acids that prevent such problems.
Traditional Chinese medicine can be rather helpful if the patient suffers from pain, muscle tension, has emotional problems and issues with balance. Alternative medicine has various approaches (homeopathy, acupuncture, etc.) that are claimed to help to relax and improve physical condition.
Physical therapy and exercises make the patients more strong and improve coordination. They are also claimed to have a positive influence on emotional condition and allow to cope with depression. Consultations with a speech-language pathologist can be advantageous when the problems with speech occur.
Stem cells injection has the same approach as the medical treatment. It is believed to increase the amount of dopamine because stem cells can be turned into dopamine-producing ones, which is a critical advantage for the patients. This kind of treatment is rather new, but it proved to be advantageous already (Xiong, Zhang, Huang, Chen, & Jia, 2011).
References
Arankalle, D., & Nair, P. (2013). Effect of electroacupuncture on function and quality of life in Parkinson’s disease: a case report. Acupuncture in Medicine, 31(2), 235-238.
Burch, D., & Sheerin, F. (2005). Parkinson’s disease. The Lancet, 365(9459), 622-667.
Calì, T., Ottolini, D., & Brini, M. (2014). Calcium signaling in Parkinson’s disease. Cell and Tissue Research, 357(2), 439-454.
Jankovic, J. (2008). Parkinson’s disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry, 79(4), 368.
Lees, A. (2010). Parkinson’s disease. Practical Neurology, 10(4), 240.
Lees, A., Hardy, J., & Revesz, T. (2009). Parkinson’s disease.The Lancet, 373(9680), 2055-2066.
López-Sendón, J., Mena, M., & Yébenes, J. (2012). Drug-induced parkinsonism in the elderly. Drugs & Aging, 29(2), 105-118.
Mandir, A., & Vaughan, C. (2000). Pathophysiology of Parkinson’s disease. International Review of Psychiatry, 12(4), 270-280.
Mori, F., Nishie, M., Kakita, A., & Yoshimoto, M. (2006). Relationship among [alpha]-synuclein accumulation, dopamine synthesis, and neurodegeneration in Parkinson disease substantia nigra. Journal of Neuropathology and Experimental Neurology, 65(8), 808-815.
Moroney, R., Heida, C., & Geelen, J. (2008). Increased bradykinesia in Parkinson’s disease with increased movement complexity: elbow flexion-extension movements. Journal of Computational Neuroscience, 25(3), 501-519.
Rodriguez-Oroz, M., Jahanshahi, M., Krack, P., Litvan, I., & Macias, R. (2009). Initial clinical manifestations of Parkinson’s disease: features and pathophysiological mechanisms. The Lancet Neurology, 8(12), 1128-1139.
Xiong, N., Zhang, Z., Huang, J., Chen, C., & Jia, M. (2011). VEGF-expressing human umbilical cord mesenchymal stem cells, an improved therapy strategy for Parkinson’s disease. Gene Therapy, 18(4), 394-402.