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Parkinson's disease is also called primary parkinsonism for which no cause has yet been found.      Learn more...
Parkinson has no cure but a variety of medications provide dramatic relief from the symptoms.     Learn more...
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What is Parkinson's?

Creating Awareness About Parkinson's Disease
The Society's principal mission is to create awareness about the disease. As part of the Global Parkinson’s Day the Chairman of Pakistan Parkinson’s Society, Mr. Haroon Basheer, participated together with two leading neurologists in a 30 minute TV program on Parkinson’s disease [PD]. This program was aired on Indus TV's program, Sehat Online, and was broadcast nationally and beamed to 132 countries of the world. Mr. Basheer shared his personal perspective as a patient and gave a message of hope and a ”Never Surrender” attitude.

Penmanship Maintenance with Parkinson's
by Erica Jacques
During one of my internships, I worked with a patient who was having trouble with his writing. I had never seen anything like his script before. The beginning of his sentence was fairly legible, but as he continued to write, the words gradually shrank in size until they were barely visible.
With little to no understanding of what was going on with this gentleman, I consulted my fieldwork supervisor. She looked at his writing sample, and passed it to another therapist. The two exchanged knowing glances. I felt like I was missing something huge.
"Does he have the diagnosis yet?" the other therapist asked my supervisor. She shook her head, and looked back at me.
"Do you know what this is, Erica?"
It was my turn to shake my head.
"I think your patient has Parkinson's disease."
At that time, as a student, I had no idea how she had come to that conclusion merely by looking at a writing sample. When I think back now, however, it was obvious.
Writing problems are common to many conditions, such as arthritis or multiple sclerosis. Most manifest as illegible words due to lack of hand control, or decreased ability to grip a pen or pencil. In most cases, words are often shaky or wavy. Only in Parkinson's do the words become impossibly small, a trait known as micrographia.
Some writing strategies for Parkinson's patients include using pens with a larger or built-up grip, or repeatedly tracing large letters or shapes on paper to make the flow of writing more consistent. Pausing between words can sometimes help, as can printing instead of writing in cursive. A great way to practice penmanship maintenance is to work on word or number puzzles that require printing one letter or number at a time.
Different methods work for different people, and no solution works 100 percent of the time, so it is always best to have a backup plan. Any of these techniques may help ease a loved one's frustration.
My patient was discharged from the hospital before I had a chance to follow up with him. Years later, I still wonder what happened to him, and if he was ever diagnosed with Parkinson's disease.
What is Parkinson's ...

What is Parkinson’s…. The overall prevalence in the world is estimated at 6.5 million at present and expected to double in the next 10-20 years. In Pakistan alone there are estimated to be 450,000 persons afflicted from the disease.

My Story

It was nice cloudy evening with cool Karachi breeze blowing when I arrived at my family physicians clinic dot on time. My doctor is a ‘gora sahib’ who is a stickler for time. At exactly 5.45 PM , the doctors clinic door opens and he comes out immaculately dressed and ushers me in. I spot a new writing instrument on his desk. We share a passion for collecting writing instruments and Doctor Sahib proudly shows his latest acquisition - a sterling silver Caran D”Ache. What a beauty

I start to narrate some problems that I am becoming aware of and ramble a laundry list of issues like my left hand dangles when I walk, my handwriting of which I have been so proud of, tends to become smaller and at times unreadable, being a senior banking executive I travel a lot but I have a problem lifting the computer case to the overhead compartment in the plane. I self diagnose and comment that I think I may have suffered a minor stroke. Doctor sahib does the usual checks, looks at my medical file and makes me walk up and down like a model on a catwalk. His face turns serious and he remarks, Haroon Sahib you are showing sings of Parkinson’s. Let me refer you to a neurologist and promises to have a medical history and introduction ready by next day.

I consult a prominent neurologist who comes from a family of goldsmiths. The whole story is repeated, I am checked for balance and made to walk. The neurologist’s prognosis is the same and he calmly says it is the early onset of Parkinson’s, but that he will prescribe no medicine and asks me to lead a normal life and return for consultation in two years. Feeling relieved I thank Allah and stop on the way from the hospital for a bite. Life goes on and the symptoms don’t go away and I learn to cope. On one of my trips to London I am meeting up with my son who is posted in Singapore and also attending a company meeting in London. On the families insistence we agree to consult a leading Harley Street Neurologist who also confirms the earlier doctor’s diagnoses and puts me on medication and assures me that I can look at at least another 12 to15 years of normal life.

Little did I know this would be a turning point in my life but with faith in Allah I continue with my career and started reading about the disease and its management and realize there is little awareness about the disease even among GPs and family doctors and was considered an untreatable old man’s disease. Perhaps Allah has given me the responsibility and opportunity to do community service.. The thought of starting a Parkinson’s Society is born as a community service. Supported and encouraged by friends and the Society is launched in April 2008 on “World Parkinson’s Day”

What is Parkinson’s ?

Parkinson’s Disease - PD for short - is a progressive degenerative disorder which features globally effecting all cultures without any ethnic, social or geographical boundaries. While the conditions usually manifests itself after 60 it is now being observed that 15-20 per cent diagnosed are below age 50 (Young Onset Parkinson’s). PD effects both men and women in almost equal numbers The overall prevalence in the world is estimated at 6.5 million at present and expected to double in the next 10-20 years. In Pakistan alone there are estimated to be 450,000 persons afflicted from the disease.

PD targets a specific area of the human brain that is a collection of nerve cells, the substantia nigra. The damage to these nerve cells affects a circuit of cells in the brain called the basal ganglia. which controls movement in the body. PD causes brain cells in the basal ganglia to die gradually, thereby decreasing dopamine in the basal ganglia and causing Parkinson's disease and the symptoms of tremor, rigidity, difficulty walking, and postural imbalance.

Scientists don't know for certain what causes Parkinson's disease, but some believe that a combination of environmental and genetic factors may be responsible. Treatment options for the management of Parkinson's disease, are available and the disease can be managed (but not yet treated) through a comprehensive treatment program which includes medication and physical therapy.

Early-stage symptoms of Parkinson’s disease may include the mild tremor of a limb or limbs at rest such as shaking of the hands and arms, trembling legs and feet, etc slowness of movement, masked facial expression, body/limb stiffness, or mild postural imbalance.

As PD progresses, a person may notice increasingly severe resting tremor of a limb or limbs, slowness of movement, body/limb stiffness, or significant loss of balance. During the advanced stage of Parkinson’s disease, a patient may require significant assistance from a caregiver and support from friends and family. Be aware that there are various Parkinson's disease treatment options that can help lessen these symptoms.

In general, someone with Parkinson’s disease will experience one or more of the following symptoms in differing degree of severity:

  • Shaking at rest ( resting tremor) A symptom of involuntary trembling that may occur in the hands, arms, and legs of a patient. This shaking is usually evident when the patient is either standing still, seated, or lying down.
  • Slow movement ( bradykinesia) Slower-than-normal movement can occur in patients with Parkinson’s disease.
  • Stiffness (rigidity) A symptom of body or limb inflexibility present in a patient with Parkinson’s disease.
  • Balance problems (postural imbalance) A symptom that manifests itself in the inability of a patient to balance or remain steady.
  • Change in volume of speaking voice ( hyperkinetic dysarthia) A symptom that may be noticeable in some patients is the low volume of their speaking voice. As a result, some Parkinson’s disease patients need to raise their voices in order to be heard.
  • Change in handwriting style ( micrographia) A symptom that produces a noticeable change in a patient’s handwriting style, as well as a shrinking in the size of the script. One place to measure this change in handwriting is to review documents that require an annual signature, such as tax returns. Other changes in handwriting in Parkinson's disease may result from shaking at rest, slow movement, or stiffness.
  • Masked face (hypomimia) A symptom where there is a reduced degree of facial expression, or rigidity, caused by decreased facial muscle movement.

If you notice any of the above symptoms in yourself of your friends or family it is recommended you consult your family physician who can guide you. Treatment options besides specific medication include physical therapy, voice therapy, occupational therapy and music therapy.

It is important to note that medicines alone do not form the full gambit of treatment. It needs to be pointed out the PD manifests itself in differing degrees and symptoms vary from person to person and worsen over a varying length of time. As a result medication has to be fine tuned by doctor after regular clinical examinations to allowed for the continued management of the disease.

Besides medication each patient needs to be motivated to take charge and make the disease “their friend”. They need to attempt to be as independent as possible for as long as possible and not be allowed to fall into a depressive state mind. Alongside the patient, their primary caregiver has a key role to play in this aspect of the management of the disease and they too should be encouraged to understand as much as possible about PD.

A significant amount of information on the steps to manage PD is available on the internet generally and specifically some key items are available and regularly updated on on the website of the Pakistan Parkinson’s Society on www.parkinsons.org.pk. One can also also contact them on info@parkinsons.org.pk.