All,
I hope this isn't a repeat. Jeana sent it while my pc was in the shop & I 
just dug it out from under a mound of e-mails. 

  March 12, 2000

New treatments to control Parkinson's disease 
By Karen Goldberg Goff 
THE WASHINGTON TIMES

     Jeana Bartlett first noticed her right hand trembling while 
she sat in the bleachers watching her sons play football. She attributed the 
shaking to nerves. The shaking kept occurring though, and neurological tests 
proved inconclusive. The trem-ors got worse, and Mrs. Bartlett, then in her 
mid-30s, became more scared. She was downright terrified when she was driving 
and could not take her foot off the accelerator.
Further tests showed the Augusta, Ga., woman had Parkinson's disease, a 
neurological condition doctors initially dismissed because of her young age.
"Parkinson's was considered 'an old person's disease,' " she says. "But 
I was actually relieved to find out that is what I had. I thought I was a 
hypochondriac or psychotic or had a brain tumor."
About 1 million people in the United States suffer from Parkinson's 
disease. About 20 percent of that number are younger than 40, according to 
data from the National Parkinson's Foundation. Though the disease is not 
fatal, it gets progressively worse. To a younger person, that can mean 
decades of adjusting medication, undergoing surgery and dealing with 
sometimes debilitating physical symptoms.
"The issues for young people with Parkinson's are very different," says 
Hilary Blue, a 51-year-old Annandale woman who has had Parkinson's for 27 
years. "Older people are expected to get all sorts of conditions as they age. 
The acceptance is very difficult when you are young. You have to think about 
issues like will you be able to work or take care of your children."
An increasing number of people younger than 40 are being diagnosed with 
Parkinson's, says Dr. Tom Chase, chief of experimental therapeutics at the 
National Institute of Neurological Disorder and Stroke, part of the National 
Institutes of Health. However, it is unknown whether more people than ever 
have the disease or doctors are just diagnosing it more accurately.
Young Parkinson's sufferers also have received newfound attention 
through the work of actor Michael J. Fox, who announced in 1998 that he had 
been living with the disease for seven years. Mr. Fox, now 39, recently said 
he will not continue with his role on ABC's "Spin City" so he can devote more 
time to raising awareness — and finding a cure.
"For many people with Parkinson's, managing their disease is a full-time 
job," Mr. Fox said in congressional testimony last September. "It is a 
constant balancing act. While I am able, for the time being, to do what I 
love best, others are not so fortunate. There are doctors, teachers, 
policemen and parents who are no longer able to work to provide for their 
families and live out their dreams."



A neurological mystery 
     Parkinson's disease is a progressive disorder caused by the 
degeneration of nerve cells in the part of the brain that controls movement. 
This degeneration creates a shortage of a neurotransmitter called dopamine.
The first sign of Parkinson's usually is a tremor (trembling or shaking) 
of a limb, especially when the body is at rest. The tremor often begins on 
one side of the body, frequently in one hand. Other common symptoms include 
slow movement (called bradykinesia), an inability to move (akinesia), 
im-paired balance and coordination, and trouble talking or completing other 
simple tasks.
What causes Parkinson's has been a subject of great debate and research 
for decades. Some scientists have suggested that Parkinson's is a result of 
toxins selectively destroying dopamine-containing neurons. Exposure to 
pesticides in the air or in food, for instance, hypothetically could be the 
trigger for the disease.
Parkinson's also can occur as a result of illness, such as encephalitis 
or other serious viruses, injury or some medications used to treat 
psychiatric disorders and high blood pressure.
More recently, NIH scientists have identified a gene abnormality that 
causes some cases of Parkinson's. That discovery doesn't explain all cases, 
but it is a step toward a breakthrough, Dr. Chase says.
"Parkinson's disease is probably due to a multiplicity of factors," he 
says. "In the past, we were looking for the cause. Now that we know it is 
likely a combination of environmental and genetic factors . . . our chances 
of stopping the disease improve."



In search of the right dosage 
     The most common treatment for the early stages of Parkinson's 
is the drug levodopa, which replaces the lost dopamine in the brain. Many 
patients control tremors for years by taking it.
"I took [levodopa] for eight or 10 years, and it really helped," Mrs. 
Bartlett says. "No one knew I had Parkinson's. I was able to keep up with my 
sons, who were 8 and 9 years old at the time I was diagnosed. I didn't tell 
most people I had the disease, not even my sons."
As the disease progressed, however, the drug began to lose its 
effectiveness, and Mrs. Bartlett began having severe side effects. That is an 
unfortunate common scenario with patients who rely on levodopa, Dr. Chase 
says.
Dyskinesia — involuntary movements such as twitching, nodding and 
jerking — commonly develops in people who take the drug over a long period. 
The period of effectiveness of each dose gets shorter and shorter over time, 
and doctors and patients have to work hard to readjust the medication or add 
other drugs.
"After I turned 40, it got to the point where the tremors were much more 
severe," Mrs. Bartlett says. "I couldn't walk well. It was like my feet were 
stuck to the floor. The dyskinesia can be worse than the disease. If I were 
sitting at a restaurant, I would weave all over the place. People thought I 
was tipsy."
Other drugs are being studied. Doctors sometimes give the drugs 
bromocriptine and pergolide, which mimic dopamine and can boost levodopa's 
length of effectiveness. The drug selegiline, which delays the breakdown of 
dopamine, can be given to early-stage sufferers to delay their having to take 
levodopa. Other drugs commonly prescribed include anticholinergics and the 
anti-viral drug amantadine, both of which help control tremors and rigidity.
A promising class of drugs, called dopamine antagonists, eventually 
might replace levodopa. A five-year study in France showed using dopamine 
antagonists at the outset and using levodopa later resulted in less 
dyskinesia. In the study, 85 people took the new drug and 45 took levodopa. 
Five percent of those who took dopamine antagonists had dyskinesia, compared 
to 36 percent who were on levodopa.



Surgery: probing the brain 
     When Parkinson's patients re-ach an impasse with medication, 
there are three surgical choices available to them.
The most common, a pallidotomy, has been around in several forms for 
decades. Refinements of the procedure in the early 1990s showed it to be a 
promising treatment for Parkinson's patients, and its popularity has seen a 
resurgence.
In a pallidotomy, doctors insert a probe into the portion of the brain 
called the globus pallidus, creating a lesion in a precise area. The lesion 
interrupts neural pathways and reduces tremors and rigidity.
In a thalamotomy, a similar lesion is made in the thalamus, which 
contains two walnut-size bundles of nerves located near the core of the 
brain. A thalomotomy, which Mr. Fox underwent, also controls tremors in a 
majority of patients whose disease originates from the thalamus.
A third type of surgery, called deep brain stimulation (DBS), is 
considered the new frontier of Parkinson's surgery.
In that treatment, which the U.S. Food and Drug Administration approved 
in 1997, high-frequency electrical stimulation is delivered to the brain via 
an electrode. The electrode is powered by a battery pack to which it is 
connected under the skin, below the patient's collarbone. The mechanism is 
controlled by a magnet to increase the frequency as the disease progresses or 
to turn off the device at night, when symptoms tend to decrease.
"It seems more people prefer DBS," says Dr. Joseph Smith, a neurosurgeon 
who has implanted many devices at the Medical College of Georgia. "It is 
reversible, and it does not destroy tissue.
"You still have to take medication, and it does not destroy the disease 
process," Dr. Smith cautions. "What people have found, however, is that after 
a year or so, it appears the disease has stopped progressing. And when the 
disease does progress, rather than re-operate, we turn up the amplitude of 
stimulation."
Mrs. Bartlett has undergone two surgeries. She underwent a pallidotomy 
in 1996. The operation was on the left side of her brain to control tremors, 
rigidity and dyskinesia on the right side.
"The operation was marvelous," Mrs. Bartlett says. "It was like I had 
been wrapped up in wires, and somebody set me free."
However, the Parkinson's continued to progress on her left side, and the 
dyskinesia worsened. In a 20-hour operation last June, she underwent DBS. The 
results of that operation are more subtle, she says.
"I don't have the dyskinesia or tremors," she says. "It got rid of a 
condition I had where my foot curled in. Having [the pack placed under your 
skin] takes some getting used to. I always feel like something is there. I 
still have balance trouble. My speech is affected; when I am tired or hungry, 
my volume and pronunciation are low.
"I do not feel I am cured," Mrs. Bartlett says. "I did feel like I was 
after the pallidotomy. But I am better."



Living and coping 
     In the past 13 years, depression has been a side effect for 
Mrs. Bartlett, as it is for many Parkinson's sufferers. She had to make 
lifestyle changes, including quitting her job at a bookstore, where counting 
change and standing on her feet were almost impossible.
Mrs. Bartlett has found that exercise helps, as does a good support 
group. She does water aerobics and lifts weights.
"I really believe that moving water does not freeze," she says. "We need 
to get our muscles moving. It has made me so much stronger. I don't think I 
could have made it through 20 hours of surgery if I wasn't strong."
Mrs. Blue, who had to give up driving a car a few years ago, says she is 
considering having DBS. She belongs to a support group in Annandale and takes 
part in a Parkinson's exercise class.
"I definitely find it helps," she says of the class. "It keeps my 
muscles working and helps me to cope. I dream of being alive when the cure 
comes, so I need to keep my muscles moving."
 
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Bonnie
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