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Parkinson's disease NEW YORK (June 4, 1998 01:08 a.m. EDT http://www.nando.net) -- Parkinson's disease, a degenerative neurological disorder, impairs the lives of more than 1 million Americans. The early symptoms are subtle, often beginning with a tremor in the hand when it is at rest. Over time, the muscles become rigid and immobile. This stiffness makes it difficult to walk, speak or perform simple activities such as buttoning a shirt. In its later stages, facial expressions often appear frozen. The most severely afflicted eventually become bedridden and may develop dementia. Not surprisingly, depression is common. Today, there is no cure for Parkinson's disease; its cause remains a mystery. The symptoms of Parkinson's disease, however, result from the deterioration of nerve cells in the parts of the brain that coordinate movement. These cells, called neurons, contain small packages of dopamine, a chemical messenger that transmits information from one neuron to another. As the neurons are destroyed, less dopamine is available. This makes it harder for the brain and body to communicate normally. By the time most people seek medical help, approximately 80 percent of the dopamine-producing neurons have already disappeared. The key to treatment is making the remaining 20 percent of these neurons perform more efficiently. New drugs allow physicians to do this in a variety of ways based on the clinical needs of the patient. The cornerstone of treatment is the use of levodopa (L-dopa) drugs, such as L- dopa/carbidopa (Sinemet) or L-dopa/benserazide (Madopar). These drugs are converted to dopamine in the brain. Although the development of L-dopa represented a breakthrough in the treatment of Parkinson's disease, some researchers worry that use of L-dopa might actually contribute to nerve cell deterioration and recommend delaying its use for as long as possible. Nevertheless, recent studies have contradicted this view, according to an article in Annals of Neurology. Fortunately, other drugs are now available, all of which work in different ways. Some physicians begin treatment with amantadine (Symmetrel), which enhances the release of dopamine. Agonists, such as pramipexole (Mirapex) and ropinirole hydrochloride (Requip), mimic the effects of dopamine in the brain. Selegiline hydrochloride (Eldepryl) and tolcapone (Tasmar) prevent the destruction of dopamine by inhibiting certain enzymes. Tricyclic antidepressants such as nortriptyline (Pamelor, Aventyl) or amitriptyline (Elavil) help the body conserve dopamine. Drug treatments allow many patients to remain reasonably active, but they do not help everyone. Researchers are now experimenting with several different surgical techniques to provide additional relief. For example, electrodes that emit electrical impulses are being placed in strategic parts of the brain, such as the thalamus or pallidum. Neurosurgeons are also transplanting dopamine neurons from fetal tissue into the brains of Parkinson's patients. All of these surgical procedures are being evaluated in clinical trials to determine how well they work. Though drug treatment is the primary defense against the disabling symptoms of Parkinson's disease, other interventions may be beneficial. Physical therapy helps maintain some muscle strength and flexibility, as well as boost morale. Special training in eating, dressing and walking can also help patients live more independently. Moreover, research suggests that daily doses of antioxidant vitamins such as vitamin E and vitamin C can protect cell membranes. For more information about treatment for Parkinson's disease contact the National Parkinson's Disease Foundation, 1501 NW Ninth Ave., Bob Hope Road, Miami, Fla. 33136, telephone 800-327-4545. Dr. Govindan Gopinathan is clinical professor of neurology at New York University School of Medicine. by Govindan Gopinathan Copyright 1998 Nando.net Copyright 1998 The Associated Press janet paterson aka calendar control supervisor 51/10 - sinemet/selegiline/prozac - [log in to unmask] quotations: http://newww.com/cgi-bin/do_cal?c:newvoice pwp event calendar: http://newww.com/cgi-bin/do_cal?c:pwpc