CONCLUSION

CONCLUSION

Today fast and competitive life pattern has resulted to an increasing incidence of Parkinson    

disease among the youth living in urban area. Because of modernization and stressful urban life

with the maximum level of pollution , this disease is making its root among the aspiring section

of the society. This class of people is not able to spare a little time for their own self like

exercise, proper  and regular diet,  a sound sleep and little of meditation.

Once the person is taken over by Parkinson disease it becomes very late to take the preventive

measures. He has to be totally dependent upon a full time care taker and he avoids himself

socially. Now he starts developing psychiatric symptoms beside the existing ones.

Such patients of Parkinson disease are to be dealt with love and affection. it becomes our duty to

encourage and motivate such people to move  in the society. They should never be bullied .The

NGOs should come forward with the idea of establishing the clubs particularly for PD patients

where they can spend their time and intermingle with their brother PDs. If possible government

agencies should encourage these people to earn their livelihood by providing appropriate job so

that they will not feel themselves dependant.  This way we can increase their moral and self

esteem. This may further curtail the psychiatric symptoms also. They will not feel worthlessness.

By keeping themselves busy the patients may not get the progression of the disease at an

alarming rate.

If the patient and his family can afford, he should be encouraged for one of the various upcoming

options like DBS surgery.

PSYCHOLOGICAL ANALYSIS IN A PARKINSON PATIENT

PSYCHOLOGICAL FIELD

The patient suddenly is in a state of mental shock, when he comes to know of his disease. He

becomes unsecured about his future and he is surrounded by a constant fear in his mind.

Being a male he is not able to accept his handicap and the helplessness attitude occupies his

mind.

He just cannot swallow the fact that someone is being engaged 24 hours as his caretaker .At the

 stage when he is not able to contribute to the earning of his family. He probably starts thinking

 that he has become an extra burden to the family. Here he starts cultivating the suicidal

thoughts. If the patient is monetarily sound, he may overcome the above said symptoms, but

there is a perfect saying that “THE IDLE MIND IS A DEVILS WORKSHOP.” The patients are

seen to develop hyper-sexuality, obsessive compulsive disorders, depressive psychosis,etc. Of

course, these are triggered by the medicines. I know personally a patient of Parkinson who went

in to the habit/ addiction of exhibitionism for which he was to suffer a lot including the social

 boycott,  hatred and insults.

The patients who develop grave psychiatric symptoms are generally referred to the

 psychiatrist for further management. The patient is put on antipsychotic drugs for a longer

 duration.

Such patients are dealt with tactfully. they are always to be accompanied by some caretaker

 and never left alone. He is always encouraged to think and act positive. He is never insulted

 or reminded of his off scene deeds. If the economy and the bank balance permit he should

 be taken for deep brain stimulation surgery (the best option presently) which will give him

 the far better lifestyle and a productive life for his remaining age. Here I must tell you the

 fact that the life of the patient remains complete and only the life style is affected. 

SOCIOECONOMIC FIELD IN PARKINSON PATIENT

SOCIO-ECONOMICAL FIELD

The cost of care associated with Parkinson diseases includes both direct and indirect costs.

Direct costs are expenditures for medical and non-medical services needed as a result of the

illness. Direct medical costs include expenditures for pharmaceuticals, physician office visits,

 emergency room care, and inpatient hospital visits. Direct nonmedical costs are costs incurred

 by the patient for special care, including costs of transportation and special equipment or

 modifications to the home or car. Indirect costs are related to changes in worker productivity,

including absence from work and decreased earning ability. There are also intangible costs

associated with the pain, suffering, and reduced quality of life associated with the illness.

 Although intangible costs are difficult to quantify in monetary terms and are often omitted from

 economic analyses, they are important to consider when examining the overall impact of PD.

Though this disease is diagnosed clinically but can be confirmed by CT scan and MRI brain

which are  costly and become difficult to be borne to  patient.

Medicines are generally very expensive which a poor patient cannot bear. All the above factors

 lead to the draining of his bank balance.

Socially the patient finds him not presentable and he starts withdrawing himself from social

Gathering, parties, functions and gets confined within the cemented walls at home .This

limitation  of his movement in the social circle gives birth to extreme depression and other grave 

psychiatric symptoms.

At a certain time of his disease the patient becomes completely dependent on his care taker and

his assistance for 24 X 7 hours. Hence the loss/engagement of two earning persons thereby a

monetary loss to the family and the nation. Moreover since the disease is male dominating, the

 loss incurred is too much to the family. This further adds up to the deteriorating psychological

 condition of the patient in Toto.

 

SURGERY

In the previous years thalamectomy was the only possible surgery but with remarkable side

effects . Now in this modern era, deep brain stimulation has come up with the out standing

results. In this surgery, the specific areas in the brain are stimulated by implanting the

electrodes/pacemakers with the remote (turning) in the patients hand. Even this surgery is

supposed to be effective only for few years .Though the life style definitely improves but the

under current progression of the disease still remains as such.

STEM CELL TRANSPLANT

 It is among the latest researches undergoing clinical trial at present. This includes the

transplantation of stem cells derived from the fetus into selective area of  brain of Parkinson. 

These stem cells take the shape and function of the neighboring cells of defective/ deficient area

where these are injected. Since this procedure involved the sacrifice of a live fetus so it was

banned in most of the countries. Though now the ban has been lifted up in US and thereby

permitting the clinical trials for the mankind. 

GENE THERAPY:

In patients with Parkinson's disease, their brains get overactive after losing the normal supply of

a chemical called GABA (gamma-aminobutyric acid). A gene that codes for glutamic acid

decarboxylase (GAD) can improve the condition of people with the disease when injected into

their brains.GAD is an enzyme that catalyses production of an inhibitory neurotransmitter called

(GABA). Typically, people with Parkinson's produce too little GABA, and consequently have

overstimulation in an area of the brain called the subthalamic nucleus. This over activity in turn

puts strain on neurons that produce another neurotransmitter – dopamine – which is vital for

movement control. This helps explain some of the symptoms of Parkinson's, which include

tremors, sluggish movements, rigid muscles and impaired posture and balance.

The new treatment, gene therapy, works by inserting billions of copies of a gene into patients'BRAIN.brains that helps them produce more GABA. The patients receive an infusion of a virus

engineered to deliver a gene called glutamic acid decarboxylase (GAD) into a brain centre that is

overactive in Parkinson's disease — the subthalamic nucleus. GAD encodes a neurotransmitter

called GABA, which quiets neurons in this area

PHYSIOTHERAPY and DIET ADVISE

PHYSIOTHERAPY

It  is said to play an important role in keeping the patient mobile. Here I would like  to quote the

reference of NOEL N BATTEN who claims that performing blood flow exercises  can overcome

Parkinson disease. Batten has mentioned in his book certain interesting points to  overcome the

Parkinsonism:

      The effects of sunrise on our mind encourages us to do things that stimulate blood flow.

      If our mind remains overactive all night, our neck muscles remain stiff the whole night,  

to inhibit blood flow and create several problems.

      Peace of mind and relaxed neck muscles encourage good blood flow in the Prefrontal

     cortex of the brain.

      Every PD patient should do shrugs; straddle squats, side bends, and knee ups exercises.

      “Hatred” is one attribute  that can develop in to Parkinson disease

DIET ADVICE

It is better to obtain fiber from fruits, vegetables and grains. Fruits such as figs , prunes ,papaya

and pine apple are valuable natural laxative . It is also important to drink plenty of drinks like

water and juices. The patient should have moderate amount of tea and coffee. Too much of

proteins interfere with the action of drugs, hence to be avoided in day time . The small helpings

of food every two to three hours may be more appealing.

SURGERY

In the previous years thalamectomy was the only possible surgery but with remarkable side

effects . Now in this modern era, deep brain stimulation has come up with the out standing

results. In this surgery, the specific areas in the brain are stimulated by implanting the

electrodes/pacemakers with the remote (turning) in the patients hand. Even this surgery is

supposed to be effective only for few years .Though the life style definitely improves but the

under current progression of the disease still remains as such.

STEM CELL TRANSPLANT

 It is among the latest researches undergoing clinical trial at present. This includes the

transplantation of stem cells derived from the fetus into selective area of  brain of Parkinson. 

These stem cells take the shape and function of the neighboring cells of defective/ deficient area

where these are injected. Since this procedure involved the sacrifice of a live fetus so it was

banned in most of the countries. Though now the ban has been lifted up in US and thereby

permitting the clinical trials for the mankind. 

GENE THERAPY:

In patients with Parkinson's disease, their brains get overactive after losing the normal supply of

a chemical called GABA (gamma-aminobutyric acid). A gene that codes for glutamic acid

decarboxylase (GAD) can improve the condition of people with the disease when injected into

their brains.GAD is an enzyme that catalyses production of an inhibitory neurotransmitter called

(GABA). Typically, people with Parkinson's produce too little GABA, and consequently have

overstimulation in an area of the brain called the subthalamic nucleus. This over activity in turn

puts strain on neurons that produce another neurotransmitter – dopamine – which is vital for

PATHOPHYSIOLOGY OF PARKINSONS DISEASE

PATHO-PHYSIOLOGY: -

There is depletion of dopamine secreting neurons in globus pallidus area of

Substantial nigra of the brain. Because of this deficiency the neuro impulses are not transmitted

across the synapsis. The above said factors results in uncontrolled involuntary movements in the

distal areas of the limbs. These are called as tremors at rest. However during sleep there are no

tremors. Any kind of stress may aggravate the symptoms.

CONSERVATIVE THERAPY:-

There are only few drugs which decrease the symptoms to a little extent either by imitating the

dopamine or inhibiting the  antagonist enzymes in  the Dopamine pathway. However, these drugs

are not the permanent solution to the problem . The brain get used to the synthetic dopamine and

its effect vanishes within a span of five years. Since this is a progressive disorder the underwater

current takes the shape of whirlpool. These anti Parkinson drugs on the other hand have shown

lot of adverse effects which include Dystonia (increased rigidity in all the four limbs), dyskinesia

(slowness and impaired body movements), insomnia (sleep disorder) and psychiatric symptoms

(obsessive compulsive disorders and hyper sexuality). Because of dystonia the distal muscles of

his arms and legs become rigid and the patient is painful and helpless in accomplishing his day to

day routine tasks like brushing the teeth, ablution in toilet, taking bath, combing his hair,

fastening the buttons of his shirt, and so on. Hypokinesia results in loss of swinging of hands

while walking, imbalance on walking, slowness of  speech, and awkward movements of the

limbs. The incoordination of skeletal and smooth muscles may even lead difficulty in speech,

difficulty in swallowing and difficulty in defecation.

etiology and clinical features in a parkinson patient

Etiology : The exact cause of this disease is not known. But in my opinion, the increase in stress

in day to day  life, the introduction of chemical pesticides in almost all eatables may be the

leading cause. The increase in oxidant levels in our body due to a fast and competitive life  can

again be one of the  main reasons behind this kind of disease. The more of a sedentary life style

and the least physical activity may also contribute to the etiology. Hereditary factor is also

known to cause Parkinson in pedigrees.

Clinical features: Tremors which initially starts unilaterally and gradually progress to all four

limbs. The patient becomes handicapped up to the level that he/she unable to eat or drink of its

own. The sufferer stops mingling in the society because of social phobia. He drags himself away

from the society and even the family. Ultimately he starts developing psychiatric symptoms   

Statistics: In the United States, at least 500,000 people are believed to suffer from Parkinson's

disease, and about 50,000 new cases are reported annually.