Parkinsonism is a state of tremor and rigidity in the limbs, with reduced flexibility of limbs and retarded movements. It is present worldwide and can be due to several causes. 

Parkinsonism occurs due to degeneration of the cerebellum (part of brain responsible for equilibrium and coordination) and cells of midbrain due to aging.  As life expectancy is increasing, the problem of Parkinsonism is also increasing. 

This degeneration is said to occur due to generation of free radicals and oxidative stress, a process which causes degeneration of other body cells as well. Apart from this, chronic   use of alcohol and tobacco also causes degeneration of cells of cerebellum. Trauma to brain stem is another cause for Parkinson’s disease.

The onset of symptoms depends on the intensity and duration of injury. A classic example is of world famous boxers like Mohammed Ali who are now suffering from Parkinson’s disease due to repetitive injury to brain stem caused by the punches to the jaw.  

Stiffness and difficulty in speaking and movements can be induced by drugs like chlorpromazine, metoclopramide and promethazine but the effect is totally reversible once the drug is stopped.

Early characteristic sign of Parkinsonism is the rigidity coming over the limbs and difficulty to walk straight. A person walks stooping forwards and shuffling his feet because the normal flexibility is lost.

This is accompanied by tremors of the hand which are known as pill rolling tremors because of resemblance to the action of rolling a pill between a finger and thumb.

There is also difficulty in speaking producing a stammering and then an "explosive” speech. The   affected person finds it difficult to articulate words and thus speaks forcibly.

The facial expression is lost due to rigidity of the facial muscles leading to a fixed expressionless gaze.

As the disease progresses, these problems are aggravated. An individual finds it difficult to carry out simple chores like buttoning a dress.  Walking gets more difficult and then one finds it difficult to even stand straight. Speaking clearly becomes impossible and feeding also gets problematic.

In advanced cases the unfortunate individual   becomes a total cripple. An elderly person affected by Parkinsonism may have a stroke at sometime thus adding to the disability. 

Sad part is that with all this happening, mentally the person remains clear in majority of the cases. One has to see an individual suffering from Parkinsonism to understand the misery inflicted. The disease is diagnosed by excluding tumours, strokes or infections affecting the brain by appropriate tests.

Unfortunately, once it develops there is no total cure for this condition. Once it starts it is progressive. Drugs which are available for Parkinsonism only retard the progress. All the care giver can do is to take good care of the patient, feed him/her well, keep him/her clean and try to avoid infections and bed sores.

The person also needs company otherwise loneliness engulfs these individuals and they feel more miserable. Though they are not able to articulate but they understand very well. Therefore it is useful for family members to see that they are not left alone.

Parkinsonism can be prevented if one takes preventive measures from a young age. Onion, carrot, guavas, oranges, germinated grains are rich in antioxidants and keep away degeneration of body cells including those of the brain.

Therefore one’s diet should include fresh fruits, vegetables and whole grains. Regular physical exercise is very beneficial in many ways including keeping limbs and body in a flexible condition even in old age.

Thus even if Parkinson’s disease affects someone doing physical exercise, the limbs and body will not become  stiff  to the extent of being  incapacitated. Avoiding alcohol and tobacco is useful to prevent Parkinsonism. 

It is prudent to avoid such degenerative diseases. Even on getting early signs, a person should become alert and try retarding the progress.

The author is a specialist in Internal Medicine

E-mail – rachna212002@yahoo.co.uk