Parkinson’s Disease( PD)
Parkinson’s disease (PD) is a long term, chronic and progressive disorder of the central nervous system which continue and worsen over time and that mainly affects the motor system of the body. The symptoms generally come on slowly over time. The specific sign and symptoms that an individual experiences varies from person to person. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Thinking and behavioral problems may also occur. Dementia becomes common in the advanced stages of the disease. Depression and anxiety are also common occurring in more than a third of people with PD. Other symptoms include sensory, sleep, and emotional problems. The main motor symptoms are collectively called “Parkinsonism”, or a “Parkinsonism syndrome”.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
Parkinson’s disease (Kampavata): Understanding the Ayurvedic Approach
Parkinson’s disease, known in Ayurveda as “Kampavata,” is a neurological disorder affecting 1% of the population over age 65 and is the fourth most common neurological degenerative disorder found in the elderly. Parkinson’s disease in the ancient Ayurvedic texts is refered as Kampavata in relation to the symptoms, such as tremors. A part from Kampavata (tremors due to vata), parkinson’s also called as, vepathu (shaking, as in being off track or out of alignment), prevepana (excessive shaking), sirakampa (head tremor), spandin (quivering), and kampana (tremors). Parkinson’s disease is most commonly called Kampavata.
The cause of Parkinson’s disease is generally unknown, but believed to involve both genetic and environmental factors. Those with a family member affected are more likely to get the disease themselves. There is also an increased risk in people exposed to certain chemicals or pesticides and among those who have had prior head injuries while there is a reduced risk in tobacco smokers and those who drink coffee or tea.
Parkinsonian syndromes can be divided into four subtypes, according to their origin:
- Primary or Idiopathic
- Secondary or Acquired
- Hereditary parkinsonism
- Parkinson plus syndromes or multiple system degeneration.
Signs and symptoms
Parkinson’s disease affects movement, producing motor symptoms. Non-motor symptoms, which include autonomic dysfunction, neuropsychiatry problems (mood, cognition, behavior or thought alterations), and sensory and sleep disturbances, are also common. Some of these non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms.
Four motor symptoms are considered cardinal in PD
- Tremor: Tremor is the most apparent and well-known symptom. It is the most common; but mostly individuals with PD do not have tremor at disease onset, later on get developed as the disease progresses. These tremors are usually rest tremor means appears when the limb is at rest and disappears with voluntary movement and during sleep. It affects to a greater extent the most distal part of the limb and at onset typically appears in only a single arm or leg or unilaterally but becoming bilateral later on.
- Rigidity: Rigidity or stiffness (an excessive and continuous contraction of muscles) causes resistance to limb movement due to increased muscle tone. In parkinsonism the rigidity can be uniform. Rigidity may be associated with joint pain, such pain being a frequent initial manifestation of the disease. In early stages of Parkinson’s disease, rigidity is often asymmetrical and it tends to affect the neck and shoulder muscles prior to the muscles of the face and extremities. With the progression of the disease, rigidity typically affects the whole body and reduces the ability to move.
- Slowness of movement (bradykinesia or hypokinesia): Hypokinesia (slowness of movement) is another characteristic feature of PD, and is associated with difficulties along the whole course of the movement process, from planning to initiation and finally execution of a movement. Performance of sequential and simultaneous movement is hindered. Bradykinesia is commonly a very disabling symptom in the early stages of the disease. Initial manifestations are problems when performing daily tasks which require fine motor control such as writing, sewing or getting dressed. Bradykinesia is not equal for all movements or times. It is modified by the activity or emotional state of the subject, to the point that some people are barely able to walk yet can still ride a bicycle. Generally people with PD have less difficulty when some sort of external cure is provided.
- Postural instability ( gait disturbance): Postural instability is typical in the late stages of the disease, leading to impaired balance and frequent falls, and secondarily to bone fractures. Instability is often absent in the initial stages, especially in younger people.
- Other recognized motor signs and symptoms include gait and posture disturbances such as festination (rapid shuffling steps and a forward-flexed posture when walking), speech and swallowing disturbances including voice disorders, mask-like face expression or small handwriting, although the range of possible motor problems that can appear is large.
Parkinson’s disease can cause neuropsychiatric disturbances which can range from mild to severe. This includes disorders of speech, cognition, mood, behaviour, and thought.Cognitive disturbances can occur in the early stages of the disease and sometimes prior to diagnosis, and increase in prevalence with duration of the disease.
A person with PD has two to six times the risk of Dementia compared to the general population. The prevalence of dementia increases with duration of the disease. Dementia is associated with a reduced quality of life in people with PD.
Behavior and mood alterations are more common in PD without cognitive impairment than in the general population, and are usually present in PD with dementia. The most frequent mood difficulties are depression, apathy and anxiety. Establishing the diagnosis of depression is complicated by symptoms that often occur in Parkinson’s including dementia, decreased facial expression, decreased movement, a state of indifference, and quiet speech.
In addition to cognitive and motor symptoms, PD can impair other body functions.
Sleep problems are a feature of the disease and can be worsened by medications. Symptoms can manifest as daytime drowsiness, or insomnia.
Alterations in the autonomic nervous system can lead to orthostatic hypotension (low blood pressure upon standing), oily skin and excessive sweating, urinary incontinence and altered sexual function. Constipation and gastric irritations can be severe enough to cause discomfort.
PD is related to several eye and vision abnormalities such as decreased blink rate, dry eyes, deficient ocular pursuit (eye tracking) and saccadic movements (fast automatic movements of both eyes in the same direction), and blurred or double vision. Changes in perception may include an impaired sense of smell, sensation of pain and paresthesia (skin tingling and numbness).
All of these symptoms can occur years before diagnosis of the disease.
So, in brief the symptoms of the PD are:
- Tremor or Shaking
- Small Handwriting
- Loss of Smell
- Trouble Sleeping
- Trouble Moving or Walking
- A Soft or Low Voice
- Masked Face
- Dizziness or Fainting
- Stooping or Hunching Over
Diagnose of Parkinson’s disease is made from the medical history and a neurological examination. There is no lab test that will clearly identify the disease, but brain scans are sometimes used to rule out disorders that could give rise to similar symptoms.
Ayurvedic Treatment (Chikitsa)
It is assumed that both internal and external medicines and treatments in the Ayurvedic system help to check the dopamine loss in the brain cells and the neuro-degeneration process is thus delayed and diluted. Gradually the patient gets power to withstand the symptoms. Ayurveda has a holistic approach towards curing Parkinson’s disease. This is a treatment in which the whole body will be treated. The whole premise of the ayurvedic approach is a natural Parkinson’s treatment that would help the body become healthier while getting rid of the disease. The Ayurvedic treatment is based on the fact that most of the problems arise due to any imbalances in the tridosha (the biological humours in the body), which include the kapha, vata and the pitta.
Ayurvedic treatment for this condition centers around the treatment of vata disturbance. For this two type of treatments are available:
- Sodhana Or Panchakarma chikitsa ( purification process )
- Shamana chikitsa or oral medication
Panchakarma chikitsa or sodhana chikitsa includes:
Initially concentration should be given to boost up the diminished jatharagni or digestive fire,so as to get best results from the panchakarma treatment. If the patient exhibits significant ama or toxin substances then, first proper ama pachana or digestive power increasing medicines should be given for certain days. When the digestion gets improved, gentle and light purification procedures like vamana or virechana should be administered first, along with other processes like
Oleation ( snehana karma) and Fomentation ( swedana swedana ). These procedures form the basis of the constitutional treatment.
- Oleation through massage (abhyanga) and enema (basti) are indicated as well as the ingestion of oils through nasal route ( nasya) as the nasal route is considered to the pathway of the central nervous system or brain.
- Fomentation ( swedana karma) through tub bath with decoctions prepared from herbal medicines, various types of herbal steam baths etc. are advisable.
Alongwith sodhana karma healthy, light diet regimen should be follow along with some medicines orally with will support and help in relieving the symptoms.
Shamana chikitsa or oral medication
Selection criteria for the oral medication is to boost up the immune system, strengthening the nervous system, pacifying vata and relieving the systems. For these benefits following medicines will be used:
- Ashwagandha (Withania somnifera)
- Bala (Sida cordifolia)
- Atmagupta or Kapikachhu (Mucuna pruriens) Levodopa is the general major drug used in treating Parkinsons disease, and Kapikachu has levodopa as the major active compound. Hence it is main and effective in PD.
- Jatamansi (Nardostachys jatamansi)
- Shankhpushpi (Convolvulus pluricaulis)
- Yashtimadhu (Glycyrrhiza glabra)
- Sankhpushpi(Centella asiatica)
- Guduchi (Tinospora cordifolia)
- Apana vayu disturbance may be treated with moist laxatives such as Eranda taila or castor oil, psyllium (Plantago psyllium), flax seed (Linum usitatissimum), or the traditional formula, triphala.
Diet for Parkinson’s disease treatment
Here are a few dietary tips for those who have Parkinson’s and are undergoing medication to treat it.
- It is vital for the patients to remember that they have to control their diet in order to get a better grasp on their weight. Being healthy and being the right weight can go a long way when it comes to keeping the body ready for the medication it takes in every day.
- It is vital for people with Parkinson’s to include high fiber foods in their diet. Some of the most important foods with high fiber include legumes like peas and beans, whole grain bread and food, vegetables, cereals, bran, pasta, rice, fresh fruits etc.
- It is important for these people to also avoid food that has a lot of cholesterol or saturated fat.
- It is best to reduce the amount of milk or yogurt a person consumes as well. Sugar intake should also be severely limited.
- Salt intake should also be limited.
- High water intake would be an important aspect of Parkinson’s disease treatment. At least 8 glasses of water should be consumed per day. However, people have to make sure that they don’t severely increase the intake of water for they might end up losing important minerals from their body.
- It is better for people to avoid alcohol when they are on medication to treat Parkinson’s for the alcohol might interfere with the medication.
Practice of yoga can help people suffering from Parkinson’s to control and endure the disease. Yogic breathing programs such as Bhramari Pranayama, kapala bhati, anuloma viloma etc are quite effective and if, coupled with ayurvedic treatments such as Pancha Karma can reduce the need for levodopa and related drugs, and helps in alleviating and reducing symptoms of the disease. Certain other yoga postures such as standing, supine, sitting or inverted postures can be performed under guidance and supervision of trained experts of yoga, in a manner such that even patients with limited flexibility can be trained to perform them. It can help in improving flexibility and overall quality of life.
Exercise in middle age reduces the risk of Parkinson’s disease later in life.Caffeine also appears protective with a greater decrease in risk occurring with a larger intake of caffeinated beverages such as coffee. Although tobacco smoke causes adverse health effects, decreases life expectancy and quality of life, it may reduce the risk of PD by a third when compared to non-smokers The basis for this effect is not known, but possibilities include an effect of nicotine as a dopamine stimulant. Tobacco smoke contains compounds that act as MAO inhibitors that also might contribute to this effect.
Antioxidants, such as vitamins C and D, have been proposed to protect against the disease but results of studies have been contradictory and no positive effect has been proven. The results regarding fat and fatty acids have been contradictory, with various studies reporting protective effects, risk-increasing effects or no effects. Also, there have been preliminary indications of a possible protective role of estrogens and anti-inflammatory drugs.