By Dr Ananya Mandal, MD
Ancient references to Parkinson’s
Parkinson's disease has been known to mankind since ancient times. It is referred to in the ancient Indian medical system of Ayurveda under the name Kampavata (where “kampa” means tremor in Sanskrit).
In Western medicine it was described by the physician Galen as "shaking palsy" in AD 175.
Ancient Chinese sources also provide descriptions that suggest Parkinson's disease.
It was in 1817 that a detailed medical essay was published on the subject by London doctor James Parkinson after whom it was named Parkinson’s disease. His essay was called “An Essay on the Shaking Palsy”. This essay established Parkinson's disease as a recognised medical condition. Parkinson studied and reported six cases in his own practice.
Sylvius de la Boë wrote of the symptoms of resting tremor, and Sauvages described festination – a form of gait or walk associated with Parkinson’s disease.
Charcot’s work on Parkinson’s
The idea was picked up by a French neurologist by the name of Jean Martin Charcot, six decades later. Charcot was the first to recognise the importance of Parkinson's work and named the disease after him. Charcot and his students described the clinical spectrum of this disease. They found two types – the tremor stage and the rigidity stage. They described in full detail the physical changes in a patient.
Gowers’ work on Parkinson’s
William Gowers in his “Manual of Diseases of the Nervous System,” described his personal experience with 80 patients in the 1880s. He correctly identified the men were more prone to the disease and also detailed the joint deformities typical of the disease.
History of pathogenesis and research on Parkinson’s disease
It was in the 1960s that that the chemical differences in the brains of Parkinson's patients were identified. The researchers found that there were low levels of dopamine and degeneration of nerve cells in part of the brain called the substantia nigra. This made effective treatment of Parkinson’s disease with dopamine agonist a possibility.
Brissaud first proposed damage to the substantia nigra as the site of brain damage in Parkinson's disease, and Trétiakoff and Foix and Nicolesco further explored the pathologic studies of the midbrain in relationship to the disease during the 1920s.
In 1953 by Greenfield and Bosanquet analyzed the brain changes and the brain stem lesions delineating Parkinson’s disease from other similar conditions. The staging and clinical progression of Parkinson's disease was studied by Hoehn and Yahr after which they introduced their internationally recognized staging system.
Development of treatments for Parkinson’s disease
In the 1960s, Levodopa was first administered to treat the symptoms and is still the most widely used medicine for Parkinson’s disease.
Parkinson in his initial essay had recommended bloodletting from the neck followed by vesicatories to induce blistering and inflammation of the skin as treatment. Jean-Martin Charcot and William Gowers were responsible for much of the advancement in understanding the disease.
One of Charcot’s interns, Ordenstein, suggested the use of belladonna alkaloids in treatment of the disease. These agents are centrally active anticholinergic drugs that are still used in some forms of Parkinsonism (Drug induced Parkinsonism). Charcot’s preferred product for Parkinson's disease was hyoscyamine that is an anticholinergic agent. Charcot advocated vibratory therapy for the management of Parkinson's disease.
Dopamine was synthesized first in 1910 by G. Barger and J. Ewens. P. Holtz discovered the enzyme, dopa decarboxylase and documented that levodopa was broken down to dopamine through its action. Birkmayer injected levodopa intravenously for the first time to Parkinsonian patients in 1961. He demonstrated the results in his paper showing that patients who could not stand up when seated, and patients who when standing could not start walking performed all these activities with ease after levodpa administration.
This was followed by modern discoveries of dopamine agonists and enzyme inhibitors that enhance the availability and activities of dopamine including monoamine oxidase inhibitors and catechol-O-methyl transferase inhibitors.
The Parkinson's Disease Foundation was established in America in1957 to assist sufferers and to fund and promote further research. After the 1960’s research in Parkinson’s progressed at a rapid rate. Michael J Fox Foundation was launched most recently after the much loved television and movie actor. Since its inception in 2000 it has succeeded in raising over 90 million US dollars.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)