Kensington NeuroBlog 5 : 200 Years of Parkinson’s Disease
2017 is the 200th anniversary of the first description of Parkinson’s disease. One of the commonest neurological disorders in the world, with a lifetime risk of developing the condition of 1.5%, Parkinson’s disease causes tremor at rest, rigidity, bradykinesia (slowness of movement) and, in some cases, loss of the postural reflexes. The condition is typically asymmetrical, at least initially. The disease commonly affects in people in their 70s and beyond, though it can present in middle age. In most cases, Parkinson’s disease does not generally affect life expectancy: people live with it, rather than die of it.
The classic description of the disease is An Essay on the Shaking Palsy, published in 1817 by James Parkinson. Parkinson was a surgeon-apothecary (the prototype of the modern general practitioner) in Regency London. After flirting with radical politics, Parkinson settled into the life of doctor and natural philosopher, publishing widely both on medical and geological topics. The Essay contains both snapshots of the condition in people whom Parkinson simply approached in the street and interviewed, and a detailed natural history of the condition in one patient over the course of 12 years.
Parkinson did not coin his own eponym. This was bestowed by the most famous of all 19th century neurologists, Jean-Martin Charcot, who christened it ‘la maladie de Parkinson’. Charcot’s clinical lectures of the 1860s and 1870s stressed the importance of rigidity, distinguished bradykinesia from weakness and emphasised the ‘pill-rolling’ tremor of Parkinson’s disease. Charcot proposed various treatments, including - after observing that the tremor of the condition diminished when sufferers travelled on the railway - a trembling armchair.
Research in 1950s established that the fundamental problem in Parkinson’s disease was the loss of dopamine-containing cells in the brain. The dopamine precursor L-DOPA was introduced as a treatment for the condition in the mid-1960s, and combination medications containing L-DOPA (Sinemet and Madopar) rapidly became gold standard treatments for the disease. In the 1970s the dopamine agonist bromocriptine was shown to be effective, and subsequent decades saw many other new medications introduced, as well as an increased awareness of, and willingness to treat non-motor manifestations of the disease, such as depression, urinary and sleep disturbances. Some patients are suitable for surgery such as deep brain stimulation; and the future may lie in stem cell treatments, or even gene therapy.
The advocacy of famous sufferers such as Muhammed Ali and Michael J Fox (whose Foundation has provided extraordinary funding for basic research into the disease) has brought Parkinson’s disease to public attention. 200 years after James Parkinson published his observations of the condition, people with Parkinson’s disease have more reason than ever to feel hopeful for the future.
By Dr Mark Weatherall, Consultant Neurologist