New technological research offers Parkinson disease a fresh lease of life | Sunday Observer

New technological research offers Parkinson disease a fresh lease of life

8 August, 2021

The rapidly aging population in Sri Lanka, and the surge in pre – existing diseases such as diabetes among elderly persons has seen an increase in several noncommunicable diseases ( NCDs) one of which is Parkison’s disease. This disease does not happen overnight . The process is slow but relentless progression is the rule.

The Sunday Observer spoke to the President of the Association of Sri Lanka Neurologists (ASN) Dr Gamini Pathirana to explain to our readers what Parkinson’s disease is , its early symptoms, and current interventions to help patients to enjoy longer and better quality of life.


Q: On World Brain day recently, the World Federation of Neurology and the International Parkinson and Movement Disorder Society came together to discuss among other brain related problems , the little understood Parkinson Disease. Enlighten us about what Parkinson disease (PD) is.

A. Parkinson’s disease mostly affects older persons and it usually affects motor aspects of brain function. Having said that non motor symptoms such as; pains, sleep issues, psychiatric manifestations too can occur in this disease. It was long known to be a disease of the brain. But now we understand that this disease can impact tissues outside the brain namely gut (constipation), autonomic nervous system (issues with blood pressure fluctuation ect). As the disease progresses it can affect most brain functions leading to for example dementia and psychosis as well.

Q: In other words it is a disease that impacts movement and almost all aspects of brain function. ?


Q: With the current pandemic people with Parkinson’s disease may be particularly impacted by the current Covid-19 pandemic. In what way are PD patients more vulnerable than others to this virus ? Your comments

A. Covid- 19 infection can infect any individual in the community. But death from pneumonia related to Covid- 19 is commonly seen in patients with chronic disease conditions.

This is attributed to immuno suppression in such persons compared to normal people in the community. In that sense Parkinson’s patients especially those who are in advanced stage of the disease too would be vulnerable for complicated Covid- 19 infection.

Q: With regard to the prevalence of PD, I understand that currently more than seven million people of all ages worldwide are afflicted by it.. Have there been any recent studies on a national scale to find out how many people in Sri Lanka have PD?

A. In general, it affects 1-2 per 1000 population and among those above 60 years of age it affects about 1%. In Sri Lanka we do not have exact prevalence of the disease.

But we assume it is as prevalent in Sri Lanka as in other countries. We also know that this is a disease of elderly, and the prevalence increases with aging. Since Sri Lanka has a rapidly aging population, it is expected that the prevalence of PD will increase further in future. .

Q: Is there a difference in the incidence in geographical locations, so, can our different climatic conditions cause it?

A. This disease occurs with advancing age. Why some develop this disease and others do not is assumed to be due to genetic predisposition. Environmental factors may play a role in the disease causation. This disease does not seem to be more prevalent in certain climates over others.

Q: Is it a disease that predominantly affects the poorer sections of the country? If so why?

A. The risk for developing this disease spans across all social strata within a community irrespective of financial, social, religious, ethnic background. Whether you are rich or poor this disease may strike when you come to a particular age.

Q: Is it a slow process or does it happen overnight?

A. It does not happen overnight. Initiation of the pathology within the brain is a slow process. In fact it is assumed that the initial phase which is called ‘pre-clinical phase’ where only pathological changes are assumed to be present without any symptoms starts around 40-50 years or even earlier.

Then the patient enters the next stage called ‘premotor phase’ where inability to smell, constipation and sleep disturbances and various pains (e.g. back pain ) may be present, followed by ‘motor phase’ where the classic symptoms of the disease will appear. Hence, it is a gradual process.

Q: When and at what age does it usually start ?

A. It usually starts after 50 years of age.

Q: Who are those most vulnerable to it gender wise ?

A. There is no major difference, but epidemiological studies have found that there is a male preponderance in all communities.

Q: What are the main underlying causes ?

A. This is attributed to deposition of a protein called ‘alpha synuclein’ in certain brain circuits.

It is observed that people who follow healthy lifestyles, namely healthy diet, exercise, lack of stress, and those who optimally control cardiac risk factors could postdate the onset of this disease as well as reduce the impact of this disease on one’s life.

It is also know that regular exercise and certain forms of dancing techniques (example; Tai Chi dance in Japan) could help reduce the impact of disease on those who have it

Q: Can one inherit it? If a person has a family history of Parkinson disease are they more likely to get it as well?

A. There are familial parkinsonian syndromes. But they are rare. Majority of patients are actually sporadic, meaning they just appear in certain persons in the community randomly. Having said that, if there is a familial tendency, such families may have a higher risk of developing this disease.

Q: Can eating the wrong foods cause it?

A. Foods generally have nothing to do with causation. But eating whole grains, vegetables, fruits, milk and dairy products, and protein-rich foods such as meat and beans are encouraged for such patients. Protein components in the diet is best taken at night in those who have the disease

Q: Underlying pre conditions like diabetes and heart problems as well as hypertension – what role do they play in causing PD?

A. These conditions are considered as cardiac or stroke risk factors. It is very important that such risk factors are optimally controlled because otherwise uncontrolled such risk factors may lead to fast progression of patient’s condition.

Q: Brain accidents? Surgery? Are they contributory causes ?

A. Frequent head trauma, like on boxers may cause Parkinson’s disease.

Q: When do the first symptoms appear?

A. Usually at 50 years or later. But young persons with PD are seen occasionally, and they are usually genetic Parkinsonian syndromes.

Q: What are the early warning symptoms we can look out for? ( explain in detail )

A. Anosmia or inability to smell may pre-date Parkinson’s disease by many years. It does not mean that everyone with an inability to smell will develop PD. They could also have constipation and sleep disturbances as early symptoms

Q: Do all those who have Parkinson disease develop the same symptoms, or do they vary from person to person?

A. Most will have the same kind of symptoms. But the pattern of involvement and the rate at which it progresses may differ from one individual to another. One may have predominantly tremor and another may have no tremor at all.

Q: What is the impact on the entire human body itself?

A. It has a huge impact on the body. Before Levodopa was discovered people were made bed bound from this disease.

Thanks to Dr Carlson who discovered Levodopa therapy which made a significant difference to those who had it. In the pre levodopa era a lot of PD people who died was not due to disease directly but from immobility which is a consequence of the condition.

Q: Diagnosis – How soon can it be diagnosed and who is able to diagnose it?

A. In the initial phase there could be a diagnostic delay due to nonspecific symptoms. It is possible that many doctors have diagnosed this condition as a stroke because this condition affects only one side of the body initially. The disease manifestations remain asymmetric throughout disease. There could be similar other diseases like Steele Richarson syndrome and many others which I would not mention here since they are rare. Usually a physician, neurologist or movement disorder specialist should be able to diagnose this condition without doubt.

Q: Spell out some of the procedures in diagnosing a patient who is suspected of having PD.

A. Diagnosis is mainly clinical i.e based on history that patients provide and by the examination findings. Further testing is only indicated in some individuals with atypical patterns .

Q: Once a patient with symptoms of Parkinson has been diagnosed and confirmed what is the next step? Does the patient have to be warded or can he or she go home ?

A. Usually they do not need admission to hospital. They can be managed as outpatients.

Q: Treatment- what are the current treatments available for patients in Sri Lanka ?

A. First line treatment is always pharmacological agents. Levodopa treatment is received by almost all patients who are diagnosed with this condition. There are also other groups of medications like dopamine agonists (ropinirole), COMT inhibitors (entacapone) and many others as well.

Q: Globally what are the new breakthroughs in diagnosis, and effective interventions?

A. There are certain treatment options like deep brain stimulations for advanced Parkinson’s disease which is standard practice for those with advanced disease and techniques like infusion of duodopa intestinal gel as well. However they are not available in Sri Lanka.

Q: As President of the Association of Sri Lankan Neurologists (ASN) tell us what your Association is doing to help these patients amid the problems created by the Covid pandemic.

A. The Covid-19 pandemic made many other patients keep away from doctors due to restrictions in travel, and general advice to stay at home. Hence this was a challenging period for both patients and their carers as well as for doctors in providing best of services in a situation where patients cannot meet their doctors.

PD patients need constant advice in order to help enjoy a good quality of life, especially at the advanced stages in this illness. We advise all PD patients to get the Covid-19 vaccine from any type of vaccine available

Q: Have you a message for readers with regard to Parkinson disease?

A. If you are young my advice is to follow a healthy lifestyle avoiding unnecessary risks that could affect your health later in life. For those who are already afflicted by PD get advice from your doctor as to how you should look after yourself.

If you are a carer for such a patient I would advise you to read, understand and educate yourself about the disease and how to look after a patient with PD.