NERVOUS SYSTEM

It occurs most commonly between the ages of 50 to 70, and its cause is unknown. It has been associated with epidemics of encephalitis, arteriosclerosis, syphilis and following head trauma such as in the case of boxing, although the connection with these diseases is often disputed.

The disease has an insidious onset with the occurrence of a slight tremor in the fingers of one hand or in one leg. The sufferer develops a fixed staring facial expression when a smile will spread slowly and disappear slowly. The voice becomes monotonous and there is a slowing down of all muscular movement. The tremor is generally most pronounced in the hands with the production of a pill rolling movement between the thumb and fingers.

In the early stages the tremor can be lessened by relaxation or by movement. Emotional disturbances and tiredness can aggravate the tremor. There is never total paralysis although eventually the patient may become so incapacitated by muscular rigidity and tremor as to be helpless in caring for themselves. However even in the late stages of the disease complex muscle movement can be performed when the patient is excited or under great emotional distress.

In the established disease there is a stooped attitude and a walking motion in which the person tends to shuffle along at an accelerating pace seeming to fall forwards.

The disease is slowly progressive. Intellect is usually normal in the early years of the disease but eventually dementia will occur in about one third to one quarter of cases who have survived for longer than 10 to 15 years.

Although there is no treatment which can stop the gradual degeneration of nerve cells which accompany the disease, a considerable degree of relief from symptoms can occur with good medical management and drug therapy.

Neurosurgery in carefully selected patients who are relatively young and in good health can be performed and can be very beneficial. There should be a satisfactory balance between exercise, activity and rest associated with physiotherapy involving massage and stretching of muscles.

Drug therapy has improved greatly in the last few years - it often controls the tremor and the rigidity. The treatment can be associated with its own side effects so regular medical review is needed.

Finally positive, compassionate and emotional support in most cases can help the person achieve a happy and effective life for many years.