Parkinson’s disease (PD) is a progressive neurological degenerative disorder of the central nervous system, resulting from degeneration of neurons in a region of the brain that controls movement creating a shortage of the brain signaling chemical dopamine, causing the movement impairments that characterising the disease. It was first described in 1817 by James Parkinson, a British physician who published a paper on what he called “the shaking palsy.” In this paper, he set forth the major symptoms of the disease that would later bear his name. It has probably existed for many thousands of years. Its symptoms and potential therapies were mentioned in the Ayurveda.
This condition is referred to in the modern ayurvedic literature by various names for tremors: Kampavata (tremors due to vata), 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. Causes of Parkinson’s Disease
According to ayurveda vayu “ vaat “ controls the voluntary & involuntary movements of the body so when the vaat dosha become vitated and effects the cells of brian it causes Parkinson’s disease. apana vayu accumulates (sanchaya) and may become aggravated (prakopa) then the stage is set for vata to overflow (prasara) into circulation. Overflow causes vyana vayu to become disturbed within the rasa dhatu. Systemic signs of vata disturbance occur, such as dryness of the membranes of the body. Vata may relocate (sthana samsraya) to any dhatus that are weak. When a preexisting weakness resides in the tissue of the brain, this becomes the site of relocation and thus we have a condition of vata (prana, samana and vyana) in the majja dhatu, damaging portions of the brain stem and causing altered coordination and tremors. Additional components of the pathology which are commonly present include vata (vyana) entering mamsa dhatu causing muscle rigidty and prana kshaya (diminished prana) in the manovaha srota causing depression.
In addition, kapha appears to be diminished in the majja dhatu in these patients. An increase in vata dries out kapha (cellular structure) in the susceptible region of the majja dhatu (brain stem). This creates an open space inviting vata to become vitiated. While the condition has a predominantly vata pathology, pitta can also play an important role in the samprapti (pathology) as its heat can burn out the cellular structure causing kapha kshaya (diminished kapha) in the majja dhatu, creating the original weakness in the brain stem. Hence personalities based in fear (vata) and intensity (pitta) are most predisposed to this condition and those of kapha nature are the most naturally protected.
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next “relay station” of the brain, the corpus striatum, to produce smooth, purposeful movement. Loss of dopamine results in abnormal nerve firing patterns within the brain that cause impaired movement. Studies have shown that most Parkinson’s patients have lost 60 to 80 percent or more of the dopamine-producing cells in the substantia nigra by the time symptoms appear. Recent studies have shown that people with PD also have loss of the nerve endings that produce the neurotransmitter norepinephrine. Norepinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system, the part of the nervous system that controls many automatic functions of the body, such as pulse and blood pressure. The loss of norepinephrine might help explain several of the non-motor features seen in PD, including fatigue and abnormalities of blood pressure regulation.
Signs Symptoms (Rupa And Laksana)
Early symptoms of PD are subtle and occur gradually. Affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. They may lose track of a word or thought, or they may feel tired, irritable, or depressed for no apparent reason. This very early period may last a long time before the more classic and obvious symptoms appear.
The most common recognizable symptom of Parkinson’s disease is known as a “pill rolling tremor.” In this condition, the thumb and fingers move uncontrollably in a manner resembling the rolling of a pill between the fingers. Tremors most commonly appear in the hands, arms and legs, though other areas may be affected.
Small movements of the hands and fingers may eventually be difficult. This condition called micrographia, can make ordinary daily activities such as buttoning a shirt very difficult.
The most common signs and symptoms of Parkinsons disease are:
Friends or family members may be the first to notice changes in someone with early PD. They may see that the person’s face lacks expression and animation (known as “masked face”) or that the person does not move an arm or leg normally. They also may notice that the person seems stiff, unsteady, or unusually slow.
As the disease progresses, the shaking or tremor that affects the majority of Parkinson’s patients may begin to interfere with daily activities. Patients may not be able to hold utensils steady or they may find that the shaking makes reading a newspaper difficult. Tremor is usually the symptom that causes people to seek medical help.
People with PD often develop a so-called parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward (called festination), and reduced swinging of the arms. They also may have trouble initiating movement (start hesitation), and they may stop suddenly as they walk (freezing).
PD does not affect everyone the same way, and the rate of progression differs among patients. Tremor is the major symptom for some patients, while for others , tremor is nonexistent or very minor.
Tremor : The tremor associated with PD has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion at a rate of 4-6 beats per second. It may involve the thumb and forefinger and appear as a “pill rolling” tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. For example, the shaking may become more pronounced a few seconds after the hands are rested on a table. Tremor usually disappears during sleep or improves with intentional movement.
Rigidity : It is a resistance to movement, affects most people with PD. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In PD, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient’s arm, which will move only in ratchet-like or short, jerky movements known as “cogwheel” rigidity.
Bradykinesia : It is the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easily — such as washing or dressing — may take several hours.
Postural Instability : Postural instability, or impaired balance, causes patients to fall easily. Affected people also may develop a stooped posture in which the head is bowed and the shoulders are drooped.
According To Ayurveda
Stambha (rigidity), in which movement becomes slow and difficult to initiate. Patients usually have to look at their feet to begin, shuffle forward to and occasionally, inadvertently break into a trot (festination). The arms do not swing in coordination with the usual stride.
The face may appear without expression (mask face), dull or depressed, though no depression may be present. Reduced blinking is an early symptom. The voice becomes monotone and expressionless, further causing some to mistake this as depression. Fifty percent of patients will develop dementia- Vishada (depression), can accompany the disease but the symptoms of mask face and monotone voice occur as a part of Parkinson’s disease and should not be confused with depression.
Upon examination, passive movements of the limbs, produces what is commonly called, “cogwheel rigidity.” This is an unconscious resistance to passive motion causing the limb to move with irregular starts and stops or a ratchet type motion. Sensory examination and reflexes are usually normal. Other signs of autonomic nervous system dysfunction may or may not be present, including orthostatic hypotension, constipation and urinary hesitancy.
A number of other symptoms may accompany PD. Some are minor; others are not. Many can be treated with medication or physical therapy. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms varies from person to person.
Depression : This is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Fortunately, depression usually can be successfully treated with antidepressant medications.
Emotional changes : Some people with PD become fearful and insecure. Perhaps they fear they cannot cope with new situations. They may not want to travel, go to parties, or socialize with friends. Some lose their motivation and become dependent on family members. Others may become irritable or uncharacteristically pessimistic.
Difficulty with swallowing and chewing : Muscles used in swallowing may work less efficiently in later stages of the disease. In these cases, food and saliva may collect in the mouth and back of the throat, which can result in choking or drooling. These problems also may make it difficult to get adequate nutrition. Speech-language therapists, occupational therapists, and dieticians can often help with these problems.
Speech changes : About half of all PD patients have problems with speech. They may speak too softly or in a monotone, hesitate before speaking, slur or repeat their words, or speak too fast. A speech therapist may be able to help patients reduce some of these problems.
Urinary problems or constipation : In some patients, bladder and bowel problems can occur due to the improper functioning of the autonomic nervous system, which is responsible for regulating smooth muscle activity. Some people may become incontinent, while others have trouble urinating. In others, constipation may occur because the intestinal tract operates more slowly. Constipation can also be caused by inactivity, eating a poor diet, or drinking too little fluid. The medications used to treat PD also can contribute to constipation. It can be a persistent problem and, in rare cases, can be serious enough to require hospitalization.
Skin problems : In PD, it is common for the skin on the face to become very oily, particularly on the forehead and at the sides of the nose. The scalp may become oily too, resulting in dandruff. In other cases, the skin can become very dry. These problems are also the result of an improperly functioning autonomic nervous system. Standard treatments for skin problems can help. Excessive sweating, another common symptom, is usually controllable with medications used for PD.
Dementia or other cognitive problems : Some, but not all, people with PD may develop memory problems and slow thinking. In some of these cases, cognitive problems become more severe, leading to a condition called Parkinson’s dementia late in the course of the disease. This dementia may affect memory, social judgment, language, reasoning, or other mental skills. There is currently no way to halt PD dementia, but studies have shown that a drug called rivastigmine may slightly reduce the symptoms. The drug donepezil also can reduce behavioral symptoms in some people with PD-related dementia.
Orthostatic hypotension : Orthostatic hypotension is a sudden drop in blood pressure when a person stands up from a lying-down position. This may cause dizziness, lightheadedness, and, in extreme cases, loss of balance or fainting. Studies have suggested that, in PD, this problem results from a loss of nerve endings in the sympathetic nervous system that controls heart rate, blood pressure, and other automatic functions in the body. The medications used to treat PD also may contribute to this symptom.
Muscle cramps and dystonia : The rigidity and lack of normal movement associated with PD often causes muscle cramps, especially in the legs and toes. Massage, stretching, and applying heat may help with these cramps. PD also can be associated with dystonia — sustained muscle contractions that cause forced or twisted positions. Dystonia in PD is often caused by fluctuations in the body’s level of dopamine. It can usually be relieved or reduced by adjusting the person’s medications.
Pain : Many people with PD develop aching muscles and joints because of the rigidity and abnormal postures often associated with the disease. Treatment with levodopa and other dopaminergic drugs often alleviates these pains to some extent. Certain exercises also may help. People with PD also may develop pain due to compression of nerve roots or dystonia-related muscle spasms. In rare cases, people with PD may develop unexplained burning, stabbing sensations. This type of pain, called “central pain,” originates in the brain. Dopaminergic drugs, opiates, antidepressants, and other types of drugs may all be used to treat this type of pain.
Fatigue and loss of energy : The unusual demands of living with PD often lead to problems with fatigue, especially late in the day. Fatigue may be associated with depression or sleep disorders, but it also may result from muscle stress or from overdoing activity when the person feels well. Fatigue also may result from akinesia – trouble initiating or carrying out movement. Exercise, good sleep habits, staying mentally active, and not forcing too many activities in a short time may help to alleviate fatigue.
Sexual dysfunction : PD often causes erectile dysfunction because of its effects on nerve signals from the brain or because of poor blood circulation. PD-related depression or use of antidepressant medication also may cause decreased sex drive and other problems. These problems are often treatable.
Diagnosis of Parkinson Disease
There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. A neurologist who can evaluate symptoms and their severity usually diagnoses Parkinson’s disease. No test can clearly identify the disease. Tests, such as brain scans like MRI & CT, can help doctors decide if a patient has true Parkinson’s disease or some other disorder that resembles it. Since many other diseases have similar features but require different treatments, making a precise diagnosis as soon as possible is essential so that patients can receive the proper treatment
Ayurvedic Treatment- Ayurvedic management offers some hope.
The exact cause of the PD is not known, there is no evidence that it is heredity. So , above all Vata is most important in Ayurveda as well as in PD , the root cause of the disease is disturbance and vitiation of vata.
1. Oral Medications
2. Rasayana Therapy
3. Panchakarma Therapy
4. Basti Treatment
5. Oil Therapies
a) Oleation and fomentation form the basis of the constitutional treatment . Oleation through massage (abhyanga) and enema (basti) are indicated as well as the ingestion of oils.
b) Shirodhara with oils medicated with ashwagandha (withania somnifera) and bala (sida cordifolia) are commonly used to pacify vata and build ojas. They are known to be rejuvenative with a strong nourishing action on the nervous system.
c) Medicated Enema ( Basti ) is most effective in this disease . Vata must be pacified at its site of origin in the colon, it is the main site of vata.
d) Massage with vata shamak medicated oils are helpful in reducing muscular rigidity.
e) Rasayana therapy rejuvenates the body and improves the immune system.
A vata pacifying diet and proper dietary habits are essential to long term success. Additional vata pacifying regimens including daily oil massage (applied by the patient or practitioner) and sensory therapies complete the treatment regimen.
Finally, a supportive environment should be created which is not overly stimulating. Meditation and yogic practices are the cornerstone of all holistic ayurvedic programs, as they cultivate a sattvic mind and teach the patient how to manage their internal energies.
This is essential for good health. When pitta is vitiated in addition to the primary vata disturbance, care should be taken that treatment and lifestyle do not overheat the mind or body.
Herbs such as Gotu Kola (VPK-, bitter-cool-sweet) which are cool and tonify the mind and nervous system may be added to any formula and are essential if there is a distrubance of sadhaka pitta (symptoms of sadhaka pitta vitiation: Anger, overly critical, intense). Another good herb to add to the formula for a pitta-vitiated individual is Gaducci (Tinospora Cordifolia), and excellent bitter, nervine tonic and pitta rasayana.