This year, World Parkinson’s Disease Day on 11 April marks 200 years since the publication of a medical classic, James Parkinson’s “An Essay on the Shaking Palsy”, which is now recognised as Parkinson’s disease (PD).

Approximately 60 years after its first publication, the neurodegenerative disease was named after Parkinson’s name by a French neurologist, Jean-Martin Charcot, who was the first to acknowledge the importance of Parkinson’s work.

Pioneer in medicine and political activist

Parkinson obtained his qualification as a surgeon when he was 29 years old from the London Hospital Medical College in 1784, the year of his father’s death. He followed in his father’s footsteps and continued practising as an apothecary surgeon.

At the same time, he was also a social reformer and a political activist. In 1792, Parkinson joined the London Corresponding Society, and having a talent for writing, drafted and revised the pamphlets to spread across England. The pamphlets criticised the political system and demanded a reform of parliament.

Later in his life, Parkinson offered humanitarian aid by promoting the importance of the welfare of children who worked as apprentices. In addition, he supported reform of the law governing apprentices, in order for the system to be reviewed.

The discovery milestones of Parkinson’s disease

When Parkinson published his essay of six cases in 1817, PD was called “paralysis agitans”, which translates to “shaking palsy” in English. He was the first to discover the features of PD.

He described the characteristic resting tumour, abnormal gait and posture, paralysis and diminished muscle strength, as well as how the disease progresses over time. Besides that, Parkinson also gave a detailed description of the symptoms and stages of this disease, which gradually took over the six patients he observed.

James Parkinson (left) first described Parkinson’s disease in his publication “An Essay on the Shaking Palsy” (right) in 1817. Photo credit: Parkinson's Disease And Movement Disorder Society
James Parkinson (left) first described Parkinson’s disease in his publication “An Essay on the Shaking Palsy” (right) in 1817. Photo credit: Parkinson's Disease And Movement Disorder Society

In the 1960s, the chemical differences in the brain of Parkinson’s patients were first identified. The low level of dopamine was found to be the cause of the degeneration of nerve cells in the substantia nigra of the brain.

This discovery paved the way to the first effective medicinal treatment of the disease. Levodopa was the first drug administered to treat the symptoms and has since become the gold standard in medicine.

Since the 1960’s, research on PD has continued to progress rapidly. Even though there is still no cure 200 years after its first discovery, the symptoms of PD can now be effectively controlled and reduced in severity with available treatments.

Parkinson’s contribution to current studies

PD was originally called a "shaking palsy," but not everyone with PD has a tremor. Today, medical researchers have identified a variety of symptoms of PD, with some patients having symptoms that evolve slowly over a span of 20 years.

“The main motor symptoms are stiffness, slowness, balance problems and tremor – although about 30% of patients don’t have a prominent tremor,” said Dr Richard Walsh, consultant neurologist at Tallaght Hospital, Dublin, Ireland.

Ronnie Gillanders, 73, is one of the 12,000 people living with PD in Ireland. He believes he had the condition for around 10 years before he was diagnosed.

“I had lost my sense of smell 10 years prior to diagnosis. I also had severe sweating at night and vivid dreams.”

Walsh confirmed that these are early signs of the PD and that current studies are seeking reliable biomarkers for earlier diagnosis. Paddy Browne, Ireland’s only Movement Disorders Advanced Nurse Practitioner, also remarked that early access and intervention to services is the key of living with PD.

“There are smell and bowel studies. The pathological changes in the brain may begin earlier in the bowel. Earlier diagnosis would be useful for preventative strategies in the future,” said Walsh.

With strenuous effort made to develop a cure for the disease, neurology researchers remain hopeful that the future for PD patients will continue to improve. MIMS

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