How to recognise the first signs of Parkinson's
GP Nina Byrnes answers questions on Parkinson's disease and lesions.
My father has developed a tremor lately. Someone suggested this could be Parkinson's disease. I don't know much about this condition and I don't want to scare him. Are there any other signs?
Parkinson's disease is a chronic progressive neurological condition. It is thought to affect about one in five hundred people and occurs more commonly in men than women. Symptoms more commonly occur in those over the age of 50 but it can also occur in younger people. The actor Michael J. Fox was diagnosed at a young age and has done a lot to raise the profile of this disease.
Parkinson's disease occurs due to the loss of nerve cells in a part of the brain called the substantia nigra which results in reduced levels of the neurotransmitter dopamine. This hormone assists in smooth movement of the body. When levels of dopamine are reduced by 60 to 80pc classic movement symptoms of Parkinson's may occur. It is thought to take many years for this reduction to occur so research today is trying to identify ways to diagnose this before dopamine levels have dropped so low.
There are many symptoms that may suggest Parkinson's disease. Losing your sense of smell may be an early symptom and can occur many years before others appear. Constipation may occur as movement through the gut slows. There may be some difficulty swallowing foods or a feeling of things occasionally catching in the throat. The arms tend not to swing when walking in those with Parkinson's disease. There may also be a change in facial features often referred to as a "masked face". This results in a stern look and lack of facial expression. This can be associated with a blank stare and reduced blinking.
Speech changes occur. Speech may become soft or hoarse and occasionally slurred. Balance problems and dizziness can be symptoms or may also occur as a side effect of Parkinson's medication. Writing may become very small.
Mental symptoms include anxiety, depression, memory problems in some and sleep problems. The classic symptoms of Parkinson's remain the presence of a tremor, slowness of movement called bradykinesia, and rigidity.
A tremor is an uncontrollable shake.This most commonly occurs in the hand or arm and is most noticeable when the limb is otherwise still. It may start with a back and forth rolling of the thumb and finger referred to as "pill rolling". Bradykinesia makes simple movements very difficult. It may be harder to initiate movement such as getting out of a chair or starting to walk. Steps become shorter and stiffer and may result in shuffling to move. There may be stiffness and soreness of muscles throughout the body.
The symptoms of Parkinson's are not specific to this disease and may occur in many other conditions and in healthy individuals. However, if several symptoms occur together it is worth considering. If you have concerns talk to your dad and offer to go with him to his GP. If Parkinson's is suspected referral to a neurology clinic will be necessary.
Question: My daughter has lots of small raised pimples on her body. I have been told this is Molluscum Contagiosum and that it will go away on its own. It's been there three months now. How long is this likely to last?
Dr Nina replies: Molluscum Contagiosum are small raised pink pimple-like lesions that appear on the skin. They can occur at any age but occur most commonly in those aged one to five years. The bumps are sometime mistaken for warts but they tend to be smooth whereas warts often have a cauliflower like surface. They can vary in size from pinpoint to the size of a small pea. This infection is caused by a virus and is contagious.
Infection can occur from close skin-to-skin contact or by touching items infected with the virus such as towels, clothes and toys. The lesions may appear anywhere on the body but in children tend to concentrate on the limbs, chest, and stomach. Lumps are normally painless but may be itchy. Scratching them may release the contagious centre fluid and spread the infection elsewhere on the body. Most people develop up to 20 lesions but those with an impaired immune system are at risk of widespread extensive infection.
Parents often bring their child to the GP as they are concerned about the appearance of the spots. Treatment is not normally advised in children as it may be painful and lead to scarring. It is important to know that Molluscae are not dangerous and usually clear up on their own. Most infections last between two and four months but some may last up to 18 months or longer.
The best thing to do is to avoid further spread of the condition and avoid passing it to others. Covering spots with a waterproof plaster may limit transmission when swimming or in situations where skin to skin contact is likely. There is no need to keep children out of activities, crèche or school.
Health & Living