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Tabernaemontana, Celastrus paniculatus, Trigonella.
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Parkinsonism is the name for a group of neurological disorders with common symptoms like tremor, rigidity, slowness of movement and postural instability. It is also known as Parkinson's syndrome, atypical Parkinson's or secondary Parkinson's disease. In the initial stages, the symptoms are usually very subtle. Constipation or soft voice may be the prime symptoms. These symptoms usually begin gradually and worsen with time.
Parkinson’s syndromes can be divided into three sub types according to their origin. Parkinson's disease, Acquired parkinsonism, and Hereditary Parkinsonism.
Parkinson's disease (Idiopathic parkinsonism,
Primary parkinsonism, Paralysis agitans, Kamba vata or Vira vata).
Large number of cases of Parkinsonism fall in this category. A familial and hereditary factor is present combined with some environmental factors. It was described in an essay on the shaking palsy in 1817 by a British physician, James Parkinson who published a paper on what he called "the shaking palsy" or paralysis agitans. Jean Martin Charcot in 19th century gave the term “Parkinson's disease". The term “dementia
paralytica” had been used to mention similar conditions before the 19th
century.
Several organizations celebrate Parkinson's disease on April 11, the birth anniversary of James
Parkinson, and red tulips are used as the symbol of the disease.
EPIDEMIOLOGY
Parkinson's disease is the second most common neurodegenerative disease after Alzheimer’s disease, and it affects approximately
1% of individuals older than 60 years.
The prevalence in industrialized countries is estimated at 0·3% of the general population. The risk of prevalence is high in those exposed to pesticides, but it is low in smokers.
The incidence increases with age, and the average age of onset is approximately 60 years. Onset in persons younger than 40 years is due to hereditary
cause. It is about 1.5 times more common in men than in women.
PATHOPHYSIOLOGY
Parkinson disease is predominantly a disorder of the certain nuclei of the basal ganglia situated at the base of the forebrain, and their neural connections.
It is a slowly progressive disorder due to degeneration or infarct at basal ganglia and deeper part of cerebral white matter including ventrolateral part of thalamus.
Neurotransmitters like Acetylcholine, Dopamine and Norepinephrine etc are responsible for transmitting signals among corpus striatum, the substantia
nigra, its connections in the cerebral cortex, and thalamus to produce smooth
and purposeful movements.
The main characteristic features of Parkinson disease are insufficient formation and activity of dopamine due to death of neurons in certain nucleus of basal ganglia especially in the substantia nigra.
The other features are microglial proliferation and the accumulation of an insoluble protein
called alpha synuclein called Lewy bodies inside the surviving neurons.
Decreased dopaminergic activity in Striatal nuclei and Substantia nigra causes increased output through cholinergic and dopaminergic
fibers of Caudate nucleus which results in tremor and rigidity (Cerebral
cortex, Caudate nucleus, Putman, and Globus pallidus internal segment- thalamic
pathway - direct) in early stage of Parkinson disease.
Further deteriorations of dopaminergic fiber
in Substantia nigra, Caudate nucleus, Putman, Sub thalamic
nucleus and Globus pallidus are responsible for bradykinesia in later
stages of Parkinson disease.
The common predisposing factors are cerebral trauma, degenerative lesions, and brain tumor (Glioma) at basal ganglia.
Iodine deficiency can promote degeneration and deposition of cholesterol in myelin sheath. Thus, it also can result in hypercholesterolemia and fatty liver (Fatty degeneration,
Insulin insuffiency).
Symptoms of Parkinson disease occur when 60% of dopamine containing nerve cells in the Substantia nigra become impaired (nerve
cells impairment).
Premonitory symptoms
Fatigue, depression, soft voice, cramped or small handwriting, slow movement or infrequent tremor etc may persist a long period before the more classic and obvious symptoms
appear.
SIGNS & SYMPTOMS
The initial motor symptoms typically start
insidiously from the distal part of the upper one limb and affect other limbs
slowly over weeks or months.
Initial symptoms in some patients are fatigue,
muscular ache, and fibromyalgia in limbs especially later half in the day.
The four cardinal symptoms of Parkinson disease are trembling, rigidity, bradykinesia and
postural instability.
Tremor
Tremor is the major symptom for some patients,
while for others tremor is very minor. The tremors are most pronounced at rest
or when a person is excited or fatigued or under stress; better on voluntary
movement and sleep. Tremors are localized in the initial stage.
The first affected arm may not swing fully when
walking, and the foot on the same side may scrape the floor first. The hand
tremor takes the form of a regular back-and-forth motion at a rate of 2-4
cycles per second with a range from 5 mm to 20 mm. It may involve the thumb and
forefinger and appear as a “pill rolling” movement. It also appears as
rotating, drum tapping, bread crumbling, cigarette rolling, or movement of
pronation and supination etc.
Tremor may be absent if rigidity is well marked or
vice versa. Some patients may exhibit a resting vocal cord tremor.
Rigidity
Normally muscles stretch when they move, and relax when they are at rest. Rigidity is due to increased tone and continuous contraction
of muscles. The increased tone may be either continuous (Lead pipe-on
lower limb) or interrupted (Cogwheeling-on neck).
Rigidity can cause general feelings of weakness,
regional pain (Muscle and joint pain) and cramping. Some patients
feel neck stiffness, tension headache, backache, or tightness in the calf and
shoulder region.
Difficulty to write in straight-line occurs
due to rigidity in interosseous muscle. Speech
becomes slow and monotonous due to rigidity of muscle of lip, tongue and
larynx.
The facial muscles become very rigid in advanced conditions
and give an appearance of an expressionless face, something akin to wearing a
mask. Failure is developed to express emotional feelings.
The neck and head rigidity may give a statue-like
posture. Eyes move before the head when looking at objects on sides.
Lips may be held apart and saliva may trickle
through them. Rigidity and tremor can inhibit shaving, cooking and social
visits.
Bradykinesia
Bradykinesia or slowness of movement is
not equal for all movements or time. Activities
once performed quickly and easily such as cooking, washing, sewing or dressing
may take several hours.
Slowness or difficulty in rising from a chair,
turning in bed, or walking, dragging of one leg also may develop. It is
modified by the activity or emotional state of the subject. Some patients have
less difficulty when some sort of external cue-hint is provided.
Akinesia (slowness in initiation of voluntary
movement) and sudden arrest of volitional movement while carrying purposeful
acts can appear. Sudden frozen state in working, eating or during walking
may occur. Some patients cannot walk but can ride a bicycle. Patients may take
smaller steps, and gait cadence is reduced when walking is affected.
Facial weakness is characterized with decreased blink rate and facial expression. Blinking is continuous as long as the tapping is continued on the glabellar region. Weakness in the right hand causes small and effortful handwriting. Speech may become
soft and less distinct.
Postural instability
Some people develop a stooped posture in which the head is bowed and the shoulders are drooped when sitting and standing (Righting reflex-Red nucleus). The flexed posture of the patient leads to kyphosis, and causes a reduction in lung capacity.
Difficulty in stooping, turning over the bed, rolling
over back to front, changing from horizontal to upright posture etc. are
developed. Elbows semi flexed, elbow pressed on sides, hand carried across the
abdomen, fingers pressed together, thumb abducted, metacarpal phalangeal joint
being flexed, inter phalangeal joint extended etc are other features.
Gait is slow and shuffling without swinging of arms
(Lesion at Globus pallidus). Step becomes short while walking. Dragging of
feet along the floor, loss of foot grip, tendency to propulsive and retropulsive
gait etc are also developed.
Dystonia
Dystonia is a common initial symptom in
young adult Parkinson's disease. This sustained,
painful, twisting muscle contraction usually affects the foot and ankle.
Dorsi-flexion of the great toe and plantar flexion of the foot occur. It also
may affect muscles of upper limbs and cause the painful adduction of the arm
and elbow.
Non motor symptoms
Several non motor symptoms are usually accompanied with Parkinson disease. The number of symptoms and their intensities are known to vary with every individual. Mental
symptoms are absent until the last stage.
Special sense and cranial
nerves are not affected.
Reflexes are always normal. Rigidity and tremor may
lead to depression. Profound
asthenia, irritability and hypersensitiveness to changes of
atmosphere may occur (Hg, P).
Dementia is prevalent in 20% of
Parkinson disease. It occurs after 8 years from the onset of motor features.
Executive function, short-term memory and visuospatial ability may be impaired.
Some people may become irritable, fearful,
insecure or uncharacteristically pessimistic. Impulse for heavy
eating, hyper sex, over use of medicines, pathological gambling etc. may
develop.
Sleep disturbances are common. Tendency for daytime
sleepiness (Excess of dopamine), restless sleep, nightmare, periodic limb
movements during sleep etc appear.
Autonomic dysfunctions are common in patients with Parkinson disease. Reflex vomiting,
delay in gastric emptying, impaired absorption, constipation, urinary
incontinence, urinary retention, erectile dysfunction and orthostatic
hypotension can occur.
Speech has become soft and monotonous.
Patients speak rapidly or hesitate before speaking. Dysphagia is common.
It may lead to excess saliva in the mouth.
Skin on the face may become very oily particularly on the forehead and at the sides of the nose. Thinning and glossiness of the skin of fingers are marked. Other symptoms are seborrhea, dandruff, sweating and flattened nails.
Other non motor symptoms include anosmia, dry eyes, watering eyes, decreased eye movements, numbness, and emaciation.
Complication
The progression time of symptoms in Parkinson
disease may take 20 years or more. Most common complications are profound
weakness, intercurrent respiratory illness and fever.
A combination of forward- stooped posture,
imbalance, and short steps called festination which mostly occurs in the later
stage of the disease, and causes frequent falls and fractures.
CLINICAL DIAGNOSIS
Parkinson’s disease is mainly diagnosed on clinical history and a neurological examination. Laboratory examinations and brain imaging are helpful in atypical cases.
Laboratory tests can include blood tests, such as a
complete blood count, Cholesterol estimation, biochemistry tests, estimation of
ceruloplasmin (25 -50mg / 100 ml); urine analysis, and ECG
(Prolonged Q-T interval, high R wave voltage and ventricular tachycardia like
pattern).
Neuron imaging like computed tomography (CT),
magnetic resonance imaging (MRI), Positron emission tomography (PET) and
single-photon emission CT (SPECT) etc. are used for rule out the secondary
causes of parkinsonism such as basal ganglia tumor, cerebral infarction and
hydrocephalus.
Other investigations include hair analysis for heavy metal poisoning (Arsenic), olfactory testing, and evaluations of response with levodopa like medications.
PARKINSONISM AND TREATMENT
As Parkinson disease is slowly crippling chronic diseases we have to arrest or delay the progression of disease early. Treatment includes medicinal cure & healing and supportive measures.
Early homoeopathic treatment can control symptoms, purify nerve cells, reduce inflammation, improve focal circulation, promote nerve cells regeneration,
and increase the overall ability of the patient.
Aim of medicinal treatment.
They purify neurons (100 billion cells), inhibit premature nerve degeneration,
promote formation of new nerve fibrils, and control the signs and symptoms.
All phenomena in nature first is increase, but it will decrease later. Like that this disease also can be categorized into the early stage with hyperkinetic symptoms, and late stage with hypokinetic symptoms.
Prefer herbal medicines with taste of sweet, salt or sour items for hyperkinetic symptoms, and medicines with taste of bitter, pungent or astringent for hypokinetic symptoms.
Styles with one prescription are being given for tremor, rigidity and balance
disorder, another for its side
effects are not rational. Prescription is the major task than
investigation.
Primary stage (Hyperkinesia)
Favorable items
They include food items with sweet, salt and sour; old ghee, olive oil, cheese, banana, pineapple, almond, and piper nigrim. Massages with camphorated oil, sweating, warmth, heat etc are beneficial for alleviating
tremor (vira vata).
Secondary stage (Akinesia)
Favorable items
They include items with pungent, bitter, and astringent; Ricinus communis, tea, coffea, alcohol, honey, tobacco, extra salt, meat, fish, milk, Blackgram, Bengal gram, Amara beans, fava beans, Mucuna puriens, large beans, heavy food, koval, young mangoes, green vegetables (Mg, N), protein rich diet in night, fasting, overwork, rain water, cold, sunlight, and good ventilation.
Homoeopathic tinctures (Homo toxins)
& Homeopathic dilutions
Medications for parkinsonism can be grouped
into three categories.
The first category of medicines include medications
that help control the mild motor and the non-motor symptoms.
The second category of medicines include medications
that help to eliminate the toxins in the nerve cells, and eliminate the
miasmatic stigma in vital force (Mind, Nerves Enzymes).
The third category of medicines include
medications that promote the formation of
new blood vessels, neurofibrils and neurotransmitters
(about 300).
*
Central nervous system. Stimulants
Ephedra, Nuxvomica, Piper nigrim, Rauwolfia, Secale cor, Thea sinensis, Spirit of ammonia,
Camphor and cold water (spray).
Cerebral stimulants
Ephedra and Piper nigrim.
Midbrain stimulants
Camphor, Coffea, Cocculus, Lobelia, and
Co2.
Central nervous system Depressants
Opium, Baptisia, Belladonna, Gelsemium, Cinchona, Colchicum, Ipecac, Piper nigrim, Rauwolfia, Salix nigra, Secale cor, Sulphur, Kali bromide, Magnesium phos, Acetic acid, Alcohol, Glucose,
Protein diet, and cold water (sponging).
Cholinergic
Brahmi, Grindelia,
Hydrocotyle, Ipecac, Phosphoric acid, Physostigma, Trigonella, Tabacum, Agaricus, Valuluva
(Jothismathi).
Anti-cholinergic
Belladonna, Hyoscyamus, Stramonium, and Duboisia.
Sympathomimetic
Tabacum, Lobelia, Coffea, Ephedra.
MAOI.
Sympatholytic
Nux vomica, Rauwolfia, Secale cor, Veratrum album, Viscum album, Yohimbinum, Aristolochia,
Asaram, Cinchona, Galega.
Peripheral stimulant
Piper nigrim, Veratrum album, Baryta carb.
Peripheral relaxant
Calcarea phos
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* Symptomatic treatment - Mild hyperkinetic |
|
|
Tremor- worse by anger; Rigidity, worse by touch; Mind clear, anxiety,
primary spasm, dilated pupil, paralysis of sphincter, urinary retention. |
Nux vomica 3 X |
|
Tremor- post influenzal, Worse by cold drinks. |
Arsenic alb 6 X. |
|
Tremor and pain after exposure to cold; worse by anger; constipation. |
Gelsemium 3 X. |
|
Tremor- post uremic, Rigidity on upper half. |
Tabacum 3 X. |
|
Tremor on upper right and lower left extremities, Spasm on face,
Cramps as if needles of ice were being thrust. |
Agaricus 4 X. |
|
Tremor from hyperaemia, worse by cold water. |
Glonoine 6 X. |
|
Tremors begin from toes; frothy salivation. |
Conium 3 X. |
|
Tremor worse by fear; fidgety of leg, urinary incontinence, Worse by
eating. |
Hyoscyamus 3 X. |
|
Tremor worse by alcohol, from Lead toxicity, from suppressed foot
sweat; fidgety feet, spasm origin from weak spinal cord, reflexively from
uterus, from eating Cashew nut. |
Zincum met 6 C. |
|
Tremor from suppressed eruption, retention of urine, stooping
attitude. |
Sulphur 6 C. |
|
Tremor of eyelids. |
Crocus 3 X. |
|
Tremor during sleep, later stage, rigidity of stomach. |
Physostigma 3 X. |
|
Tremor begins from the arm and periphery. |
Cuprum met 6 X. |
|
Tremor fibrillation type, cold sweat on forehead, Rigidity during
sleep. |
Veratrum viride 3 X. |
|
Tremor before spasm, frothy salivation. |
Cicuta 3 X. |
|
Tremor on right side; Spasm of glottis, spasm from loss of sleep,
origin from weak spinal cord; sleepy leg, locomotor ataxia. |
Cocculus indica 3 X. |
|
Rigidity worse by hot drinks, worse by sleep; mania, singing and
laughing without reason; swallowing difficult, staggering gait, frozen ankles. |
Stramonium 3 X. |
|
Rigidity on hot environment. |
Passiflora 3 X. |
|
Rigidity and weakness from atmospheric changes, loss of seminal fluid. |
Phosphorus 8 X. |
|
Rigidity, numbness, neuralgia of spinal cord origin, anxiety. |
Aconitum 3 C. |
|
Rigidity of lower extremities- Lead pipe type. |
Phosphoric acid 4 X. |
|
Rigidity left side. |
Silicea 6 C. |
|
Rigidity rheumatic origin, worse from wet. |
Rhux tox 4 X. |
|
Spasmodic cough, uterine spasm. |
Tabacum 4 X. |
|
Rigidity worse by hot drinks, constricted pupils. |
Veratrum album 4 X. |
|
Rigidity with coldness. |
Camphor 4 X. |
|
Rigidity on the right side. |
Tarantula 30. |
|
Rigidity at hypochondria, reflex from uterus. |
Cimicifuga 3 X. |
|
Rigidity begins from face; involuntary discharges, emaciation. |
Secale cor 3 X. |
|
Rigidity of the stomach. |
Ephedra 3 X. |
|
Rigidity from compression from hydrocephalus, polyuria. |
Cypripedium pubes 3 X. |
|
Symptomatic treatment -Mild hypokinetic |
|
|
Vertigo before paralysis begins. |
Oleander 4 X. |
|
Dilated pupil, paralysis of sphincter. |
Nux vomica, Ignatia, Spigelia. |
|
Paralysis on the right side, absence of sweat. |
Plumbum met 6 C. |
|
Paralysis on one side, tremor on the other side tremor, complaints are
worse by heat. |
Apis mel 3 X. |
|
Paralysis one side, other side tremor, incontinence of urine, red
face. |
Belladonna 3 X. |
|
Paralysis on lower limb, constipation, optic atrophy. |
Alumina 6 C. |
|
Paralysis rheumatica. |
Kalmia 3 X. |
|
Orthostatic hypotension. |
Thuja 4 X. |
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Constipation. |
Ricinus communis 2 X. |
|
Erectile dysfunction, day sleepiness. |
Ephedra 3 X. |
|
Severe weakness of the muscles, apathy, tremors, mask-like face. |
Gelsemium 4 X. |
|
* Symptomatic treatment |
|
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Worse by cold wet weather. |
Dulcamara 3 X. |
|
Worse by touch. |
Coffea 4 X. |
|
Worse by overwork of brain. |
Piper nigrim 3 X. |
|
Worse on touch and after sleep, left sided symptoms. |
Lachesis 6 C. |
|
Childish personality, mouth partly open. |
Baryta carb 6 C. |
|
Consciousness of time and space, over sensitiveness. |
Cannabis 3 X. |
|
Anxiety with hypertension |
Rauwolfia 3 X. |
|
Old age, weeping disposition. |
Causticum 6C. |
|
Salivation, drooling. |
Mercury 30. |
|
Pain & inflammation. |
Salix nigra, Aloe socotrina, China, Gelsemium, Arsenic alb. |
|
General weakness. |
Arsenic alb 3 X, Cinchona 3 X, Alfalfa 3 X. |
|
Loss of fluids. |
Cinchona 3 X, Ferum ars 3 C, Natrum mur 4X. |
|
Cyst formation; Cholesterol deposit. |
Kali iodide 3 X, Iodum 3 X. |
|
* Treatment - Motor disorder - mild |
|
|
Early stage |
Nuxvomica 3X, Secale cor 3X, Asafoetida 3X, Brahmi 3X, Agaricus 5X, Physostigma 3X, Hydrocotyle 3X, Fenugreek 3X, Mercurius 6 C, Plumbum met 6C |
|
Acute stage |
Belladonna 3X, Hyoscyamus 3X, Stramonium 3X. |
|
Late stage |
Arsenic alb 4X, Arnica 3X, Causticum 6C, Camphor 4X, Lachesis 6C. |
|
General medicines |
Beriberis vulgaris 3X. Gentiana lutea 3X. Ginseng 3X. Hypericum perfoliatum 3X. Nux mos 3X. Piper nigrim 3X. Rauwolfia 3X. Ruta graveolens 3X. Thea 3X. Tribulus terrestris 3X. Xanthoxylum 3X. Yerba Santa 3X. Yohimbinum 3X. Acetic acid 6X. Selenium 6X. Zinc Met 6C. Nigella sativa (Roman coriander, Black seed) 3X. |
|
Neurotoxins |
Antidotes |
|
Lead |
Arsenic album, Cuprum met, Opium, Platinum, Iodum, Nux vomica. |
|
Mercury |
Staphysagria, Allium sativa, Stramonium, Sulphuric acid,
Selenium, Nitric acid, Sulphur, Hepar sulph. |
|
Copper |
Stannum. |
|
Tobacco |
Nux vomica, Cicuta. |
|
Alcohol |
Sulphuric acid, Quercus. |
|
Ipecac |
Tabacum. |
|
Arsenic |
Cuprum met, Cinchona, Nux vomica. |
|
Phosphorus |
Belladonna. |
|
Thuja Iron |
Mercury, Mezereum. Arsenic album. |
The physical and the mental characteristics
of the patient have to be taken into consideration when deciding the medicines
and diet.
Purification treatment
If the mechanism of the cell's disposal system
fails to work properly, toxins and other substances can accumulate and lead to cell
degeneration, or premature cell death. (French word “cure” means to cleanse).
Arsenic album is good for cellular purification
of ferum.
Take Achyranthes aspera Q with milk to purify brain
cells.
Take green juice of young ash gourd, apple, carrot
or beetroot with sugar for 3 weeks.
Take apples or grapes with skin (pectin) to bind
metals from the GI tract.
Take an apple mono diet or raw vegetable diet for 3
days every month.
Continue the elimination treatment for 6 to 12
months.
Vegetable Mercury treatment.
Calcium ion treatment.
External treatment with Homo-toxicology.
Manganese nano therapy.
Other treatment
Somnolence and oculogyric effects developed
after influenza can be transiently controlled by tea and chocolate beverages.
These agents can promote dopamine release primarily, but
can cause early depletion of the dopamine pool. Dopamine reserves may become
low in habitual tea drinkers (Avoid excessive intake of tea. Senile tea
tremor).
Eradicate the risk factors
Avoid inter relation marriage in parkinsonism
families. Most cases of Parkinson disease are believed to be due to a
combination of genetic (5%) and environmental factors (80%). Genetic
factors appear to be very important when the disease begins at or before age 50
years.
Unusual protein particles are developed and
deposited inside brain cells in response to miasm (Oxidative stress, Toxins, Aluminum, Petroleum products). This protein particle promotes over
stimulation, inflammation, degeneration,
and the premature death of neurons and its fibrils
(Auto immune disease).
Eliminate the suspected negative
environmental factors
Environmental factors. They include living proximity to industrial plants or quarries, drinking well water (fluoride), pesticides (Trichloroethylene, rotenone, toluene, hexane), herbicide (agent orange, paraquat), fungicide (maneb), phosphorus (depletion of cholinesterase), exposure to carbon monoxide (Pink skin in chronic cigarette smokers, in garage workers), carbon disulphide, manganese dust, cyanide, compounds of copper, sulfur, mercury, and iron; and Injection of MPTP (1 methyl 4 phenyl 1,2,3,6 tetra hydro pyridine found in synthetic
heroin).
Avoid food and water contaminated with toxic heavy
metals
Lead rich items include organ meat, oysters, shellfish, canned food; hair dyes, glazed ceramics,
and tobacco sprayed with insecticide contain Lead arsenate.
Use tempered glass or stainless glass utensils in
normal life.
Aluminum rich items include tubers,
antacids, baking powder, foil, under arm deodorants, drinking water, and any
juices and drinks packaged in aluminum-lined cartons.
Avoid aluminum cookware utensils for cooking acidic
vegetables.
Copper contained items include
soya bean, canned green vegetable, beef, meat of large animals, and grass or
vegetables sprayed with pesticide containing copper sulphate.
Mercury rich items include wild
game, swordfish, tuna, shark, martin (bird), dental amalgam and vermillion.
Cadmium: soft drinks dispensers.
Manganese: Pesticide, Chemicals, Image contrast
(Treatment: Homeopathicity, Herbal).
Avoid following drugs
Haloperidol.
Chlorpromazine (Antipsychotic).
Thioridazine (Anti-depressants).
Trifluoperazine and Fluphenazine (Tranquilizers).
Metoclopramide (Anti vomiting).
Prochlorperazine (Anti migraine).
Promethazine (Anti vomiting).
Sodium valproate (Anti epilepsy).
Reserpine (Anti-hypertensive).
Cinnarizine and Calcium blockers.
Antihypertensives.
(Treatment: Homeopathicity).
Avoid excessive use of following items also
Camphor, Tea (Oxalate, Lead, Dopamine), Coffea, Tobacco, Alcohol, Alkaloid of ergot, Croton (saponin), Cashew nut, Amygdalus amara (Hydrocyanic acid), Rauwolfia and
Opium.
*
Supporting measures
Children. Ensure good care and proper nutrition in
growing periods.
Correct the deficiency of monosaccharides,
choline (It is absent in maize, Present in eggyolk), casein (rich in milk),
lecithin, methionine, inositol, vitamin B1 and B12.
Avoid diets containing excess fat from animal
sources after age 40 as a precaution to prevent premature degeneration of
neurons and deposition of cholesterol in myelin sheath (Pork).
Take proper early measures to rectify the
premature softening, atrophy, sclerosis, morbid deposit and calcification in
brain and spinal cord (Fluorosis, heavy metals).
Correct the disturbance of cerebral circulation
due to ischemia, blood loss, venous stasis, hyperemia, sclerosis,
thrombosis and embolism.
Maintain optimum blood pressure in adults to prevent subsequent cerebrovascular accidents.
Correct hypotension periodically (Thuja) if present to prevent
cerebral degeneration.
Take treatment promptly in diseases like syphilis, scrofulosis
and viral fevers.
Correct Calcium and Iodine deficiency.
Protect from mosquito bite and arbor viral infections (Group B encephalitis, western equine encephalomyelitis, eastern equine encephalomyelitis, Japanese B encephalitis).
Keep good personal hygiene (Encephalitis
lethargica, Influenza, HIV and Herpes simplex).
Protect from water borne infections. Avoid
shellfish. Avoid the brains of fish. Drink boiled water (Encephalitis
Group A, Herpes, Coxsackie and ECHO virus).
Abstinence from excito- toxins and irritable stimuli (Spices.They can help to reduce the level of inflammatory enzymes that promote premature degeneration of neurons).
Restrain from nervous exhaustion, over excitement,
over exertion, night watching, hyper sex, repeated adharma actions.
Refrain from bad habits
Control the desire for gambling, and unnecessary
shopping.
Avoid exposure to extreme cold, thunderstorm
or atmospheric influences.
Avoid heavy tobacco smoking when young(Arsenate can activate neurons and facilitate formation of new fibrils by promoting microcirculation. It can increase the central dopamine level by inhibiting enzyme- monoamine
oxidase B. Micro dosage).
Cultivate a positive living environment.
Neglect all unwanted objects, subjects and environment.
Develop minimum ambitions, and fulfil it early.
Protect brain from injury.
Keep moderate in all items of diet, thoughts,
exercise, and alcohol.
Dietary treatment
Give preference to diet which requires low oxygen for the metabolism (Carbohydrate with
fiber diet).
Prefer items include lacto vegetarian diet, organically
grown foods, horse gram, fenugreek, green gram, garlic, gooseberry, legumes
(lipotropic factors), pumpkin
seeds, sun flower seeds, curry leaf, old ghee, citrus fruits, lime juice, and rain water.
Avoid neutral protein in day time. Avoid meat, mutton, organ meat like kidney and
liver; beans neutral amino acids rich food contains
tryptophan (It may inhibit absorption (phenylalanine-tyrosine)
and transport of the other amino acids in brain).
Drink plenty of water.
increase items in diet contain insoluble fibers like fruits, vegetables and whole grains to prevent constipation (Soluble fibers may promote
fiber infiltration in neurons) .
Fatty acids are essential for maintaining
the integrity of cell membranes of neuron. Dietary
sources of essential fatty acids are nuts, seeds, fish, Cod liver oil, evening
primrose oil, and vitamin E. Dietary sources of vitamin E are green leafy
vegetables (Mg also), whole grain products, wheat germ, eggs, milk, raw or sprouted
seeds or nuts, ground nut, coconut oil and sunflower oil.
Fresh water fish and ocean reef fish are advisable.
Include sufficient quantity of Magnesium rich items in daily life. Legumes, green vegetable, and all kinds of nuts, wholegrain, shellfish and meat are the main source of Magnesium. Magnesium requirements differ from one individual to another. Daily requirement for adult men is 350 mg, while of adult women is 300 mg. Hypokalemia is usually associated with hypomagnesemia
(SVT, rigidity).
High calcium level may promote psychosis in some individual with depleting dopamine. So calcium blockers (Mg) have a role in Parkinson’s disease. It has reported that calcium blockers are harmful in some individual. Vitamin D supplements may reduce the risk of stooped posture but excess may promote
Calcium ions have a role.
Take fasting once in every week.
Restrict the egg yolk to once in week.
Prefer semi solid diet, and keep an upright posture
when eating in case of dysphagia.
Exercise
Practice exercises to maintain independence with regard to personal hygiene and daily living activities. Exercises may improve the dopamine synthesis or increase levels of beneficial compounds in the brain. It warms up muscles. They are helpful to prevent stiffness, to improve range of motion, flexibility, balance, and even emotional well being. Exercises can correct constipation. Continue a simple program
of exercises on a regular basis. Do not get discouraged if exercises seem
difficult on some days. Any physical activities including walking,
swimming or gardening are beneficial.
Fatigue can be corrected by daily home or outdoor exercises. Practice passive and stretching exercise of neck, hand, elbow, wrist, fingers, knee, and foot muscles. Select
items like dance for adolescence and “namaskar” for adults. Choose a time to
exercises when feel strong.
Practice long walk for 1 ½ km daily. Take long steps, and exaggerate lifting legs and swinging arms. (Prefer walking style of Mahatma Gandhi). Walking exercise is helpful to prevent complications like flexion contractures
and gait disorder. Wear rubber-soled shoes. Avoid running shoes. If become
stuck in place, ¾ rocks gently from side to side. If notice shuffling,
slow down or walk with feet 8 inches apart.
Practice deep diaphragmatic breathing exercises
to improve chest wall mobility and vital capacity.
Keep the correct body posture.
Avoid bed rest for prolonged period.
Bath
Enjoy ocean bath (Mg salt) and sun bath (in
temperate climate). Warm bath is beneficial to control painful cramps as
well as contraction headache. Warm tub bath added with 1tsf of urea is also
beneficial. Prefer cold bath on head and spinal
cord. Massage on whole length of spine and muscle of limb with oil to
prevent or reduce rigidity, immobility, adhesion of joints and limb pain.
Other measures
Install handrails, especially along
stair-ways. Install grab bars around the tub and near the
toilet. Remove all rugs from home, and make sure carpet is secured firmly
to the floor. Keep electrical and telephone cords out of the
way. Prefer cordless phone always. Choose simple dresses or pants
with elastic waistbands or fabric fasteners.
Keep dental hygiene to prevent secondary
infection to paranasal sinus and brain.
Prefer substitute for mercuric amalgam.
Use large and light pen holders for writer’s cramp.
Wear gold ornaments, or cold metals.
General advice
Do everything we can, no matter how slowly.
Avoid hurry. Concentrate on one activity at a
time.
Practice reading or speaking in loudly.
Keep sleep hygiene and follow regular sleep schedule.
Avoid tea, coffee, chocolates, spicy food, extra fluids near bed time.
Avoid heavy night meals.
Moderate quantity of depressant like alcohol (100
drops) is agreeable.
Support groups can help people with parkinsonism, their families, and their caregivers by providing valuable information, advice, experience and support.
Consult only experienced physicians.
Rejuvenation therapy
Prefer ghee or honey as the prime item for Rejuvenation.
Arsenic alb 4X, Ginkgo biloba Q, Cinchona Q and Secale cor Q are helpful to promote
microcirculation in brain. Take Arsenic alb 4X 15 drops thrice daily for 2
weeks followed Ginkgo biloba Q 20 drops thrice daily for 1 week. Repeat arsenic
alb after 1 week.
Enjoy rejuvenation medicines periodically to strengthen the general vitality from age of 60 onwards. Mother tincture of Thuja, Aconitum, Allium sativa, Amloki, Boerhavia diffusa, Curcuma longa, Ginseng, Hydrocotyle, Lolium, Nux vomica, Ricinus communis, Quassia, Secale cor, Tinospora cordifolia, Terminalia chebula, Withania somnifera, Xanthoxylum, and Zingiber can be used as rejuvenator based on constitution of individual.
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Parkinson's disease & Differential diagnosis
Early signs and symptoms of Parkinson’s disease may
sometimes be confused with a number of disorders and each of these
disorders has specific features that help to distinguish them from Parkinson’s
disease.
Parkinson-plus syndromes
These are primary neurodegenerative disorders that have parkinsonism symptoms with additional features. These include multiple system atrophy, corticobasal degeneration, progressive supranuclear
palsy and dementia with diffuse Lewy body disease.
Early cognitive dysfunctions, symmetry at onset,
faster progression rate, early speech or postural instability with little or no
tremor may indicate a Parkinson plus disease. These have a worse
prognosis than those with Parkinson disease. Levodopa related medications are
typically less effective at controlling symptoms.
Multiple system atrophy
This slowly progressive disorder affects both the central and autonomic nervous system. Features of upper motor lesion, cerebellar ataxia, nocturnal stridor, and slurred speech etc. occur with tremor. Tremor is worse on rest. Symptoms of autonomic dysfunctions include hypotension, breathing and swallowing difficulties, impotence, constipation and urinary difficulties also appear.
Cortico-basal degeneration
It results from degeneration and atrophy of multiple areas of cerebral cortex and the basal ganglia. Combined features include cognitive impairments, loss of the ability to make familiar or purposeful movements, difficulty in speech or swallowing, rigidity in arm, impaired balance, poor coordination, tremor worse on rest, myoclonus, and dystonia etc.
Progressive supra nuclear palsy
This progressive disorder is caused by degeneration
and atrophy of neurons in the brain stem. Early dementia, depression, apathy,
balance complaints, and weakness of eye muscles with voluntary down-gaze are
the main features.
Dementia with diffuse Lewy bodies
This degenerative disorder is due to deposit of abnormal protein in certain areas of the brain. Lewy bodies (an insoluble protein called alpha synuclein) first appear in the olfactory bulb, medulla oblongata, pontine, tegmentum, substantia nigra, area of mid brain, basal fore brain, and last in neo cortex. It also observed in autonomic nerves of the gut and heart (accumulation from below upwards). Dementia, hallucinations, delusions, depression etc. are prominent with symptoms of parkinsonism.
Prognosis is good.
Post-traumatic Parkinsonism
A history of severe head injury or frequent head
trauma that result from boxing or other activities is present.
Vascular parkinsonism
Sometimes known as pseudo parkinsonism, Arteriosclerotic parkinsonism or atherosclerotic parkinsonism. Dementia is common. Rigidity or tremor is more marked in lower extremities. One sided parkinsonism may resemble hemiplegia. Age of onset is late. Tremor is less than rigidity. Signs of pyramidal lesion (increased tone clasp knife rigidity, exaggerated knee reflex, absence of abdominal reflex, extensor plantar reflex etc) are present. Hairs may be lost in affected side. Levodopa related medications are less effective at controlling symptoms.
Pressure hydrocephalus
Dementia, progressive mental impairment, symptoms
like impaired bladder control
with urinary frequency etc are seen with symptoms of parkinsonism.
Senile tremor
Tremor appears more on upper limb and head in aged individual. It is fine, rapid and non rhythmic; and worse on voluntary movement. Tremors become constant and nonprogressive. Tone is normal. No weakness.
Essential tremor
This non progressive disease begins in adolescence. It is an abortive form of parkinsonism. Tremor involves in both hands and head, but absent in legs. Tremors are fine and rapid than Parkinson disease, worse on emotion, exertion and social functions; and temporarily relieved by drinking alcohol. Family history of tremor is present. Pill rolling rest tremor, rigidity, akinesia and postural abnormalities
etc are absent.
Amyotrophic lateral sclerosis
It is a rapidly progressive neurodegenerative disorder appears with combined symptoms of dementia and Parkinsonism. Fibrillatory tremors mostly appear in limb that previously affected with poliomyelitis. Adduction of thumb and sign of lower motor lesion are other features. Neuro fibrillary tangles and Lewy bodies are absent. (This disease occurs more in cycad eaters and among the Chamorro populations of Guam
and in the Mariana Islands).
Hepatolenticular degeneration (Wilson’s disease)
It occurs due to bilateral degeneration of lenticular nucleus and lobes (parietal and frontal) of cerebrum. It is a genetic disorder in which there is an abnormal metabolism of copper and amino acid. The excess of copper content may be due to either excessive absorption from gut, or less excretion through bile or lack of copper binding globulin- ceruloplasmin. If it not deposits on liver or other organs, it deposits on brain.
The onset of symptoms is before age 40 years. Males are more affected. H/o liver cirrhosis may present. Common features are low ceruloplasmin in blood (ceruloplasmin normal value is 20 -50 mg/dl); presence of copper in urine (normal value is 100pg/24 hours), glycosuria, amino aciduria, and increased excretion of uric acid and phosphate due to renal lesion by copper deposition; presence of Kayser Fleischer tinge on cornea, and sunflower cataract in some individual. Tremor is rhythmical character, and most marked at distal part of limbs. Tremor is worse on excitement, on emotion, voluntary movement, and inversely related to rigidity. It is absent during sleep. Face loses its expression. There is staring look due to less blinking. Speech is slow and monotonous with slurring of consonants and repetition of syllables. Hand writing may be cramped. Reflexes are normal. No sensory and sphincter changes. Pyramidal signs are absent.
Alzheimer’s disease
Rapid course of dementia and aphasia are developed. Tremor is less pronounced, no jerky movement. Rigidity
may appear. Accumulation of neuron fibrillary tangles and senile plaques in
neocortex are the characteristics.
Dystonia
It begins in childhood is due to glial scarring. It affects proximal group of muscles. Abnormal tone of muscle results in torticollis and tortipelvic or other deformities of pelvis. Spasmodic dorsi flexion of foot causes an abnormal posture.
Difficulties in speech are common.
Multiple sclerosis
It is due to degeneration of oligodendroglia of brain and spinal cord due to some auto immune reaction. It starts in younger age before 35 years. Patient feels back pain, numbness, weakness and stiffness especially in leg. Ultimately whole body become rigid and tremor tends to spread from limb to limb and becomes bed ridden. Patient become unable to speak, write but whose intelligence remains clear.
Some patient may feel euphoria. Evidence of upper motor lesion, intention tremor (lesion at red nucleus and cerebellum), nystagmus, diplopia and scanning speech are present. Bladder complaints may occur due to spinal lesion. Other symptoms are due to complications.They are bronchitis, urinary retention, or gradual failure of mental functions. Recurrence and relapse are common.
Schilder’s disease
It is a
progressive demyelinating disorder of
white matter at cerebrum without involvement of spinal cord and
brain stem. Blindness, bilateral deafness, bilateral ataxia or bilateral
spastic paralysis may occur according the parts of cerebrum degenerated. It
affects children and aged individual.
Anxiety, Thyrotoxicosis, Intoxication (Action
tremor)
Tremor is more rapid, low amplitude, irregular (Tic, Wilson’s disease) and is worse on movement.
Cerebellar tremor
Tremor is better on rest, worse on voluntary
movement and sleep.
Chorea
Word chorea means dance. Multiple lesions are occurred in striatum. Predisposing factors include fear, reflexes, cerebral infections, hyperthyroidism, S L E, carbon monoxide poisoning, rheumatic fever, anemia, low calcium, malnutrition
etc.
Sydenham’s chorea (Acute form)
It mostly occurs in childhood. Movements are brief, irregular, involuntary, uncoordinated,
unpattern, unpredictable, jerky and explosive. Movements are worse on movement
and absent in sleep. Tone is normal. No pain and no wasting. Abnormal gesture
on speaking, difficulty in chewing, clumsiness of limbs, hyper extensibility of
fingers due to loss of tone, weakness of abdominal muscle, awkward gait etc.
are seen. Wrist is flexed, fingers are hyper extended. Other signs include
irritable behaviour, emotional instability and poor performance at school etc.
Huntington chorea
It is the hereditary and familial slowly
progressive degenerative disorder of cerebral cortex and
basal ganglia (lesion at caudate nucleus). It begins in adults near age 40
years. Jerky movements begin shoulder, trunk and more at lower limbs gives rise
to a dancing look. Dementia, high type of irritability and bouts of depression
are present. Abnormal gesture of face during speaking may occur. (Rauwolfia can
control these movements). Death occurs within 15 years of onset.
Tic
Spasms are rapid, brief, sudden, irregular and
purpose less. It affects single group of muscles and appears as eye blinking,
shrugging of shoulder, or sudden gesture of limbs (Usual cause is stress).
Hemi-ballism (hemi chorea)
It is a non progressive condition. Movements
are irregular, sudden, unilateral, and violent as throwing movement. (Lesion is
at subthalamic nucleus and its connections at opposite side due to
atherosclerosis or tumor in old age in 50% of case).
Lipiodosis
It is a condition of abnormal fat accumulation in brain and spinal cord. It occurs more in certain race (Jews). Lecithin is absent. Cherry red spot appear in retina. Hypochlorhydria, Postero lateral degeneration due to B12 & B1 deficiency, hypoglycemia are the other features. Symptoms
of liver cirrhosis also develop due to lecithin deficiency.
Myelitis (Spinal
cord lesion -viral origin)
Pain is increased above the level of spinal lesion.
Pain is felt at level, but pain less below the level of lesion. Other features
are flaccid paralysis like lower motor neuron lesion, loss of deep reflexes and
lack of sphincter control.
Athetosis
Lesions are at cerebral cortex, striatum and globus pallidus; pigments or lipids are deposited in myelin sheath. Basal ganglia may become marbled. Common causes include birth injury, lipoidosis, toxins, vascular lesion, or tumor. It starts in infancy due to birth trauma. Bilateral, slow, involuntary, irregular, spontaneous, jerky, coarse and worm like movements appear on distal segments of hands, neck and lips. Movements are absent during sleep. Other features include internal rotation of shoulder, flexion of hand, tetany, internal rotation of foot, plantar flexion and dorsi flexion of toe (dystonia). The tone is normal athetosis.
Familial myoclonus
It is a familial cerebral disorder due to
lipoidosis or inclusion body encephalitis. Proximal muscle of upper limb is
commonly affected. Unpredictive, irregular shock like movements is better on
voluntary control. Speech difficulties may occur.
Kernicterus (lesion at subthalamic nucleus)
It mostly occurs with haemolytic jaundice (Favism, Rh incompatibility). Movements are brief,
irregular, involuntary and hemi chorea type.
Post encephalitis tremor
Lesion is at cortex, sub cortex, central
part, substantia nigra or red nucleus. Convalescent
encephalitis appears on 14th day of vaccination against mumps or small pox. The
weak virus can activate the other specific viruses that dormant in the
body. Brain congestion may also be developed due to suppressed eruption,
venous thrombosis, or perivascular demyelination.
Encephalitis A (Naso-oral route)
It affects all age groups. Fever, somnolence,
diplopia, mid brain syndrome (anorexia and polyuria) etc are the common
symptoms.
Encephalitis B
(Infections are got through mosquito bite. Domestic
birds, chicken and pigeon are reservoir of infections).
Non progressive tremor begins in middle life with
sudden onset. Tremors are less than rigidity. Movements of choreiform
(brief and explosive), athetoid (slow, coarse and worm like) or tic (brief,
irregular and localized) type may appear. It may disappear suddenly. H/o fever,
narcolepsy, oculogyric crisis, alternation of pupils, changes in temperament
etc. present. Increased sweating, oily skin, excessive salivation etc. are
prominent than in idiopathic parkinsonism. Mortality rate is about 20 %.
Thalamus tremor
Spontaneous tremors appear on opposite side.
Oversensitivity to touch, pain, heat and cold are seen. Causes include
vascular lesion, localized tumor, or
inflammation of interstitial tissue etc.
PROGNOSIS
Disease with pronounced tremor has good prognosis than diseases with rigidity. Mortality ratios are around twice than those of unaffected people. Patient can live 15 years or more after the onset of initial symptoms. Disease effects on lower limb has a bad prognosis.
Ricinus communis (Vathari), Nuxvomica, Mucuna puriens, Belladonna, Rauwolfia, Mercurius, Manganum, Calcarea carb, fluoric acid, Phosphoric acid and Arsenicum album are the common homeopathic remedies.
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Treatment for Alzheimer's disease & Parkinson disease.
1. Purification therapy (Macro and Micro level).
2. Cellular toxins antidote therapy.
3. Symptomatic therapy (Hyperkinetic depressant, and Hypokinetic stimulant).
4. Enzymes therapy.
5. Reflex therapy.
6. Vascular therapy.
7. Anti degeneration therapy (Soft parts & hard parts)
8. Rejuvenation therapy.
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Synopsis of Materia Medica Vera.
