Introduction
Margaret, a woman in her thirties, ...
...began to experience tremors and stiffness of her left arm while she walked. When these symptoms continued, she saw several neurologists to determine what was going on. Because she was young, the doctors initially thought she might have a brain tumor or multiple sclerosis. However, after a brain scan and neurological examinations, she was diagnosed with Parkinson's disease.
Margaret did not take any medications for the disease until several years after her diagnosis. She then began medication that reduced her symptoms but did not stop the disease from getting worse. She eventually developed involuntary movements called dyskinesias, which are a common side effect of levodopa, the most common Parkinson's drug. Because of this, she decided to undergo a new therapy called deep brain stimulation (DBS), which provides electrical stimulation to the brain through surgically implanted wires. The DBS immediately reduced the amount of levodopa Margaret needed to take, which stopped the dyskinesias. The stimulation has since been adjusted externally many times in order to improve control of her symptoms. While Margaret still takes medication, she needs fewer pills than before the DBS.
Now, almost 25 years after her diagnosis, Margaret is able to function very well in the morning and early afternoon. Late in the day, however, problems with balance, speech, and fatigue return. She manages by planning her activities carefully, avoiding many commitments during the late afternoon and evening, and increasing her medication when necessary.
Joel, a retired university professor, ...
...went for regular walks with his wife. Ten years ago, his wife began to notice that he was shuffling his feet and was not swinging his arms as most people do while walking. She also noticed some changes in his posture and unusual movements of his left arm. Joel's primary doctor referred him to a neurologist, who told him he had Parkinson's disease and prescribed a combination of drugs to treat the symptoms. He later saw a movement disorder specialist as well.
Joel's symptoms have gradually grown worse with time. He now has tremors and rigidity of movements on both sides of his body, and balance problems when his medication wears off. The disease also makes it difficult to project his voice. He takes a combination of drugs that help him to walk and to perform daily tasks. However, he can no longer work in the woodworking shop he had developed as a retirement hobby. His loss of mobility and speech impairment limit his social interactions. He and his wife also have had to give up many of their retirement travel plans.