Family doctor

Stress management, good sleep and exercise are cornerstones in the effective management of Parkinson's disease, a Parkinson's disease conference in New Zealand has been told.

Auckland neurologist Dr Barry Snow said low stress levels and a good night's sleep are major factors in reducing the symptoms of Parkinson's disease such as tremors, stiffness and slow movements.

He said doctors were now spoilt for choice in the range of medications available to treat Parkinson's disease. New variations of the older medication levodopa were available including slow-release preparations to help sleeping and those whose medication was becoming less effective.

Dopamine agonists were also available to compliment levodopa, or may be tried first in younger patients with Parkinson's disease.

There has been controversy about the use of levodopa because of claims that it could be toxic to the brain. However, Dr Snow said studies have failed to establish this.

He said the type of medication used needed to be tailored to the individual's needs, and most patients respond well to the drug treatment for several years.

Once the effects of the medication begin to wear off, higher doses of the drug are given and this can cause dyskinesia (abnormal wriggly movements).

Dr Snow said holidays were extremely useful in easing symptoms of Parkinson's disease through reduced stress levels. He has had some patients whose symptoms had reversed by up to two years by taking a good break.

"The holiday effect on Parkinson's is a miracle. The right amount of rest and the sensible control of stress is a very important part of controlling the symptoms of Parkinson's," he told the conference.

Alternatively, stressful life events had the potential to accelerate the progression of disease in some patients. Some patients with early disease whose symptoms were barely perceptible to others, and who have been involved in a car accident, noticed their symptoms become much worse. This acceleration could be reversed after the stress had been dealt with in some cases, but in others their disease remained more pronounced.

Exercise is another important factor in the control of Parkinson's disease. Dr Snow recommends rhythmic exercise to patients such as rowing, and walking, and said keeping fit is one of the best self-help treatments for the disease.

The cause of Parkinson's disease remains unknown. Dr Snow said in some cases the disease was a little more common in some families but that does not mean it is an inherited disease, rather it could mean some members were exposed to an external influence in the environment which may be a risk factor.

There is a possibility that those with young onset of Parkinson's disease in their 20s or 30s may have inherited the disease. However, the disease in 50s and over, appears to have no inherited basis.

Dr Snow said the cause is not believed to be a poison in the environment or a virus.

The disease occurs in all ethnic populations around the world so it's believed the cause must be widespread.

The disease is becoming more common and it is more prevalent in the western world. It also occurs more in farmers and those working in the agricultural sector. However, there is no evidence that a pesticide is responsible. There are many people with Parkinson's disease who are not farmers or exposed to pesticides.

There is evidence that the disease is less common in smokers, but the reason for this is not known.

Dr Snow said the disease starts with just subtle symptoms and if there is no tremor at first then it may take months to years before a diagnosis is made. For example, those presenting with a stiff shoulder may spend some time having orthopaedic treatment before other causes are considered.

He said patients did not need to worry about a delayed diagnosis because early treatment makes no difference to the progression of the disease.

He advised people to get on with their lives following the diagnosis of Parkinson's disease because it was not a debilitating disease in the early stages. He said some patients wanted to sell their houses or businesses and completely change their lives following their diagnosis, but there was no need for this.