Understanding Neurological Disorders: Parkinson’s Disease and Multiple Sclerosis

What is Parkinson’s Disease?

Parkinson’s disease is a motor system disorder caused by a loss of dopamine-producing brain cells. This loss results in trembling of the hands, arms, legs, jaw, and face—known as tremors—postural instability, impaired balance and coordination, and slowness of movement. Parkinson’s most commonly affects people over the age of 60. The disease generally progresses slowly over time, but some cases progress more quickly than others.

Signs of Parkinson’s Disease

  • Slight shaking or tremor in the fingers, thumb, hands, or chin
  • Decreased size of handwriting, called micrographia
  • Loss of smell
  • Thrashing in bed or acting your dreams when deeply asleep
  • Newfound stiffness in the body, especially when walking
  • Constipation
  • A softened or low voice
  • A “masked face,” or a look of seriousness or anger even when you’re not in a bad mood

Sources: 1) Parkinson’s Disease Information Page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/ All-Disorders/Parkinsons-Disease-Information-Page. Accessed Dec 12, 2017; 2) Dr. Chauncey Spears. 10 Early Signs of Parkinson’s Disease. Parkinson’s Foundation. http://www.parkinson.org/understanding-parkinsons/10-early- warning-signs. Accessed Dec 12, 2017.

The Effects of Exercise on Parkinson’s Disease

A review of published in Lancet Neurology in 2013 sought to highlight the potential role of exercise in promoting neuroplasticity and repair in Parkinson’s disease. Specific exercises recommended for people with Parkinson’s disease include goal-based motor skill training in order to engage cognitive circuitry that is essential to motor learning. This style of exercise can help people with Parkinson’s maintain control of movements and motor skills that are threatened by the disease. In addition, the ability of cardiovascular exercise to increase neuroplasticity holds true for those with Parkinson’s and is recommended as an essential facet of the exercise approach. Studies on exercise and Parkinson’s have shown success in patients participating in exercises such as low- and high-intensity treadmill training, Tai Chi, tango dancing, boxing, and cycling. People with Parkinson’s should speak to their doctor and a physical therapist in order to create an exercise plan that is optimal and safe for their individual condition.

Source: Petzinger GM. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol. 2013 Jul;12(7):716–26.

Understanding Multiple Sclerosis (MS) and Identifying the Symptoms

Multiple sclerosis (MS) occurs when an abnormal immune response causes the body’s immune system to attack the central nervous system, made up of the brain, spinal cord, and optic nerves. Specifically, the immune system attacks the fatty substance surrounding and insulating nerve fibers, called myelin, along with the nerve fibers themselves. This causes nerve impulses traveling to and from the brain and spinal cord to be distorted or interrupted, which in turn produces the symptoms of MS. MS does not progress in a constant manner; the disease follows one of four disease courses, or phenotypes, and each course is unique in the way that active periods, or periods of disease worsening (called “attacks” or “flare- ups”), and stable periods are structured. Severity of the disease ranges from mild, to moderate, to severe.

Signs and Symptoms

• First symptoms to arise include tingling of the face, body, and limbs, as well as problems with vision

• Fatigue
• Muscle weakness
• Dizziness, vertigo, and loss of balance
• Muscle spasms
• Bladder, bowel, and sexual dysfunction
• Emotional changes, mood swings, and depression
• Difficulties with memory, problem-solving, focus, and perception
Source: National Multiple Sclerosis Society (https://www.nationalmssociety.org)

Nutrition Facts in Multiple Sclerosis

In a review of research available on the National Multiple Sclerosis Society’s website, Dr. Pavan Bhargava goes into detail regarding which aspects of nutrition affect symptoms of multiple sclerosis, and how diet possibly plays a role in the wellness of a patient with MS. Five popular diets that have been studied for MS were discussed, including the paleolithic diet, the Mediterranean diet, the McDougall diet, the gluten free diet, and the Swank diet. However, Dr. Bhargava argues that there is insufficient evidence to officially recommend any of these five diets for patients with MS. He does, however, identify common themes among these diets, noting that they each recommend avoiding processed food, foods with high glycemic index, foods high in saturated fats, and fatty red meat. Each of the diets advocate for high consumption of fruits and vegetables. In addition, he elaborates on the idea of caloric restriction for patients with MS, citing efficacy in animal models and explaining that clinical trials of caloric restriction for people with MS are currently underway at Johns Hopkins University. Dr. Bhargava explains that while the MS community awaits the results of these and other trials, adopting these common themes might have beneficial effects for MS, and especially for overall health.

Source: Bhargava P. Diet and multiple sclerosis. National Multiple Sclerosis Society website. http://www.nationalmssociety.org/NationalMSSociety/media/ MSNationalFiles/Documents/Diet-and-Multiple-Sclerosis-Bhargava-06-26-15. pdf

Latest Treatment Options for Multiple Sclerosis

A doctor will determine if a patient has MS through a series of blood tests, a lumbar puncture, an MRI, and evoked potential tests, during which electrical impulses are applied to nerves in order to measure activity. Treatment for MS focuses on speeding recovery from flare-ups, slowing the progression of the disease, and managing symptoms as they arise. There is no complete cure for MS. For MS flare-ups, corticosteroids are prescribed to patients with MS in order to reduce nerve inflammation. Another course of treatment for flare-ups, mainly in severe cases, includes plasma exchange, in which the liquid portion of the blood, called plasma, is removed, separated from the blood cells, and replaced with a protein solution. For modifying the progression of MS, different medications are available for patients depending on the specific type of their disease. These treatments are best used early in the disease process rather than later, to lower the relapse rate and slow the formation of new nerve lesions. For the management of MS symptoms, physical therapy is utilized in order to combat muscle weakness and gait problems, and muscle relaxants are used to control muscle stiffness and spasms.

Source: Mayo Clinic Staff. Multiple Sclerosis: Diagnosis and Treatment. 2014. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis- treatment/drc-20350274. Accessed Dec 12, 2017.

Tai Chi for Multiple Sclerosis and Parkinson’s Disease

Tai Chi is a form of exercise that focuses on integrating controlled movement, breathing, and mindful connection with the body. Studies have shown that Tai Chi can be an effective exercise for managing balance- and mobility-related symptoms in patients with MS or Parkinson’s disease. In a small study of 32 patients with MS, half of the patients participated in 90-minute Tai Chi sessions twice a week for six months, while the other half received treatment as usual. After six months, the Tai Chi group showed significant and consistent improvements in balance, coordination, and depression when compared to the group not participating in the Tai Chi sessions. In addition, the Tai Chi group saw greater life satisfaction and decreased levels of fatigue. In a separate review of research surrounding Tai Chi and Parkinson’s disease, researchers cited studies showing increased mobility, ease of walking, and health-related quality of life.

Sources: 1) Burschka JM, et al. Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol. 2014 Aug 23;14:165.
2) Ni X, et al. Efficacy and safety of Tai Chi for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Jun 13;9(6):e99377.

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