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72 m a s s a g e & b o d y wo r k s e p te m b e r/o c to b e r 2 0 2 3 In 1817, a renowned English surgeon, paleontologist, apothecary, and political activist (yes, all the same person), published "An Essay on the Shaking Palsy," in which he described some of his patients, along with some other people he had observed, who shared similar signs of stiffness combined with uncontrollable tremors. He named this condition paralysis agitans. The doctor was James Parkinson. Sixty years later, a noted pioneer in neurological diseases, Jean-Marie Charcot, promoted changing the label paralysis agitans to la maladie de Parkinson, or Parkinson's disease. In 1886, another pioneer in medicine, Sir William Gowers (the same doctor who identified what we now call fibromyalgia as fibrositis), sketched a man with Parkinson's disease. His illustration captures many of the physical characteristics we look for today: a mask-like face, stooped posture, shuff ling gait, and a suggestion of tremor in the arms. Parkinson's disease (PD) is now recognized as the second most common neurodegenerative disease in the world (after Alzheimer's disease). At this time, about 1 million people in the US live with PD, and about 90,000 new diagnoses are made each year. Men have PD more often than women, at a ratio of about 1.5:1. 1 PD is usually found in people over 65 years old, but about 4 percent of cases are found before age 50. 2 A small percentage of cases are related to an identifiable genetic anomaly, but for most people, this disease is probably the result of a combination of genetics and other factors. Some contributors include exposure to pollution, tainted well water, or agricultural chemicals; mitochondrial damage and oxidative stress; long-term, low-grade inf lammation; and a history of head trauma. PD PATHOPHYSIOLOGY: NEW DISCOVERIES It would be possible to devote an entire column to the current understanding of all the underpinnings of PD, but we will limit this discussion to a brief critical thinking | PATHOLOGY PERSPECTIVES overview. New discoveries about PD pathophysiology are coming frequently, and within a few years, the way this disease is described may be substantially different. Two main issues are at the forefront of our understanding of PD today: low dopamine production in the basal ganglia, and Lewy body deposition. Dopamine Production Dopamine is a multifunction neurotransmitter. When it stimulates certain neurons in the limbic system, we call it our reward system. Too much of it in the frontal lobe can cause psychosis. But just the right amount of it, in the correct locations, allows us to have smooth, coordinated, voluntary muscle contractions. Lift your water bottle gently toward your mouth. Take a sip, then gently put it back down. This action, performed without shaking, spilling, or dropping your bottle, relies on perfect dopamine production that allows a series of neurons to communicate and control voluntary muscles. This Parkinson's Disease The Shaking Palsy, or Paralysis Agitans By Ruth Werner

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