THE DIGITAL REVOLUTION
Back to the Future : Parkinson ’ s Disease
by VASUDEVA IYER , MD
During teenage years , my favorite books were science fiction novels . I was a devoted fan of H . G Wells and adored his book The Time Machine which he wrote in 1895 . Like many other youngsters , I was awe-struck with the idea of time travel and relished imagining the sights and sounds of the past and the future . The Back to the Future movies with a similar concept were fabulous and I enjoyed watching all of them with my son and later with my grandson , admiring the theme and the actors . I happened to see the reunion of the stars of those movies and was impressed with the grace and charm shown by Michael Fox , despite the significant disabilities imposed on him by Parkinson ’ s disease . I was tempted to board the time machine and see the past , present and future of Parkinson ’ s disease , the second most common neurodegenerative disorder , next to Alzheimer ’ s disease .
Let us go back to the year 1817 , when James Parkinson first published “ An Essay on the Shaking Palsy .” 1 He defined the Shaking Palsy ( Paralysis agitans ) as “ Involuntary tremulous motion , with lessened muscle power , in parts not in action and even when supported ; with a propensity to bend the trunk forward and to pass from a walking to a running pace : the senses and intellect being uninjured .” James Parkinson was born in Hoxton , just north of London in 1755 . He became well-known for his two-volume medical encyclopedia , Medical Admonitions Addressed to Families , with directions for treatment of the sick on the first appearance of disease by which its progress may be stopped and a fatal termination prevented from taking place through neglect or improper inference .” He was not only a highly respected physician , but also a renowned geologist , having published a three-volume book : Organic Remains of a Former World .
Treatment of Parkinson ’ s disease ( PD ) for the next century consisted of centrally acting anticholinergic agents and supportive therapy . Dopamine was first synthesized in 1910 by Barger and Ewens , but its role in Parkinson ’ s disease was not recognized initially . Localization of dopamine within the brain to the striatum and development of the reserpine model of Parkinsonism led to the hypothesis that dopamine loss caused PD . Levodopa was found to be a natural precursor of dopamine and Birkmayer injected it in PD patients in 1961 . Results were published the same year , and the authors Birkmayer and Hornykiewicz wrote : “ Bed-ridden patients who were unable to sit up , patients who could not stand up when seated , and patients who when standing could not start walking performed all these activities with ease after L-Dopa ( levodopa ). They walked around with normal associated movements , and they could even run and jump . The voiceless , aphonic speech , blurred by palilalia and unclear articulation , became forceful and clear as in a normal person .” While a “ budding ” neurologist , I have been privy to the feeling of the wonder and gratification bestowed on the
8 LOUISVILLE MEDICINE