A mask worn with trembling hands

-Madhura Mandlik

Like every other day ,I stood there by the operating table ; a scalpel in my hand and a patient lying before me. But today was no ordinary day , today my band would tremble and cause a havoc in my life. The surgeon assisting me asked “ Did you not eat today? “ Trying to blame that fine tremble on hypoglycaemia. But I knew ,this wasn’t something so trivial. Life as I knew it would never be the same again.

Parkinson’s disease or Parkinsonism is a movement disorder due to deficiency of dopamine owing to degeneration of the nigrostriatal pathway. It is usually attributed as a disease of the old but young onset Parkinsonism is on the rise. Young onset Parkinson’s disease occurs before the age of 50. It shows the symptoms similar to those of typical Parkinson’s disease :

Bradykinesia/ Dyskinesia
Resting tremors – Pill rolling tremor
Cog wheel rigidity
Postural instability

Adults with young onset Parkinson’s disease are more prone to depression. Such individuals have to face a debilitating disease at an age where they would want to concentrate on their career or start a family. YOPD usually has a higher genetic predisposition and mutations in the genes SNCA, PARK2, PINK1 and LRRK. Patients may have a positive family history and would worry about passing it on to their own children.
Such individuals might show slower progression of symptoms, but at the same time are more prone to side effects of drugs like levodopa carbidopa. YOPD individuals may develop disabling dyskinesia and painful and dystonia.

Drugs commonly used in Parkinson’s are Levodopa with carbidopa, COMT inihibitors tolcapone and entacapone , MAO-B inhibitors selegiline and rasagiline, amantadine and anti-cholinergics . Another modality of treatment is Deep Brain stimulation. DBS uses a surgically implanted, battery-operated medical device called an implantable pulse generator (IPG) – similar to a heart pacemaker. This delivers an electrical impulse to certain parts of the brain , thereby blocking the abnormal impulses. The common areas of the brain that are stimulated are the thalamus, subthalamic nucleus, and globus pallidus.

Apart from medical intervention, Parkinson’s disease requires tremendous support from the family and society. These young individuals have a life expectancy of thirty years and may develop psychosocial and behavioural difficulties. Support groups and counselling must form an integral part of treatment plan.

I smile looking at my baby girl
She loves playing ball with mama
But sometimes
I can’t throw the ball at her
I can’t fall in step behind her.
When she gives me a toothy grin
I try to smile back
Only to look like a mask .
When I braid her hair
The strands keep on slipping through my fingers.
And when I teach her to color
My hand cannot stop shaking
Fumbling to hold the paint brush right.
“Will you teach me how you do that with your hand maa?”
She ask’s me with naivety.
And all I ever hope is
She never has to go through this.
Because it isn’t a game
It’s a living nightmare.

References:

http://www.parkinson.org/Understanding-Parkinsons/What-is-Parkinsons/Young-Onset-Parkinsons
http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=2828