Q: My father is 68 years old. He fell down on the road earlier this year. Since then he has rapidly deteriorated in health with very weak muscular movements and brain response. Our doctor says that he has Parkinson Disease. We consulted a neurologist but the response wasn't positive. My father is not able to move himself. He keeps sleeping and has low count of haemoglobin. His blood sugar is slightly elevated but the doctors say that it is under control. We have done all sorts of medical tests like scannings and hosts of blood tests. All the reports suggest that he has a pretty normal system as compared to his age. His haemoglobin count is 6.4. How should I go about treating his condition?

A:Parkinson disease is a chronic, progressive movement disorder caused by neuro-degenerative changes. It occurs when a group of cells in an area of the brain called the substantia nigra begin to malfunction and die. These cells in the substantia nigra produce a chemical called dopamine, which is a neurotransmitter (chemical messenger) that sends information to the parts of the brain that control movement and coordination. In this disease the dopamine-producing cells begin to die and the amount of dopamine produced in the brain decreases. When approximately 80% of the dopamine-producing cells are damaged, the symptoms of Parkinson disease appear. It is one of the most common neurological disorders and affects about 1% of individuals older than 60 years. The 3 cardinal signs of the disease are resting tremor (shaking), rigidity (stiffness), bradykinesia (slowness of movement), and postural instability (difficulty with balance) and 2 out of 3 are required to make the clinical diagnosis. Postural instability occurs late in the disease, usually after 8 years or more. Treatment aims at controlling the signs and symptoms for as long as possible while minimizing side effects. Drugs usually provide good symptomatic control for 4-6 years following which disability progresses despite best medical management. Symptomatic therapy is dopamine replacement therapy and this can be achieved using several groups of drugs. a) Dopamine prodrugs (levodopa); b) Dopamine agonists (directly stimulate postsynaptic dopamine receptors); Catechol-O-methyltransferase (COMT) inhibitors (inhibit the peripheral metabolism of levodopa); Anticholinergics (provide benefit for tremor in approximately 50% of patients); and MAO-B inhibitors (inhibit the activity of MAO-B oxidases that are responsible for inactivating dopamine). Newer neuroprotective therapies aim to slow the underlying loss of dopamine neurons and Selegiline is the medication that has been studied the most. Surgery can ease the symptoms of Parkinson disease, but it is not a cure. As it poses risks, it is only considered when all appropriate medications have been tried unsuccessfully. When considering surgery, it is important to see both a neurologist and brain surgeon who specialize in the treatment of Parkinson disease. Stereotactic techniques include thalamotomy and chronic thalamic stimulation. They are effective in reducing medically refractory tremor while thalamic deep brain stimulation (DBS) involving high-frequency stimulation also helps. His anaemia is unrelated to Parkinson disease and needs to be investigated. Please get a complete blood count, reticulocyte count and peripheral blood film examination done initially to find the cause. In case of nutritional deficiency, appropriate hematinic can be given. A bone marrow examination may be required in case of refractory anaemia to exclude the possibility of a myelodysplastic syndrome.