Parkinson's disease, one of the most mysterious and disabling of common nervous disorders, is on the way out, according to two Boston authorities. Although the number of new cases reported in the U.S. has mounted steadily, to an estimated 34,000 last year, they believe this was about the peak. Now they expect the number to decline steadily, so that within 20 years, Parkinson's should cease to be a major medical problem, though a few new cases will still occur.
Known to most laymen as "shaking palsy," the condition was named for James Parkinson, an English physician who described it in 1817. An affliction that has claimed many famous victims,-it is marked by slowness and stiffness of movement, facial immobility, shuffling gait, forward-leaning posture, and "pill-rolling" movements with the fingers. Most characteristic is the tremor, usually of the limbs, sometimes of the head, especially noticeable at rest. It does not kill. Drugs relieve a few of the symptoms, but the only radical treatment is daring brain surgery pioneered by New York University's Dr. Irving Cooper, followed by intensive physiotherapy and exercises.
Deep in the Brain. Last week Drs. David C. Poskanzer and Robert S.
Schwab of Harvard University completed a study of 1,436 Parkinson's patients seen at Massachusetts General Hospital since 1875 and concluded that the great majority of current cases are the result of a baffling epidemic of encephalitis that swept around the world in 1915-25. The evidence is indirect, but the Harvard researchers make a persuasive case. Key links in their chain of evidence: EUR| For more than a century, Parkinson's was a rare disease; only 2 2 of the cases at "the General" occurred in the first 42 years studied, while 1,414 appeared in the next 43 years.
CJ Most of today's victims of Parkinsonism were born within ten years of 1897, and the average age of new cases has gone up from 23 in 1920-24 to 62 this year. Parkinsonism results from damage to nerve cells below the thalamus, deep in the brain. Though the cause of this damage in many cases cannot be traced, it is known that encephalitis is often to blame. Its effects may not show up for years.
Delayed Fuse. This brings the Harvard researchers to the enigmatic epidemic. First noted in war-ravaged Rumania in 1915, it was an inflammation of the brain that left some victims comatose for weeks or months—hence its medical name of encephalitis lethargica, or "sleeping sickness." Unrelated to any form of sleeping sickness previously known, it was apparently caused by a virus. The epidemic reached the U.S. in 1918, died out by 1926. No proved case has been found since. The virus vanished.
Though this form of encephalitis killed up to 30% of its victims and left others crippled by nerve damage resembling Parkinson's, most patients seemed to make a full recovery. And physicians suspect that, as in all such epidemics, there were many undetected cases. In these, Drs. Poskanzer and Schwab believe, de-layed-fuse damage to the nerve cells in the subthalamic region caused Parkinson's disease up to 40 or more years later.