Michael J Fox Credits His Wife Tracy Pollan For Helping Him Through His Diagnosis And Beyond
When diagnosed with a chronic disease as Michael J. Fox was, it’s only natural to ask, “Why?” Perhaps there’s a comfort in understanding the cause and effect in this situation. Maybe just being able to connect the dots creates some control. However, the “why” is often the most difficult if not impossible factor to determine.
Despite all of the research into Parkinson’s, the exact cause of it remains unknown, according to the Michael J. Fox Foundation. Several components are connected to the disease, but like random jigsaw puzzle pieces, it is still not clear how these elements come together to cause Parkinson’s. What we do know is that early-onset Parkinson’s usually has a genetic factor . In fact, research is finding connections between certain genes and the likelihood of developing this form of Parkinson’s disease. Yet, it is possible to have these genes and never develop the disease at any point in your life.
Despite all of the unknowns, Fox has maintained an optimistic outlook in part because of the support of his wife Tracy Pollan. “We didn’t know what to expect,” Fox tells NBC’s Today. “One of the things I’ll always love Tracy for is that at that moment, she didn’t blink.” And according to a teary-eyed Fox, through all the ups and downs that followed, she still hasn’t blinked.
What Causes Parkinsons Disease
The cause of Parkinsons disease is unknown. It is believed it may be due to a combination of genetics and environmental causes.
The condition is the result of the loss of the brain chemical dopamine. In Parkinsons disease, nerve cells in the brain slowly degenerate and lose their ability to produce dopamine, though the reason this occurs is not understood. This loss of dopamine causes the symptoms of Parkinsons disease to develop gradually and become more severe over time.
In a small number of cases, the condition may be passed from family members about 10 to 15 percent of patients have at least one first-degree relative with the disease. In patients diagnosed before age 50, genetic mutations may play a role.
Signs Of Parkinsons Disease
In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.
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Find A Movement Disorder Specialist
- A movement disorder specialist is a neurologist who has pursued specialized training in movement disorders. Outcomes are much better in people who see a movement disorder specialist because their doctors can customize treatment and fine-tune multiple medications.
- Click here to find a movement disorder specialist in your area.
How Does Parkinsons Progress
Parkinsons is a chronic and slowly progressive disorder. This means that symptoms normally appear slowly and develop gradually over time. The stage at which symptoms appear, speed at which they progress and the severity of those symptoms will vary from person to person. The most important point is that Parkinsons affects everyone differently.
There are a wide range of symptoms, but it is highly unlikely that you will experience every possible symptom. Some of the early symptoms of Parkinsons include handwriting changes, reduced sense of smell, tiredness and constipation. As Parkinsons progresses symptoms will change over time, and new symptoms will emerge. It can take many years for symptoms to progress to a point where they cause problems.
Ultimately symptoms will begin to impact on your day to day life. Many symptoms are related to physical movement, so you may find that walking becomes difficult. You may also experience non-movement symptoms such as mood changes, disrupted sleep or difficulty communicating. As these symptoms worsen it may become difficult to manage all of your daily activities.
Currently, there is no known way to slow the progression of Parkinsons. However, medications and other treatments can help to effectively manage your symptoms. To ensure the effectiveness of medications, they will need to be reviewed regularly by your specialist or doctor.
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Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
The Actor Wasn’t Initially Open About His Parkinson’s Diagnosis
Michael J. Fox was diagnosed with Parkinson’s disease in 1991, but he stayed quiet about it for seven years, only telling people who needed to know . Finding new career success with the film “The American President,” Fox returned to television with the sitcom “Spin City.” This, however, meant talking about his diagnosis with the network and production company. “I said it could get very bad or not get bad,” he recalled to People in 1998. “They said, ‘Let’s go!'” It would be two seasons into the show’s run before Fox told his costars about his condition.
It’s understandable that someone with Parkinson’s would feel anxiety and not want to talk about the disease. The European Parkinson’s Disease Association’s website explains that it is common for someone with this disease to experience mild to severe general social anxiety in which they are worried about being judged. And, unfortunately, that fear can exacerbate some of their symptoms like shaking. But beyond this, research shows that the way Parkinson’s disease can change a person’s brain chemistry may alone bring on feelings of anxiety. In addition, someone with Parkinson’s might develop akathisia, a different condition which mimics anxiety in that the person is uncontrollably restless.
Ultimately, Fox came to an important realization: To properly accept having Parkinson’s, he needed to be open about it. This turning point for Fox, however, meant he had to make significant changes in his life.
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Some Parkinson’s Treatment Options
Parkinson’s disease has no cure, but there are treatment options to control your symptoms and improve your quality of life which include:
- Medication. Levodopa and other medications, which are trying to boost dopamine . There are number of those medications which can be used alone or in combination. Although many of those medications can help you significantly control your motor symptoms , you might also experience side effects and diminished efficacy over time.
- Physical, occupational, and speech therapy are usually part of your treatment plan and can improve your balance, mobility, ability to do daily tasks, and speech.
- Deep brain stimulation is a surgery performed by a neurosurgeon, and in indicated patients can help with motor symptoms, though non-motor symptoms, such as falls, constipation, low blood pressure and incontinence do not improve.
- Tai Chi is a Chinese martial art that may help sufferers regain some of their balance and strength, as well as decrease the risk of falling. Dance, such as a Zumba, may also help, as can using a stationary bicycle and rock steady boxing.
Many treatment options for Parkinson’s are most effective when used in conjunction with others such as taking medication and doing physical therapy.
Whats Different About Young
The age of diagnosis matters for a variety of reasons, from probable causes of early cases to symptoms and treatment:
- Genetics. As with any case of Parkinsons disease, the exact cause is usually unknown. That said, The young-onset cases of Parkinsons disease are, on average, a bit more likely to be familial or genetic, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic.
- Symptoms. In many patients with YOPD, dystonia is an early symptom. People with YOPD also report more dyskinesia . They also tend to exhibit cognitive problems, such as dementia and memory issues, less frequently.
- Progression. Patients with young-onset Parkinsons appear to have a slower progression of the disease over time, says Pontone. They tend to have a milder course, staying functional and cognitively intact for much longer.
- Treatment. Most patients with Parkinsons take the medication levodopa. However, other drugs, such as MAO-B inhibitors, anticholinergics, amantadine, and dopamine receptor agonists, may be used before levodopa.
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So What Do We Know So Far
Location of the substantia nigra. CC BY-SA 4.0
The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.
There are a right and a left substantia nigra, and often one side is affected before the other. Because of this, people with Parkinsons often experience symptoms primarily on one side of their body, particularly in the early stages. Indeed, this common feature of the condition often helps to distinguish Parkinsons from other similar conditions.
When it comes to confirming a diagnosis, it is the substantia nigra where pathologists look for changes at the end of life in brain tissue that has been donated to research. And the loss of the dopamine-producing cells in this area of the brain, accompanied by the presence of clumps of alpha-synuclein protein , has been the hallmark of Parkinsons for decades.
You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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There’s No Time Like The Future For Michael J Fox
Titled “No Time Like the Future: An Optimist Considers Mortality,” Michael J. Fox’s 2020 memoir describes how Fox came to understand and embrace his new form of reality-based and gratitude-driven optimism . Although Fox is unable to physically write with a keyboard or a pen, he dictated this fourth memoir through as assistant. “He has increasing difficulty in forming words, and occasionally needs a wheelchair,” The Guardian noted. But that didn’t stop him from engaging in an almost two-hour interview, nearly skipping lunch to keep the conversation going.
Although Fox has stepped away from acting, he’s still involved in his foundation. Its Deputy CEO, Sohini Chowdhury, sees possibly big advances in Parkinson’s treatments happening in the next few years. “It’s important to remember that a cure can mean different things to different people,” she told the European Parkinson’s Disease Association. “If you’re able to improve the symptom management of the disease to an extent where having the disease has very little impact on your day-to-day life, that could be considered a cure.”
Fox himself told The New York Times that better treatments for managing Parkinson’s symptoms can make a big different in people’s lives. “Now, if we can prophylactically keep Parkinson’s symptoms from developing in a person, is that a cure? No. Would I take it? Yes.”
Arguments Against Early Use
Few will argue about the superior effectiveness of levodopa, and all Parkinson’s patients will likely eventually need this medication. There are some persuasive arguments for starting it later in the disease’s course, though.
Medications need to be titrated throughout the progression of a disease. In other words, someone with mild Parkinson’s disease who is started on levodopa will need the medication to be steadily increased as their disease worsens. In general, dopamine’s potency will wear off after three years. When maximum doses of levodopa no longer control the symptoms, what else is there to turn to? Without stronger medicinal options, surgery may be the only recourse. Isn’t it better to save the “big gun” for later, when symptoms are more severe?
In addition to the side effects of levodopa already discussed, there are additional potential complications including worsening cognitive function, psychosis, and diminished impulse control. It’s true, though, that other medications such as dopamine agonists also have side effects, such as swelling, somnolence and psychiatric side effects, such as a gambling addiction.
In short, why would you use your “big gun” early, especially when past researchers have suggested it can make the disease worse? Especially when you can use a milder medication that might actually slow the disease process, in addition to helping with symptoms?
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Diagnosing Early Onset Parkinsons Disease
There is no single test to detect Parkinsons. A diagnosis may be difficult and take a while. The condition is usually diagnosed by a neurologist based on a review of your symptoms and a physical exam.
A DaTscan to visualize your brains dopamine system may help confirm diagnosis. Blood tests and other imaging tests, such as an MRI scan, dont diagnose Parkinsons. However, they may be used to rule out other conditions.
Early Onset/young Onset Parkinson’s
Parkinsons can occur at any age. Early onset Parkinson’s, also known as young onset Parkinsons , is defined as occurring in someone below the age of 40. Research suggests that genetics may play more of a role in early or young onset than in people who are diagnosed over the age of 40.
In early or young onset Parkinson’s, the symptoms you experience and how you respond to medication may differ slightly from older onset, although for some people these can be very similar.
Motor symptoms generally respond well to medication in both young and older onset Parkinsons. In early or young onset, motor fluctuations such as dyskinesia and wearing off tend to occur earlier but they generally progress more slowly. This is thought to be due to the most commonly prescribed medication, levodopa, and for this reason, young onset is usually treated initially with alternatives to levodopa such as MAO-B inhibitors or dopamine agonists. Levodopa is generally only added in when other medications do not provide adequate symptom control.
Dystonia is also a more common early motor symptom in early or young onset, whereas some of the non-motor symptoms that occur in older onset Parkinsons, such as memory problems, are less common.
Deep brain stimulation has also been shown to be effective at an earlier stage of Parkinsons if medication no longer controls motor symptoms so well, and you may want to discuss this option with your care team. See Deep brain stimulation.
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Research Is Underway To Further Understand The Cardiac Effects Of Parkinsons
It is possible to image the sympathetic nervous system of the human heart by injecting a radioactive tracer, meta-iodo-benzyl-guanidine, . Development of this technique, known as MIBG cardiac imaging, holds much promise as a test to confirm the diagnosis of PD , to identify those who are at risk of developing PD in the future, and to distinguish PD from related disorders. MIBG cardiac imaging is still considered an experimental procedure for detection of PD and is not yet in use as a clinical tool for this purpose.
A recent research was conducted in monkeys in which the destruction of the sympathetic nerves of the heart was chemically induced to mimic the changes that are seen in PD. The cardiac system was then imaged using a number of new-generation radioactive tracers, which bind to markers of inflammation and oxidative stress. This model system may help to shed light on the molecular changes that accompany the loss of the sympathetic nerves of the heart and can also be used to track the response of the cardiac system to therapeutic agents.
The Effects Of Parkinsons Disease
* Memories: Brain stores short-term memories of the experience in a part of the brain called the hippocampus, then those memories are later consolidated and transferred to another part of the brain, more precisely in neocortex, for a long-term storage Memory cells are placed in three parts of the brain, the hippocampus, the prefrontal cortex, and also the basolateral amygdala, which is responsible of emotional associations. In fact these cells are necessary to evoke the emotions linked with
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Why Is Distinguishing Young
Socially, people who are affected by PD at a younger age experience the disease differently they may be at a different stage of their career and often have less time to engage in their own care. They may also have children or are planning to have children and have questions regarding passing on PD genes.
Medically, doctors tailor treatment when it is a younger person with PD. The younger you are, the more likely the disease is genetic. Your care team may offer genetic testing or counseling. Younger brains also have a higher neuroplasticity potential which allows the brain to handle and respond to disease and therapy differently.