The Parkinson's Puzzle

Is Parkinson's disease dying out? The "shaking palsy" that Dr. James Parkinson, a London physician, distinguished in 1817 was relatively uncommon until the 1930s, when this ancient nervous disorder inexplicably erupted to nearly epidemic proportions. Now new cases of Parkinsonism are appearing less frequently, prompting a debate as to whether this scourge of the mid-20th century may in fact be disappearing.

Parkinson's disease has always been wreathed in mystery. For centuries nothing was known of its causes, though it was noted that in many cases it followed an attack of encephalitis, inflammation of the brain. Then, from 1916 to 1926, there came a worldwide epidemic of brain inflammation, caused by a virus and named encephalitis lethargica because the most severely stricken victims spent days or weeks almost comatose and immobile. Some of these patients soon developed full-blown cases of Parkinsonism, marked by alternations of involuntary movements and rigidity, a fixed gaze and a shuffling gait. Even after this encephalitis virus disappeared in 1931, the incidence of Parkinsonism continued to rise. Why?

Searching over the records, two Boston researchers, Dr. David C. Poskanzer and the late Dr. Robert S. Schwab, found that the number of Parkinson's patients diagnosed at Massachusetts General Hospital increased exponentially from the 1920s into the 1960s. Then they noticed something else: with each passing year, the average age of the new patients increased by a year.

14 Bottles. The two physicians evolved a hypothesis: except for a few rare cases caused by chemical poisoning, the great epidemic of Parkinsonism resulted from something that happened long ago and then ceased. What was that something? Poskanzer has an idea: a mild, probably unrecognized infection with the virus of encephalitis lethargica back in the 1920s could have damaged certain brain cells; later, as the brain's chemistry was impaired with advancing age, the signs of Parkinson's began to appear.

The Poskanzer view still has not won total acceptance. Dr. Caleb Finch, a biologist at the Ethel Percy Andrus Gerontology Center in Los Angeles, is one of many researchers today who point out that it is still only an intriguing hypothesis. Finch notes that little is known about the effects of aging on the brain. There may be other causes that produce symptoms of Parkinsonism without being clear-cut cases of the disease.

Poskanzer concedes that his hypothesis has not been technically "proved"--but he is literally betting that it will be. "I have a reporting system," he points out, "and I offer a bottle of Scotch to any doctor in the U.S. who can send me a report of a clearly diagnosed case of Parkinson's in a patient born since 1931. So far it's cost me 14 bottles--just 14 of these younger patients identified since 1961." If Poskanzer is right, Parkinsonism will subside with the passing of the generation born in the early 1900s and now in their 60s and 70s.

The victims' futures brightened immeasurably with the development of an effective drug treatment in 1967 by Dr. George C. Cotzias of the Brookhaven (L.I.) National Laboratory. The drug, L-Dopa, counters the major chemical defect in Parkinsonian brains, which is a deficiency of dopamine, a natural body chemical essential to normal nerve activity. Thousands of Americans today are leading much better lives than would be possible without the treatment. But there should be many fewer such patients in the future--provided, of course, that Poskanzer wins his bet.

This file is automatically generated by a robot program, so viewer discretion is required.