(SHAKING PALSY)
=Definition.=—A chronic, nervous disease, characterized by tremors,
muscular weakness, muscular rigidity and alterations in the gait.
=Etiology.=—The disease usually commences after forty years of age,
but occasionally it occurs from the thirtieth to fortieth years. It
is more frequent in males than in females. Heredity seems to have but
little influence in the cause of the disease. Among the principal
causes are physical injuries, exposure to cold and wet, emotion, worry,
alcoholism, sexual excesses and acute diseases. Physical injury,
in conjunction with exposure to cold is the best determined cause.
Disorder of the vertebræ of the cervical or dorsal regions, or of the
upper and middle ribs, can generally be found. Traumatic influences
probably affect the nerve centers, causing a disturbed innervation,
either by the direct effect of the deranged structures upon the nervous
tissues or obstructing nutritive channels to the nervous tissues.
In most cases no changes have been observed in the central nervous
system or in the sympathetic ganglia. Some observers have noted
induration of the pons, medulla and cord, but these changes may be due
to senility or to the indirect consequences of the long disturbance
of function. In a few cases, interstitial sclerosis of the peripheral
nerves is observed; these are probably secondary changes. Osteopathic
experience regards paralysis agitans as an affection of the central
nervous system, due to a disordered structure in the locality affected.
=Symptoms.=—The onset is usually gradual, but may come on quite
suddenly after exertion. The =initial= symptoms are usually tremor,
stiffness or weakness in one hand. In rare cases, at first there may
be neuralgic pains, dizziness and symptoms of a rheumatoid nature. The
tremor can be controlled by the will at the onset of the disease. The
affection gradually extends until an entire side or the upper or lower
limbs are involved. At this =advanced stage= of the disease, a peculiar
muscular rigidity of the involved region takes place. Muscular weakness
comes on at about the same time as the rigidity, and the loss of power
varies much in degree. The condition is most marked in the fingers and
hands, whence it extends to the arms and legs. It commonly passes from
the right arm to the right leg, then to the left arm, and then to the
left leg. At this stage the movement between the thumb and fingers is
like that of crumbling bread. The writing is greatly affected and in
time it is impossible to write. The trembling may be so violent as to
prevent sleeping. There is occasionally an intermission of days in the
tremor.
On account of the rigidity of the muscles, the patient assumes a
characteristic =attitude= and =gait=. The position of the body is
that of a tendency to go forward, the head is bent forward, the back
curved outward, the arm bent at the elbow and held away from the body,
and the knees so close together that they rub in walking. The gait
is a “propulsive” one, and when once started in a forward walk, the
patient’s gait becomes more and more rapid and he cannot stop until
he comes against some object. The expression of the face is stiff and
mask-like, the speech slow and monotonous and the voice shrill. The
patient is generally restless and troubled with insomnia. The general
health is in fairly good condition. Reflexes are usually normal. The
intellect is generally retained, although the physical ailment may
cause mental depression.
=Diagnosis.=—Is usually easy and can oftentimes be made at a glance.
=Disseminated sclerosis= has a tremor, but is shown particularly in
voluntary movements. The speech is scanning and the gait ataxic. The
disease begins in the lower extremities, the attitude is different
from that of paralysis agitans, and there is nystagmus. In =chorea=
the movements are general, irregular and more intermittent, and it
particularly involves muscles of the face. Also chorea is a disease of
children and young adults.
The =tremors= of old age, hysteria, and certain toxic conditions due to
tobacco, alcohol, etc. are generally easily diagnosed.
=Prognosis.=—The disease does not necessarily shorten life; the patient
oftentimes dies with some intercurrent disease. Improvement usually
results from careful, prolonged treatment. Early treatment, of course,
will give the most satisfactory results, and occasionally, if taken
very early, the case can be cured.
=Treatment.=—A most careful examination of the physical structures of
the patient should be made, particular attention being paid to the
=cervical= and =dorsal vertebræ=, the upper and middle =ribs= and the
=muscles= along the spinal column. All irregularities found should be
corrected if possible, and strong, thorough treatment given to the
region of innervation of the affected parts. Traction of the rigid
areas is of some value. Treatment of the arms and legs will also be of
aid. All mental strain and physical exhaustion should be prevented if
possible. General =hygienic measures= are to be employed. The life of
the patient should be quiet and regular. Bathing, fresh air, massage
and outdoor life will aid in improving the general health. =Persistent=
treatment will retard the progress and frequently improve the general
condition. Simple and hysterical tremor must not be confounded with
that of paralysis agitans. E. Ashmore[119] reports an interesting case
which shows about what may be expected under treatment.