Some Individual Cases of Parkinsonism

Abstract

Since Cotzias (1) first described an effect of L-Dopa on Parkinson's Disease, the effects have been intensively investigated in all parts of the world. Our region has shared in this work and Dr. Heathfield was one of the first people in England to receive authority to prescribe L-Dopa for the purpose of assessment of the drug before it was freed from restrictions for general medical use. Dr. Heathfield and Dr. Dallos (2) have already published the results of their initial trials both of L-Dopa and Amantadine in Parkinson's Disease, conducted at Whipps Cross Hospital. In April 1970 Dr. Heathfield offered me the opportunity to participate in these investigations, since when I have assessed and treated a series of cases of Parkinson's Disease at Oldchurch Hospital. The purpose of this paper is to present some features of particular cases who have participated in this investigation, and not to present a statistical analysis of all the results obtained, for while statistics form an invaluable written record they usually detract from the clarity of the spoken word. Material and methodsThe cases that I have personally treated and followed up in this series number 26, of whom 12 have been male and 14 female. Three were in their fourth decade at the commencement of treatment, ten in the fifth, ten in the sixth and three in the seventh. Six were cases of post-encephalitic Parkinsonism and twenty were idiopathic. Seven of the cases had already had stereotactic surgical treatment at the start of the investigation. Eleven of the cases have been under treatment for 18 months to two years, eight have had treatment for one year to 18 months, two have been treated for 6-12 months, and five have not yet reached six months of treatment with L-Dopa.The cases have been assessed in precisely the same way as the cases investigated by Dr. Heathfield at Whipps Cross Hospital. Disability is expressed as a numerical score based on the results of neurological examination, socio-occupational assessment and a series of standardised performance tests. Features numerically assessed were as follows;-Neuorological: Tremor, rigidity, mask face, shuffling gait, festination, feet stick to ground, attitude of flexion, loss of arm swinging, weakness of voice. Socio-occupational: Employment, use of public transport, ability to walk, bath, get up and down stairs, dress, get up from a chair, turn over in bed, and feed. Performance tests: Threading beads, putting beads into a tin, putting pegs into peg boards (large and small), handwriting, speed of gait. The neurological assessment was performed by myself and the socio-occupational assessment and performance testing was done in the occupational therapy department by Miss J. Heal and her staff.