Parkinson’s Symptoms–Not Only A Movement Disorder
Parkinson’s is known for the shuffling gait, the masked face, the stooped posture, the soft, almost inaudible voice, the slowness of movement, the trembling and rigidity. These motor or movement symptoms are what most people seek treatment for, and they form the basis of the diagnosis.
Non-motor symptoms such as loss of the sense of smell, constipation, depression, anxiety, fatigue, restlessness, irritability, and sleep difficulties may appear 20 years or more ahead of the motor symptoms. They do not improve with standard medications. They contribute to a diminished quality of life as Parkinson’s progresses. Researchers are searching to identify and work with early, non-motor symptoms, in the hope of earlier diagnoses and better treatments. (see Michael J. Fox Foundation on biomarkers)
60-75% of people with idiopathic1 Parkinson’s may have a characteristic personality, going back as far as many can remember into childhood. The most commonly observed traits are: suppression of pain or stoicism or denial in the face of pain; cynicism or anticipation of negative outcomes; avoidance of illicit pleasure-seeking or risky behaviors; diminished novelty-seeking; and difficulty with self-love or self-compassion–even though the person may be altruistic or compassionate towards others.
Dopamine circuits motivate people, animals, even insects to move towards perceived benefits or rewards and away from threats. Could traits of avoiding pleasure, and not seeking rewards, contribute to the shutdown of the dopamine circuits, on the principle of use it or lose it? More importantly, can these traits be reversed to “turn on” dopamine production at a late stage of dysfunction of those circuits?
Most researchers assume that this personality pattern is a consequence of dopamine depletion, and it is sometimes associated with genetic markers. Some research studies suggest that these personality patterns may precede other symptoms, although certainly not everyone who is cautious, cynical and stoic develops Parkinson’s. And some people with Parkinson’s are cheerful and optimistic. Is the personality pattern a subtype or risk factor?
Known Parkinson’s Risk Factors
There is no single known cause, but there are several factors associated with a higher risk of developing Parkinson’s. Risk factors include: high dietary levels of dairy consumption, low levels of Vitamin D, multiple head injuries, early childhood or in utero infection, and toxic exposures to pesticides, herbicides, or industrial chemicals. An increasing number of genetic risk factors have been identified. Some sources suggest that specific kinds of childhood trauma may also be a factor, especially where the child was in pain and couldn’t get help, and developed stoicism or bodily dissociation.
Decades of the most promising laboratory research has failed to find any medication that can slow the progression of Parkinson’s or provide neuroprotective benefits.
Movement or exercise that demands focus and concentration, such as tango, Irish dance, boxing, dancing to upbeat music, forced exercise cycling, and Tai Chi seem to show the most hope. These activities were “highly recommended” for newly diagnosed two or three years ago, and the evidence is getting stronger that they might be neuroprotective.
There is small but growing evidence that antioxidant supplements and an antinflammatory diet can benefit. There is even evidence that what we do with our minds can influence symptoms.
Neurofeedback and Motor Imagery: Improvement of Parkinson’s Symptoms
There have been several clinical trials5, 6 of Parkinson’s neurofeedback training with fMRI (functional, real-time MRI feedback) using motor imagery, or imagining movement. In one, the person watched their brain’s motor cortex fMRI when they moved their hand. They then imagined the movement, to see if they could activate the same part of the brain without moving their hand. Compared to matched controls of people with Parkinson’s who didn’t have neurofeedback training, they showed up to 37% improvement in motor symptoms. The authors were cautiously optimistic that this treatment might benefit people with Parkinson’s in slowing the progression of the condition and in decreasing the need for medications in people with early-stage PD several years ago. Some researchers consider this to indicate neuroprotective or even neuroplastic benefits.
The dopamine circuits have an emotional component, as they interact with the limbic system. Parts of the brain previously thought to be incapable of healing have shown amazing neuroplastic changes. With intensive therapy, people walk after spinal cord injuries, regain use of a limb after strokes, control seizures in epilepsy, and recover from obsessive compulsive disorder. There is increasing awareness that emotional and personality traits can be changed with thought2 or motor imagery.3
Parkinson’s, Placebo, Lessebo Effect
People with Parkinson’s, when they knew they were engaged in a placebo-controlled trial, figured they would probably get a placebo and actually showed less benefit from the active medication! This was dubbed the Lessebo effect, for the anticipation of negative benefit. Is it plausible that an effort to stimulate positive motivation, self-love, and anticipation of benefit might also positively impact the dopamine circuits?
Neuroplasticity research with MRI imaging in other populations has documented intentional personality changes using mindfulness meditation. Patients changed belief in what was possible, and learned to anticipate positive benefits, improving health. To support patients in making these changes, massage and body-based therapies4 can offer relief of depression, anxiety, stiffness and rigidity, increase relaxation and motivation, and improve kinesthetic body awareness. They have the potential to stimulate dopamine, oxytocin, and serotonin, two other neurotransmitters deficient in PD. However, this approach has not been trialed in patients with PD.
Mindfulness-Based Stress Reduction has been taught to over 20,000 patients through the University of Massachusetts Medical Center, (see MBSR post) and people have improved in measures of mood, anxiety, stress, pain, self-efficacy, and self-confidence. Could mindfulness training, intentional personality changes, feedforward principles, movement programs and body-based therapies activate the motivation/reward/movement system and regulate dopamine circuits while they relieve non-motor symptoms?
Treatments that use some of these combined approaches
I use many of these proven practices as part of mindfulness-based bodywork treatments to encourage neuroplasticity in Parkinsons. However, I know a cookie cutter approach doesn’t work. Thus, each session is individually tailored to your needs. Ortho-Bionomy®, massage, brain plasticity exercises7, neurological exercises and mental imagery training are combined to find if we can change the symptoms of Parkinson’s. Call for a free consultation: 503-708-2911.
1 Idiopathic means no known cause: see Risk Factors in the middle of the post.
2 Highly recommended by some people who have Parkinson’s: Dr. Joe Dispenza’s You Are the Placebo—Healing by Thought Alone.
3 Real-Time fMRI Computer Interfaces for alleviating psychiatric disorders, and The effects of mental practice in neurological rehabilitation
4 Read more here about Integration Massage research.
5 Subramanian, et al. (2011). Real-time functional magnetic resonance imaging neurofeedback for treatment of Parkinson’s disease. J. Neurosci. 31 16309–16317. and Volitional Regulation of SMA in PD with fMRI Neurofeedback: A Pilot Study
6 This study showed people with Parkinson’s could use motor imagery effectively: Motor imagery ability in patients with early- and mid-stage Parkinson disease.
7 For example in Jon Kabbat-Zinn’s Full Catastrophe Living, Rick Hansen’s Buddha’s Brain, and Norman Doidge The Brain that Changes Itself.