Unravelling The Interplay Of Post-Traumatic Stress Disorder With Parkinson’s Disease

People living with post-traumatic stress disorder (PTSD) have higher risk of developing Parkinson’s disease in later life. Here’s a case study.

Imagine living through the tumultuous experiences of war, carrying the weight of trauma, and successfully navigating life for decades. This is the story of Colonel Srijesh Shetty (name changed), a 75-year-old retired army officer who served in the military during his younger years and endured challenging and harrowing events amid the riots that took place post-India’s independence. Despite facing post-traumatic stress disorder (PTSD), he managed to lead a relatively stable life. However, as he entered his 70s, his world took an unexpected turn as he encountered a new and formidable adversary – Parkinson’s Disease (PD).

For Col. Shetty, the early signs of Parkinson’s were subtle and easy to overlook. Friends and family noticed slight tremors, an occasional shuffle in his walk, and subtle changes in his handwriting. Initially, they attributed these signs to the natural process of ageing. Unbeknownst to them, a complex interplay of factors was brimming beneath the surface.

PTSD can increase risk of developing Parkinson’s disease

At the time, nobody knew that Col. Shetty’s prolonged exposure to stress and trauma during his military service might have laid the groundwork for the development of Parkinson’s later in life. As researchers have suggested, stress could potentially impact the brain’s neurotransmitters and trigger or worsen neurodegenerative processes.[1] Moreover, people living with PTSD had an elevated risk of developing Parkinson’s disease in later life.[2]

As his symptoms progressed, Col. Shetty realised that seeking medical advice was imperative. He approached his primary care physician, who referred him to a neurologist. The initial diagnosis pointed towards essential tremor, and Col. Shetty was prescribed medication accordingly. However, the treatment did little to alleviate his symptoms, leaving him frustrated and anxious. Over the next six years, Col. Shetty embarked on an arduous journey of seeking answers from multiple specialists. Each consultation led to a different diagnosis – benign essential tremor, anxiety-induced movements, and more. New medications were prescribed each time, but none offered the relief he desperately sought.

Finally, after years of navigating through a labyrinth of uncertainty, a ray of hope emerged. Col. Shetty was referred to a specialised movement disorders clinic, where a comprehensive approach was adopted. The medical team delved deep into his medical history, uncovering the significant chapter of PTSD that he carried with him. The doctors recognised the potential links between his history of trauma and the development of Parkinson’s Disease. This pivotal connection opened a new avenue of investigation as they carefully examined Col. Shetty’s neurological symptoms alongside his emotional struggles from the past. The specialised clinic conducted several diagnostic tests, including a DaTscan and MRI, to better understand Col. Shetty’s condition. The meticulous analysis and consideration of his present symptoms and past experiences led the neurologists to a confident diagnosis of Parkinson’s Disease.

Over 12 million people will be living with Parkinson’s by 2040

Parkinson’s is a neurodegenerative disease commonly associated with getting older, as it usually affects people 65 years of age and older. As per research by the National Center for Biotechnology Information, the incidences of Parkinson’s will witness a significant rise globally to over 12 million by 2040. Despite the high occurrence of this condition and the progress made in medical science, there still exists a considerable gap in identifying the symptoms during the initial phases, which causes delays in diagnosis, just like in Col. Shetty’s case.

Finally, with a definitive diagnosis, Col. Shetty’s treatment plan was tailored to address his specific needs. A combination of medication with Apomorphine, physical therapy, and lifestyle adjustments formed the pillars of his management strategy. The prescribed medications, especially Apomorphine, targeted the different symptoms of Parkinson’s, while regular physical exercise worked wonders for his mobility and balance.

Apomorphine for treatment of Parkinson’s disease

Dr. LK Prashanth, aNeurologist at Manipal Hospitals, Bangalore, emphasised the efficacy of Apomorphine as a valuable treatment option for managing Parkinson’s disease. “This medication proves particularly beneficial in cases where other treatments may be less effective or when patients experience regular fluctuations in motor symptoms,” he said.

Apomorphine belongs to the class of drugs known as ‘dopamine agonists’, which effectively imitate the actions of dopamine in the brain. In Parkinson’s disease, there is a gradual loss of dopamine-producing cells in the brain, resulting in motor symptoms like tremors, stiffness, and difficulties with coordination. By employing continuous infusion, Apomorphine effectively alleviates the motor symptoms associated with the disease, providing significant relief and enhancing mobility.

“One of the notable advantages of apomorphine lies in its rapid onset of action. The medication’s effects generally last for approximately an hour and work swiftly to alleviate ‘off’ episodes, which are characterised by a decline in the effectiveness of standard Parkinson’s medications, leading to the return of symptoms. Apomorphine can be administered through various routes, including subcutaneous injection or continuous infusion, using a portable pump, offering flexibility and convenience in its application.” Dr. Prashanth added.

Like Col. Shetty, many people are living with Parkinson’s who are not diagnosed with the condition timely. Hence, this underscores the significance of increased awareness and sensitivity in diagnosing and managing conditions that may have underlying connections with past trauma and other medical comorbidities. By adopting a comprehensive approach and acknowledging the intricate interplay of physical and emotional well-being, we can improve diagnosis rates and patient outcomes, offering hope and support to those facing similar battles with Parkinson’s disease.

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[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/

[2]https://pubmed.ncbi.nlm.nih.gov/28416268/