A Problem With Specialization
Medicine has embraced the concept of “specialization” – the aquisition of knowledge that is deep but narrow. There are some obvious strengths to this approach, it is true. However, there are some major weaknesses that are not so obvious. One of the problems with this approach is that the divisional lines are sometimes drawn by Medicine rather than Nature. These divisions are by definition far from the center and are therefore a gradient. But Medicine has, for its own convenience, insisted on drawing them sharply. As a result, things that should be sharing a table aren’t even in the same hall. Parkinson’s is one of those disorders that fall through the cracks.
Nature does not exist for Man’s convenience. The nervous system is not neatly cordoned off from the immune and neither is truly separated from the endocrine. Quite the contrary, these various systems flow seamlessly into one another. Unfortunately and for a number of reasons, in modern Medicine the neurologist does not have the time to read the journals of the immunologist who lacks the background to grasp the finer points of endocrinology who…etc. To understand Parkinson’s our first task is to overcome those divisions.
A similar point was made by no less a personage than Dr. J. William Langston in an article entitled “PD: More Than a Movement Disorder” and published in the Fall 2006 newsletter of the Parkinson’s Disease Foundation.
“How precisely we proceed from here – what new studies are needed, what symptoms we should be studying, how we can connect the dots among them, whether in fact we need to rename Parkinson’s to redirect attention beyond its exclusively motor symptoms – is far from clear, and will require the attention of scientists from a variety of specialties and viewpoints. What is clear is that our concept of Parkinson’s must change, perhaps radically.
We need, among other things, to broaden the clinical definition of Parkinson’s to include all of the syndromes described in this article along with depression, anxiety and other problems that are commonly reported among people with the condition. This will serve as a constant reminder that we need to look at our patients as more than just victims of a failing nigrostriatal system, and look at a variety of other symptoms and signs – many of which do not traditionally fall within the purview of the neurologist. (This last point, incidentally, suggests that we either need to develop multi-disciplinary teams to treat these patients, or find some way to ensure that the neurologists who care for them seek much more diverse training.)”
In order to understand Young Onset Parkinson’s Disease it is going to be necessary to embrace the overused term of “Wholism”. Nature requires it and cares not at all if we approve. Our only other choice is to sit in the darkness cast by the walls Medicine has erected.
And so, in that spirit, let us consider YOPD.
The Unique Nature of YOPD
As noted earlier, the emerging view of PD is built around a long term activation of the innate defensive systems of the brain which, over time, leads to neuronal death and the disruption of neurochemical function. The condition seems to fall into two primary divisions based on age of onset.
The more familiar Senior Onset (SOPD) is, as the name implies, directly related to aging. The accumulated insults combined with the increasing sensitivity of the microglia eventually tip the scales and, in the neighborhood of the mid-sixties, symptoms develop. If the oft-quoted twenty-year degenerative process is held, then SOPD begins at mid-life and is relatively straight forward.
Young Onset, however, shows up before SOPD even makes its subterranean beginning. First symptoms in the thirties are common which would push YOPD back to puberty. Can this be so?
Not only can this be so, YOPD goes back even farther, as we shall see. As in SOPD, the microglia lie at the heart of the problem, but in YOPD they are not alone.
The Role of Bacterial Endotoxins
But first, a short digression- There exists a vast family of bacteria called “gram-negative” due to their non-response to a particular laboratory staining technique. These bacteria have as part of their cell wall a toxin called lipopolysaccharide (LPS). So long as the particular bacterium is healthy, the toxin is safely contained within its cell wall, but when it dies or is killed the toxin is released into the host’s system. A brilliant defense worthy of the greatest sharks of Wall Street!
LPS exposure can have a wide range of effects upon body systems. Some of the variables are at what age it happens, how sensitive is the individual to it, how much toxin is involved, how long is the time of exposure, what other factors are at work, etc. These factors can combine to produce outcomes ranging from none to a quick death. In addition, our genetics, prior encounters, environmental co-factors, etc. all play a role. LPS is a many headed hydra and it lies at the heart of YOPD and is one reason for the frustration in trying to understand. This wide range of variables interacting with one another produce a bewildering array of results.
This complex interaction, when it occurs pre-puberty, has a molding effect upon the still-plastic parts of the body. These effects encompass more than the nervous system and extend to the immune, endocrine, and even gastrointestinal systems as well. All these are a part of PD and all are influenced by exposure to LPS.
YOPD as More Than a Nervous System Disorder
If there is a body system at the center of this web, it is not the nervous system despite the neurological effects that seem so plain. Nor is it the immune system even though the actions of the microglia dominate the scene. The center of the web is occupied by the endocrine system. In particular, the parts of that system that regulate the response to stress upon the body. These parts are primarily the hypothalamus, pituitary, and adrenal axis – the HPAA. Arguably this is the most important part of the organism for it is here that the inner and outer worlds interact – the threat and the reaction. Survival itself. But it is also here that the conscious and unconscious interact – the mind and body.
This center has one overriding purpose – the pursuit of health, survival, stability, homeostasis – balance. When the tiger threatens, it is this center which has you running before your “mind” knows why. When the infection has been dealt with, it is this part which issues the orders to “stand down.” Anything which threatens the delicate balance of life in a hostile universe is dealt with here. Its function is so important that it has complete and absolute veto power over most of the rest of the body and mind. It does not “think” – it doesn’t have to. Like some martial arts master it acts far too quickly for thinking.
The endocrine system is capable of seizing control of the immune system and the nervous system without hesitation. It commands forces that can preserve one’s life by lending speed to the feet. Those same forces can give up life by allowing those feet to carry one into a burning building to attempt to save another. The conscious mind does not understand it, cannot over rule it, could not exist without it, and cannot even keep up with it.
It does not even exist in one spot but is distributed around the body in a collection of structures known as glands by means of which it issues its orders having made its decisions at lightning speed. When balance is recovered and all is well, it hands over control to our conscious mind. But it is only a loan.
Even under less dramatic circumstances there is a continuous interaction between these systems, much of it mediated by the endocrine system in response to stimuli we know as stressors. These include not just the tiger, but the bacterium as well. They also include include its own actions by means of complex loops of constant feedback. The endocrine system continuously monitors its charge as well as the environment.
The demands placed upon this system and the importance of its functions are so high as to be near-impossible to be overstated. But any system can be stretched out of alignment and even broken. Conditions such as Post Traumatic Stress Disorder are the result of such stretching. Take it further and the misnamed Nervous Breakdown is the result. Many of the non-motor symptoms of YOPD originate in this realm.
I have made some bold statements in the above and will support them with solid research from peer reviewed journals as time goes on. For now allow me to state plainly what I have hinted at above:
Parkinson’s Disease is not only “More Than a Movement Disorder” as Dr. Langston stated, it is also more than a disorder of the nervous system – far more.