The patient’s phone calls precede his appointment. He has read researchers have found a link between influenza and Parkinson’s disease. Diagnosed with PD not long ago, he found a journal from a year ago in which he describes a transient flu-like illness. The nurse coordinator brings the patient’s phone call notes, as the patient may want to discuss the matter directly with him. She recalls the Spanish influenza outbreak that occurred in 1918, with patients subsequently suffering with encephalitis lethargica and later developing Parkinson-like symptoms. The doctor begins to expound on the relationship between influenza and PD as the patient appears with the nurse.
A small, balding man the patient engages immediately with the doctor. He’s read an article exploring the relationship between inflammation brought on by a virus, and the loss of dopamine-rich cells in the brain. His interest was piqued because he’d discovered he’d had a virus before he was diagnosed with PD. The medical student asks, “How long was the gap in time?” She notes a recent study in Movement Disorders sites the span as being within weeks of diagnosis. The patient nods. His face and gestures enthusiastic, he states this describes his personal scenario. Behind the desk the doctor nods, lifts his eyebrows and shares that the relationship between influenza and later PD might be trickier than they think. For example, some researchers report inverse relationships between childhood infections and later PD. Childhood red measles may offer some protection against later viral infections that may threaten dopaminergic populations by activating the immune system at an early age.
The medical student notes a secondary issue bridging influenza and PD was the medical attention severe illness warrants, bringing an increased scrutiny of the patient, and therefore any symptoms would likely be caught by the healthcare team. The doctor concedes studies of antibodies would reveal what exposures a patient’s had. The student interrupts him, “They found no relationship between examination of influenza antibodies and PD patients, when compared to controls.”
The doctor adds an influenza virus may have been the final insult, precipitating Parkinsonism. Unfortunately, whatever the reason, the patient has symptoms that are worthy of management. Whatever the cause, the pathology; the dwindling population of dopamine neurons requires attention, if one hopes to lead a high quality of life. The doctor slides from his seat and take the patient’s elbow in his hands. He opens and closes the arm feeling the response of the muscles to movement. He notes a fraction of rigidity. The student follows him, mimicking his motions as the doctor asks whether the patient has other concerns. The patient asks about his research and how far into the future will it be before there is something new for the illness. The doctor agrees too many years have passed since the sixties when levodopa first became available. A lot has changed since those days, we think of Parkinson’s disease as a group of related illnesses now. Theories exist on how the illness develops. Drug companies are looking for ways to address other dwindling neurotransmitters. With an aging population such questions will demand more attention.