Progress and Prospects in Parkinson's Research/Causes/Trauma

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General
“Trauma" is the Greek word for "a wound" (and for "damage or defeat").  In medical parlance it refers to a serious or critical bodily injury, wound or shock, which can be inflicted physically or emotionally.  For editing purposes here we shall regard 'trauma' as any physical abnormality linked to the onset  of PD.

Trauma can be classified according to its severity under the headings:- : 1 Minor, 2 Moderate, 3 Serious, 4 Severe, 5 Critical, 6 Maximal. It is a major cause of mortality with some 10% of deaths worldwide being attributed to this cause.

Research
1991

Factor & Weiner reviewed 97 PD patients with 64 spouses acting as controls. Twenty PD patients and five controls reported head injury associated with alteration or loss of consciousness (p less than 0.05). Injury occurred at a mean of 37.7 years before onset of PD and 37.2 years before survey completion in the two groups, respectively.

1997

Lees (1997) stated that:-

"Post-traumatic Parkinson's syndrome may occur following cumulative head trauma in contact sports and exceptionally rarely after single severe closed head injury. It remains uncertain, however, whether physical injury should be considered one aetiological factor in the pathogenesis of Parkinson's disease."

1999

Taylor et al recruited 140 PD patients and analysed the risk factors that may have led to their condition. They concluded that:-

"Head trauma was a significant risk factor in the onset of the disease and A mean latency of 36. 5 (SE=2.81) years passed between the age of first reported head injury and PD onset."

2002

Tsai et al studied the causes of Parkinson’s Disease among people under 40 years old and concluded that:-

"“Keeping all other variables constant, head injury was a risk factor and exercise appeared to be a protective factor.”"

1991

Contradictory evidence came from Goetz and Stebbing who monitored 10 PD patients with head trauma for one year and concluded:-

"” Based on these data, we conclude that trauma or stress caused by motor vehicle accidents can transiently exacerbate parkinsonian dysfunction without causing persistent increased disability or an alteration in disease course."

2012

Lee, Pei-Chen et al enrolled 357 incident idiopathic PD cases and 754 population controls from 2001 to 2011 in central California. Participants were asked to report all head injuries with loss of consciousness for >5 minutes. Paraquat exposure was assessed via a validated geographic information system (GIS) based on records of pesticide applications to agricultural crops in California since 1974 and ambient pesticide exposure within 500 m of residences and workplaces were recorded.

They observed a 2-fold increase in risk of PD for subjects who reported a Traumatic Brain Injury (TBI),  and a weaker association for paraquat exposures. However, the risk of developing PD was 3-fold higher in study participants with a TBI and exposure to paraquat than those exposed to neither risk factor.

Dementia pugilistica
(Also known as chronic traumatic encephalopathy (CTE)).

This form of Parkinsonism is specifically associated with athletes. Contact sports such as football, boxing, wrestling, rugby, hockey, lacrosse, soccer, and skiing have all been implicated. In boxers the term ‘punch drunk’ is frequently used. Notable current cases are Mohammed Ali, former world heavyweight boxing champion, and Jansher Khan, who won the world squash open squash championship eight times. The condition has also been reported in epileptics, head bangers and domestic abuse victims, and former soldiers.

Other boxers who showed symptoms of the condition are. Joe Louis, Rocky Graziano, Tony Zale, Jimmy Ellis, Floyd Patterson, Bobby Chacon, Jerry Quarry, Mike Quarry, Wilfred Benitez, Emile Griffith, Willie Pep, Freddie Roach, Sugar Ray Robinson, Billy Conn, Joe Frazier, Fritzie Zivic and Meldrick Taylor.

The condition has been described at length by McKee at al 2009. Their paper includes an excellent bibliography.

The condition is different from other forms of PD in that it is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain.