Tuesday, April 6, 2010

Parkinson's patient's cycling ability stuns doctors

BY GINA KOLATA
NEW YORK TIMES
Monday, Apr. 05 2010
Dr. Bastiaan R. Bloem of the Radboud University Nijmegen Medical Center in the
Netherlands thought he had seen it all in his years of caring for patients with
Parkinson's disease. But the 58-year-old man who came to see him recently was a
total surprise.

The man had had Parkinson's disease for 10 years, and it had progressed until
he was severely affected. Parkinson's, a neurological disorder in which some of
the brain cells that control movement die, had made him unable to walk. He
trembled and could walk only a few steps before falling. He froze in place, his
feet feeling as if they were bolted to the floor.

But the man told Bloem something amazing: He said he was a regular exerciser —
a cyclist, in fact — something that should not be possible for patients at his
stage of the disease, Bloem thought.

"He said, 'Just yesterday I rode my bicycle for 10 kilometers' — six miles,"
Bloem said. "He said he rides his bicycle for miles and miles every day.

"I said, 'This cannot be,'" Bloem, a professor of neurology and medical
director of the hospital's Parkinson's Center, recalled in a telephone
interview. "This man has end-stage Parkinson's disease. He is unable to walk."

But the man was eager to demonstrate, so Bloem took him outside where a nurse's
bike was parked.

"We helped him mount the bike, gave him a little push, and he was gone," Bloem
said. He rode, even making a U-turn, and was in perfect control, all his
Parkinson's symptoms gone.

Yet the moment the man got off the bike, his symptoms returned. He froze
immediately, unable to take a step.

Bloem made a video and photos of the man trying to walk and then riding his
bike. The photos appear in the April 1 issue of The New England Journal of
Medicine.

After seeing that man, Bloem asked 20 other severely affected patients about
riding a bike. It turned out that all could do it, though it is not clear why.

Bloem and other Parkinson's specialists were amazed. People with Parkinson's
disease can often dance, run, walk smoothly and do complex movements for a few
minutes if they are given appropriate signals — emotional or visual cues. There
are famous examples, such as a group of Parkinson's patients who were caught in
a fire and managed to run down steps and escape, only to freeze in place when
they got outside.

But this effect, known as the kinesia paradox, does not last long. Riding for
miles and miles is very different from walking for a few minutes. And until
now, Bloem said, it was not known that patients with Parkinson's could ride
bikes.

He said bicycling offers patients an opportunity to be symptom-free while they
are riding, to look and feel normal, and to get some real cardiovascular
exercise.

Bloem said he hoped that perhaps regular exercise might slow the progress of
Parkinson's disease. It does in rats, he said.

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