每次在報章雜誌上讀到人類對某一種原本束手無策的疾病有任何新的研究發現，內心總是十分雀躍，儘管可能是一個很罕見的疾病，或只是研究上一點小小的進展。任何小突破或新發現都是希望，人類對抗疾病與不幸的希望。
得到帕金森氏症的人都會有運動障礙，走路都很困難。研究人員卻發現，即使不良於行，帕金森氏症末期的患者卻仍可以騎單車。這不僅是我們一般人覺得不可思議，就連專業神經科醫師也覺得驚訝；因為這並不是單一個別案例，醫生後來請20位重度帕金森氏症的患者試騎單車，發現這20位病患也都能騎。
對於這種現象，專家們仍不明白箇中原因。我想可能是走路與騎單車，控制這兩種運動的大腦區塊不同；如此一來便可以解釋同學John為什麼喜歡騎單車，卻厭惡登山、健行這類走路的活動。
Cycling Provides a Break for Some With Parkinson’s
By GINA KOLATA
Published: March 31, 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 Dr. 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, Dr. Bloem thought.
“He said, ‘Just yesterday I rode my bicycle for 10 kilometers’ — six miles,” Dr. Bloem said. “He said he rides his bicycle for miles and miles every day.”
“I said, ‘This cannot be,’ ” Dr. 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 Dr. 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,” Dr. 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.
Dr. 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, Dr. 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.
Dr. 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, Dr. Bloem said, it was not known that patients with Parkinson’s could ride bikes.
“The observation is so novel and exciting that I keep amazing audiences when I show this video during my lectures, even when the audience consists of movement disorder experts,” Dr. Bloem said.
Of course, he added, he is not advocating that Parkinson’s patients hop on bikes and go out on busy roads. They need help in mounting a bike and can get into trouble if they have to stop at traffic lights. They need to ride in safe areas. He recommends that patients ride tricycles, or use stationary bikes or trainers — devices that turn road bikes into stationary ones.
Still, 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 even when their disease is so far advanced that they cannot walk.
Parkinson’s experts were intrigued.
“This is an impressive thing,” said Dr. C. Warren Olanow of the Mount Sinai School of Medicine. “He has described a terrifically interesting case, and there are things to learn from it.”
Dr. Bloem said one explanation for the finding might be that bicycling uses a different part of the brain than walking and might not be so severely affected by Parkinson’s disease. Or it might be that the rhythmic pressure of the pedals on patients’ feet cues the nervous system to allow a cycling movement.
Bicycling does not cure patients, of course. And, added Dr. Lisa M. Shulman, a neurology professor at the University of Maryland School of Medicine, whether most patients with severe Parkinson’s disease will be able to ride a bike “is an empirical question that would need to be tested.” And, she said, those who cannot do one sort of exercise may be able to do another.
But Dr. Bloem said he hoped that perhaps regular exercise might slow the progress of Parkinson’s disease. It does in rats, he said, and he is running a clinical trial in 600 patients to see if exercise also slows the disease in humans.
In the meantime, Dr. Bloem said he knew there was a long way to go from observation to scientific fact. But, he said, that does not mean an observation is useless.
“I’m a strong believer that single cases can provide crucial evidence,” Dr. Bloem said. “Even though this is a single patient, it is very, very provocative.”
http://www.nytimes.com/2010/04/01/health/01parkinsons.html?src=me&ref=general
The story was taken from The New York Times. The copyright remains with The New York Times Company. The author of the story and The New York Times are not involved with, nor endorse the production of this blog.
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