Parkinson’s and Trauma Part 2: Trauma can Trigger Onset. 4 Cases and a Survey

The role of trauma and adverse life experiences is still frequently underestimated and considered to be controversial in many chronic illnesses, including Parkinson’s disease (PD). This post presents 4 examples of traumatic events triggering the onset of Parkinson’s disease, different from injuries that triggered onset in Part 1. These stories help validate the role of adversity in PD and for anyone with a chronic illness or condition, to suggest that healing trauma at any stage of illness may provide powerful tools for working with your health. This offers hope through actions we can take, including during difficult and intense times such as many people are currently experiencing.

In this post I show you how we can make sense of some of the symptoms that might occur during or after adverse events that can trigger onset of Parkinson’s, based on research and science in trauma. This can help identify whether events you experienced before the onset of PD or another chronic illness may have involved trauma or intense stressors for your nervous system to suggest opportunities for healing.

You can learn about adverse pre-onset experiences (APOEs) and get your APOE score in the survey at the bottom of this post.

A note about the images in this post. I frequently use an animal or other symbol to represent a chronic illness as a gentle way to accompany posts. It is also a metaphor for the possibility that symptoms may reflect intelligent adaptations in wild animals. I use the sloth as a symbol for Parkinson’s disease. This is not because people with PD are lazy (far from it) but because sloths move very slowly as part of a highly successful adaptation. This slowed pace is similar to one of the predominant symptoms of Parkinson’s known as “bradykinesia,” or slowed movement. For people with PD, this slowed movement can make activities of daily living much more difficult, such as for the processes of rising from a chair, dressing, writing, walking and much more. See my posts on bears in hibernation as a symbol for diseases associated with insulin resistance and chronic fatigue syndrome.

Case 1: One of 3 cases Awarded Compensation by the Courts in Canada for PD onset due to Trauma

Postraumatic Parkinsonism: Onset after an Accident

The following case example was presented by Michael J. Slater in a published article in 2000. Slater is a lawyer who won the case for a photographer named “Heringa” who was awarded compensation in Canada for symptoms of Parkinson’s disease believed to have been caused by an accident. Slater’s article includes a highly detailed history of the role of trauma in Parkinson’s disease. The free PDF of his published article can be found here.

Heringa: A photographer who developed Parkinson’s after an injury

Heringa was a 38 year-old professional photographer when he was struck on his left arm and left leg while crossing the street in a crosswalk in January 1995. He was thrown 12 feet through the air but did not hit his head. He did not lose consciousness although he was slightly confused after the accident.

At the scene of the accident he described “shaking like a leaf.”

“Shaking like a leaf” is a common symptom following a traumatic event

Shaking after an intense, typically overwhelming experience is a well-recognized involuntary symptom of nervous system activation during stress or trauma (Scaer, 2001; Levine, 1997, 2010).

Shaking is one way the body processes the adrenaline of fight and flight that gets activated after an accident like Heringa’s. Shaking can occur when our fight or flight energy has no use and nowhere to go, such as because there is no option to fight the vehicle and no time to escape and flee.

Threatening experiences that we cannot escape can lead to a freeze response, which can immobilize us and suppress the adrenaline and movement responses linked to our body’s natural survival impulses. The shaking many of us experience after a trauma or stressor causes no harm and appears designed to enable mammals to liberate and come out of that survival response (Levine). Shaking can easily get interrupted for many reasons, including at the time of an accident when so much is going on, medical professionals. the police or bystanders may need to speak with the person who experienced the event, etc. Shaking and trembling is something we often interrupt later on as well because it tends to be an unknown symptom. As a result, it can feel scary to allow shaking to simply be, which is one way to allow the healing process to take place, even years or decades later.

Shaking after trauma can continue, on and off for days, weeks or months. The shaking may appear once we feel safe, or it can show up years later when we are thinking or talking about the event if it has not processed through. (Here’s a blog post I found on a google search describing symptoms after a traumatic event. For more, see books like the one from Dr. Peter Levine, founder of the trauma healing modality Somatic Experiencing in Waking the Tiger (1997) to learn more about the symptoms and physiology of trauma. While this is an older book it does a nice job explaining the process of shaking and discharge in wild animals, which is also seen in humans. In his book Peter also describes how he first worked with fight/flight and shaking with a client with fibromyalgia, and how healing happens by making space for that trembling process and other forms of what he refers to as “dishcarge”).

Symptoms of Freeze rather than a Concussion?

Two days after the accident, Heringa experienced headaches, dizziness, nausea, forgetfulness, distractibility and difficulty with concentration. He was diagnosed with a concussion by his family doctor.

The symptoms diagnosed as a concussion above are consistent with a trauma response. They particularly relate to the state of parasympathetic dominance associated with freeze when we are in shock or feeling distant, disconnected or overwhelmed after a traumatic event. Heringa’s symptoms may have been from emotional or psychological trauma from the accident he was in, in addition to or even instead of from a concussion (Scaer, 2001, p. 19).

Symptoms and shaking after the event

Slater describes Heringa as being “a professional photographer who could take hand held, clear photographs at a shutter speed of 1/15 of a second. When he returned to work after the accident, he noticed a subtle tremor in his left arm. He could no longer take hand held photographs and had to use a tripod.”

Physiotherapy records beginning a month after the event documented the following symptoms, which are consistent with Parkinson’s:

• weakness on one side of his body,
• a very rigid posture
• the inability to lift the left shoulder
• in April, 3 months after the accident, a fine tremor in the hamstrings and left forearm.
• in May a decrease in the swing of the left arm, tremor in the left leg after exertion

Seven months after the accident a neurologist diagnosed posttruamatic parkinsonism.

Prior history of concussions with no symptoms of Parkinson’s

Heringa had a history of two mild concussions a few decades before the accident. He had no symptoms from these events and no symptoms of Parkinson’s prior to the accident (Slater, 2000, p. 36-37). While these concussions appear to be unrelated to the onset of his symptoms, their existence raises a question about past trauma. Concussions have been associated with risk for Parkinson’s disease. Might Heringa’s concussions (or trauma) in the distant past have contributed to a invisible process that led to his risk for PD being unmasked or augmented by the accident in present day? Perhaps he might have never developed PD had he not had that final accident when he was 38. This is an ongoing question for all of us who work with trauma and work with healing trauma, both from present day events and events in the past.

You can read the free PDF of Slater’s published article describing the history and role of trauma in Parkinson’s, along with other case examples, here.

Cases 2,3,4: Three young women develop PD after events in pregnancy or childbirth

Below are case reports of 3 women diagnosed with Parkinson’s at the Department of Neurology, Manchester Royal Infirmary, Manchester, England. Their experiences are described in a paper published in 1979 (Murphy).

The women were all young for the onset of Parkinson’s disease, being 25 to 40 years of age at the onset of symptoms. A more common age range of onset of PD is 50 to 64. None of these women had a family history of PD. They had not taken any medications known to cause Parkinsonism. There is a brief note about medications used for anesthesia that can contribute to flares of symptoms in people who already have PD but do not seem associated with initiating onset of PD.

CASE 1: Onset at 19 years, symptoms 3 weeks after severe hemorrhage.

“J” was diagnosed with Parkinson’s at age 19 in 1945. Her symptoms had begun 3 weeks after a severe hemorrhage during an abortion. 10 years later when J was 29, she had experienced a significant worsening of her tremor after giving birth. She had had another hemorrhage during birth that was so severe she had lost consciousness.

Note: An abortion, on its own, can be a physically and psychologically traumatic experience for a woman as well as for her partner. A hemorrhage is by nature potentially life threatening. To lose consciousness from a hemorrhage is an indication of severity and thus can represent an event that is even more traumatizing. Hemorrhages are both life-threatening and inescapable at the time they occur. These are two characteristics of trauma described by founder of Somatic Experiencing trauma healing Dr. Peter Levine and others.

CASE 2: Onset at 41 years 10 days after cesarean for breech baby.

“A” was 41 years old when she developed symptoms of gradual slowing of movement with tremor in her right hand and dragging of her right foot, She was diagnosed with Parkinson’s disease 4 years later. These symptoms began 10 days after an elective Cesarean performed because her baby was breech. The surgery had been under general anesthesia and there had been no complications or problems with the surgery.

Note on Medications and Parkinson’s: The medications used for the Cesarean mentioned in the journal article were not considered to be potential contributors to risk of Parkinson’s for A. A google search while working on this blog post includes the following comments about the potential role of anesthesia and PD:

• Thiopentone (Pentothal), a barbiturate used for anesthesia, sedation and anxiety, can temporarily exacerbate symptoms of existing PD in some people because it decreases dopamine. Low dopamine is understood to be the main cause of Parkinson’s disease and symptoms.
• Succinylcholine (also known as Alectine or Quelicin) may increase symptoms of existing PD by temporarily increasing potassium levels.
• Nitrous oxide (“laughing gas”), still used for pain and stress management during labor and surgery, can be toxic to nerves. There is no clear data about affecting risk for PD in humans. Negative effects are thought to occur primarily from repeated exposures rather than single exposures.

CASE 3: Onset at 31 years. Onset after long labor.

“P” was diagnosed with Parkinson’s at age 42. She first developed a tremor in her right foot and leg nine days after giving birth at age 31. She had had a long labor. The pushing stage had been especially lengthy and she had developed broken blood vessels in the white parts of her eyes (conjunctival hemorrhages), due to the increased pressure that comes with intense straining and pushing. The red areas from the broken blood vessels had persisted for three weeks. The symptoms of PD had progressed over a few years:

• the tremor spread to the left hand and then to both hands and legs
• daily activities were affected by slowness of movement
• fine motor movements such as sewing became difficult
• facial expressions decreased and became “masked”
• stiffness

Note. Long labor or pushing for a very long time can be painful, exhausting, and stressful. The situation may stimulate feelings of helplessness or hopelessness and, for this and other reasons not described in the short journal article, may have been traumatic.

Trauma and Adverse Events can Trigger the Onset of Parkinson’s Disease

Trauma and adverse experiences are now known to lead to changes in our biology ⁽¹⁾Shonkoff, J. P., Garner, A. S., The Committee on Psychosocial Aspects of Child Family Health, & Committee on Early Childhood Adoption and Dependent Care Section on Developmental Behavioral Pediatrics. (2012, Jan). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-246.

Adverse experiences, in other words, affect our physiology and physical bodies, in addition to influencing emotions and cognitive function.

This post highlights that there are many different kinds of adverse experiences associated with triggering the onset of Parkinson’s disease, in addition to the role of injuries as described in the previous blog post on PD. The role of trauma appears to be a real factor in triggering the onset of Parkinson’s.

Musings: Is trauma a last straw or initiator of PD?

The concept of trauma and other kinds of stressful events triggering the onset of a chronic illness is a phenomenon seen in other chronic diseases such as inflammatory bowel disease (Hollander, 2003), multiple sclerosis (Warren, 1982), rheumatoid arthritis (Al-Allaf et al, 2001), type 1 diabetes (Dalhquist, 1991; Nygren et al, 2015), fibromylagia (Clauw, 2001) and more, as described in this blog post. In the research, these events are not necessarily traumatic and may consiste of loss of a job, a promotion or other positive event, a period of caregiving etc. Infections can also trigger onset of a chronic illness.

If Parkinson’s follows the research in these other chronic conditions, what I would expect to see is evidence that the triggering events are LAST STRAW events rather than experiences that initiate the onset of the PD. If this is the case, I would wonder about evidence of ACEs (adverse childhood experiences) and missing ACEs in babyhood as risk factors for PD. I would also look for evidence that the symptoms of PD may have been brewing, perhaps unnoticed or subtle, for some time before onset. This would suggest that trauma may have been involved in initiating the disease and not just unmasking it. From such a perspective, I would be curious about childhood and early histories for the young women who developed PD after pregnancy and birth related events. I will explore this question about earlier exposures to adverse events in Parkinson’s in Part 3 of this Parkinson’s series.

Why it matters if trauma is a risk factor for PD

The reason for understanding whether trauma, stress or other adverse experiences play a role in triggering the onset of Parkinson’s disease is that it may help explain why symptoms began or provide a context for symptoms. It also suggests there may be tools and approaches that could be helpful if you are at risk of developing PD or already live with Parkinson’s. This refers to the large number of tools currently being used world-wide for healing and working with trauma and its effects. See more in my post about trauma therapies such as Somatic Experiencing, EMDR; practices such as TRE, mindfulness; and more.

With Part 1 and Part 2 of this series on Parkinson’s I wanted to establish that trauma appears to play a role in the disease because this is not widely known or accepted despite the research.

Next in Part 3, I will provide a more in-depth exploration of whether trauma earlier in life may also play a role in PD. In Part 4, I will provide examples of what some people are doing that is helping them with Parkinson’s using trauma and nervous system and other perspectives. You’ll find resources below to learn more about the role of trauma in other chronic diseases, which may shed light on its role in PD.

Take the APOE Survey (Pre Onset Experiences)

Did a stressful or other type of adverse event trigger the onset of any chronic illness or other chronic condition you live with?

Get your APOE score with this survey and explore the kinds of events that can affect onset.

Resources

Parkinson’s and Trauma Part 1: Injuries can trigger onset

Parkinson’s story: Marit’s Chrillog

Therapies for Working with Trauma and Directories to Find a Therapist

Tips for Working with Symptoms

Other surveys (Childhood, Add your Health Conditions)

• All surveys can be found on this page
• All surveys can also be found on this page with images specific for Parkinson’s