Parkinson's disease is often described simply as a condition of shaking hands, but the reality is far more complex. In Nepal, it is becoming a growing public health concern. As people live longer and more Nepali reach older age, neurological disorders are rising across the country. The World Health Organization recorded around 760 Parkinson's-related deaths in Nepal in 2020, yet public awareness remains limited, and many early signs are overlooked. By the time families seek help, the condition has often reached a stage where treatment becomes more difficult, and quality of life has already begun to decline.
Parkinson's develops when dopamine-producing cells in a region of the brain called the substantia nigra slowly die. These cells regulate movement, motivation, and emotional balance. The loss of cells happens gradually over many years, making the early phase difficult to identify. Aging, genetic vulnerability, long-term exposure to certain pesticides, and disruptions in gut health all contribute to the disease. Because symptoms appear only after many of these cells are already damaged, early diagnosis is uncommon, especially in low-resource settings like Nepal.
The earliest signs rarely involve visible shaking. A fading sense of smell, persistent constipation, anxiety, acting out dreams, reduced arm swing, soft speech, and very small handwriting can appear 10 to 15 years before obvious movement problems. In Nepal, these symptoms are often dismissed as normal aging or stress. As a result, many individuals do not reach a neurologist until tremors, stiffness, or slowness begin to interfere with daily activities.
Misconceptions about who gets Parkinson's further delay diagnosis. The disease is widely believed to affect only older adults, but younger people can also develop it. Young-onset Parkinson's, appearing between the ages of 21 and 40, is documented worldwide. In Nepal, many young patients are first treated for joint pain, overwork, or the effects of manual labor before neurological causes are considered. Because this age group represents the most productive years of life, delays can disrupt employment, financial stability, and mental health.
Several broader factors are contributing to the rise in cases. Life expectancy has increased, raising the number of people at risk. Many Nepali farmers continue to use pesticides like paraquat, maneb, rotenone, and chlorpyrifos. Studies from Nepal and across South Asia have shown that long-term exposure to these chemicals increases the risk of Parkinson's disease. Specialist care remains concentrated in Kathmandu, and several provinces still lack trained movement-disorder experts. Advanced diagnostic tools such as genetic testing or specialized brain imaging are available only in major cities and remain unaffordable for many families.
Health Science Reports estimate that Nepal may see between 1,500 and 10,000 new Parkinson's cases each year, with national prevalence around 50 to 60 per 100,000 people. Yet these numbers capture only part of the burden. Rural families face the greatest challenges. Traveling long distances for consultations is physically exhausting and financially draining.
For older adults who rely on family members for support, a single hospital visit can mean missed work, transportation costs, and emotional stress. Studies from rural districts describe declining independence, reduced social participation, and long-term uncertainty about care.
Despite these challenges, Nepal has meaningful opportunities to strengthen its response. One major gap is the absence of a dedicated public neurological institute. Establishing such an institute and linking it with provincial and district hospitals would improve coordination, expand specialist training, and make early evaluation more accessible. A centralized structure could also support standardized screening programs, rehabilitation networks, and long-term management pathways.
Telemedicine is another promising solution. Remote consultations have already helped patients in remote districts by providing follow-up visits, medication adjustments, and basic evaluations from home. Evidence from African and South Asian countries shows that well-designed telemedicine systems can reduce travel burdens, strengthen continuity of care, and make medical guidance more affordable.
Rehabilitation must also be prioritized. Activities such as walking, stretching, yoga, and community-based dance therapy improve balance, mobility, and mental well-being. Research shows that dance programs encourage social connection and reduce stiffness, which is especially helpful for individuals who may feel isolated. Expanding physiotherapy and exercise services to provincial and district hospitals would give patients accessible ways to maintain independence.
Looking ahead, Nepal's response must combine early awareness, prevention, and expanded access to care. Farmers should be encouraged to use protective equipment and safer pesticide-handling practices. Public education campaigns can help families recognize early symptoms. Strengthening telemedicine, expanding rehabilitation services, training more neurologists and physiotherapists, and improving insurance coverage can create a more equitable system. Parkinson's is becoming more common in Nepal, but with greater awareness and coordinated planning, the country can reduce its impact and better support families nationwide.
Pokharel is a Ph.D. Candidate in neuroscience specializing in Parkinson's disease research at The University of Toledo
