Parkinson’s is not just a disease of the elderly. It can attack at the age of 21-40 and even earlier. Unfortunately, it is impossible to identify a group of particularly vulnerable people. The disease cannot be detected before symptoms appear. However, there are four main signals that must not be underestimated. Neurologist Dr. Olga Milczarek from SCM clinic told about them. The specialist also explains what happens to the brain in Parkinson’s disease and what it leads to. This is not good news.
- Parkinson’s disease is a neurodegenerative condition. Neurologist Dr. Olga Milczarek: it can be said that the patient is slower than what is going on in his head
- The development of parkinson’s is associated with genetic disorders. Age also plays a role in its development. In fact, however, this disease is like a lottery – it is impossible to determine who is most at risk
- Neurologist: Parkinson’s disease “can be inherited, but it can also occur in the family for the first time as a result of a primary gene mutation”
- Parkinson’s cannot be detected before symptoms appear. The four main symptoms must not be underestimated. This includes slowing down of movements, stumbling
- «Unfortunately sooner or later Parkinsonism, including Parkinson’s disease, will lead to the patient’s death. It cannot be avoided »says Dr. Milczarek and explains why
- More information can be found on the Onet homepage
Assistant professor at the Department of Pediatric Neurosurgery, Institute of Paediatrics, Jagiellonian University Medical College in Krakow, active researcher and teacher. She completed her specialization in neurology in 2013. She completed her specialization internship in pediatric neurology at the Department of Child and Adolescent Neurology of the Institute of Mother and Child in Warsaw. For many years he has been cooperating with neurosurgical centers all over Poland as an intraoperative neurophysiologist.
Monika Mikołajska / Medonet: Parkinson’s disease is usually associated with uncontrolled trembling of the hand, chin, and difficulties with balance. It is as if the sick person has no control over his own body.
Dr. Olga Milczarek, neurologist: Indeed, it may seem that the patient is outside his body. You could say that he is slower in relation to what is going on in his head. We, doctors, talk about the so-called the freezing effect – the patient is sluggish, stiff, has posture disorders (his movements are uncoordinated). This characteristic tremor also appears.
In fact, the entire diagnosis of parkinsonism is based on these symptoms – how we see the patient. I used the term parkinsonism on purpose because it is not just Parkinson’s disease itself, although it is the most common. Parkinsonian syndrome also includes other disorders that exhibit symptoms similar to those listed.
What happens to someone who is attacked by parkinson’s? It has been established that it has to do with the black matter of the brain … It sounds quite mysterious, even threatening
The black matter of the brain is located in the midbrain, specifically in the brainstem, a very important structure in life. There are main roads / nerve routes, including the so-called dopaminergic pathway. Its elements are dopaminergic neurons, i.e. a group of nerve cells that synthesize, store and release dopamine. This substance is responsible for the proper motor functioning, as well as cognitive functioning – for people to have energy and strength to act. In Parkinson’s disease, this pathway is damaged due to a build-up of abnormal substances called Lewy bodies.
The rest of the article is available under the video.
Do you know why this happens?
This is largely due to genetic disorders, so heredity is at stake. And that’s really the basis of parkinson’s. Age also plays a role in its development – it is a neurodegenerative disease related to the aging of neurons. This process also promotes the deposition of Lewy bodies in the brain.
In approx. 3 percent. cases we are dealing with the so-called primary Parkinson’s disease, when the substantia nigra is damaged for unknown reasons.
Most people with Parkinson’s disease develop symptoms in their 50s or older. It is known, however, that it can appear in people much younger, between the ages of 21 and 40. Why so early?
The disease may occur even earlier, even before the age of 21. We are talking then about juvenile parkinson (JPD parkinson). And here genetic factors play the biggest role. However, such patients are very rare, they can be counted on the fingers of one hand. If the disorder occurs before the age of 40, we are talking about early-onset parkinsonism. It also happens rarely, although more often than in JPD. It’s about 5 percent. all cases of Parkinson’s disease. We do not know how many such people live in Poland, there are no such statistics.
However, it can be said that the earlier the disease occurs, the more likely it is to be of genetic origin. There are several leading genes that determine the appearance of parkinson’s. Unfortunately, it is impossible to identify a group of particularly vulnerable people. This disease is a lottery. It can be inherited, but it can also occur in the family for the first time as a result of a primary gene mutation.
What are the symptoms of ‘early parkinson’s’? Do they differ from the “typical” in late age?
There are four main symptoms in Parkinson’s disease. They largely occur in a similar percentage of patients. We mentioned them at the beginning. The characteristic slowing down of stimuli (bradykinesia) is the basic criterion necessary for the diagnosis of the disease. They are often confused with, for example, behavioral disorders or depression.
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In addition, there is a characteristic resting tremor (most often in the hands, less often in the lower limbs) and muscle stiffness (in younger patients it may appear later). They are expressed by the so-called gear symptom. When we try to bend the patient’s arm, for example, the movement is not smooth, but there is a characteristic jump, like in a rack.
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There are also gait and posture disorders. In the case of patients with juvenile parkinsonism, they very often come to the fore. Patients often stumble, there are falls, patients seem to be clumsy in movement (in the elderly the torso is tilted forward).
Parkinson’s patients, also young, have a characteristic mask-like expression, their facial expressions are very poor (so-called hypomimia). Sometimes it is interpreted as a symptom of mental disorders, while these people find it harder and harder to express their emotions physically. In early parkinsonism, writing difficulties are often seen (tremors and stiffness overlap). Very often Parkinson’s disease affects one side of the body first.
All these disorders are related to motor skills, are there any non-motor signals?
Yes, we call them accessory symptoms. They can appear in younger people in the early stages of Parkinson’s, they can even be the first symptoms of the disease. They include, among others erectile dysfunction, excessive sweating, fatigue, depression, burnout, sensory disturbances, smell disorders, gastrointestinal problems, trouble sleeping. As you can see, they are non-specific and often escape the patient’s attention. This also includes Because of this, Parkinson’s disease is sometimes diagnosed late.
Is there any way to catch it as early as possible?
Unfortunately not. It is impossible to detect the disease before the symptoms appear, and the inclusion of prophylactic treatment will also not bring anything here.
If a child or younger patient develops symptoms typical of parkinsonism, a detailed differential diagnosis is first performed to understand the underlying causes of these changes. In most cases, you will find that they are not Parkinson’s, but another disease, and are secondary in nature.
Maybe there is some specific symptom that should light a warning light in your head?
These are the axial symptoms that we talked about: slowing down of movements, feeling stiff, stumbling. All this should prompt you to visit a neurologist. So let’s be careful not to ignore these signals.
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You can imagine that diagnosing an incurable chronic disease at a young age turns the whole world upside down. There are questions about work, starting a family, and the rest of your life. What can medicine offer such people?
Not much, really. Treatment of Parkinson’s disease is primarily symptomatic and its aim is not to cure but to alleviate the symptoms. It goes, among others to replenish the dopamine that is missing due to damage to the dopamindergic pathways. Only two groups of drugs are involved. These measures are designed to reduce stiffness and tremors. Unfortunately, their use is associated with side effects. In addition, you need to carefully adjust the dose and the time of taking. If not, patients will experience dyskinesias, i.e. abnormal additional movements, episodes of total freezing (the patient does not move at all) or shutdown (dose depletion effect).
Neurosurgical treatment is also used in parkinson’s therapy. It involves implanting an implant that enables deep brain stimulation (the so-called DBS), which will turn off movement disorders. The good news is that treatments in neuroscience are evolving. The future is the functional neurosurgery I was talking about. Early implantation of this simulator gives the possibility of many years of functioning in health.
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What could be the consequences of living with parkinson’s? It is said that the disease does not take life but changes it. To what extent can one lead a normal life with such a disease?
Parkinson’s disease greatly affects the quality of life. Moreover, there comes a point when dopamine secretion can no longer be stimulated, dopaminergic pathways are depleted, receptors stop working, which exacerbates the patient’s disability. Eventually, the patient’s stiffness, freezing, and turning off will be so severe that it becomes impossible to eat, swallowing disorders, and breathing problems appear. On top of that, there are usually cognitive impairments, similar to alzheimer’s.
Unfortunately, sooner or later, parkinsonism, including Parkinson’s disease, will lead to the patient’s death. This cannot be avoided. Although, of course, you can live with parkinson’s for many years. Parkinson’s disease is never sudden, it is a slow disease, and early treatment will slow down its progress even more, relieve symptoms, and bring tremendous relief to the patient.