Parkinson’s disease – causes, symptoms, treatment

Proven content

Neurodegeneration, the progressive degeneration of nerve cells, underlies many diseases of the nervous system that lead to the death of neurons. In most neurodegenerative diseases, this process is very slow: it takes months or even years. During this time, the nerve cells are already damaged and malfunctioning.

1. The name “Parkinson’s disease” is due to the London doctor James Parkinson, who was the first to recognize and describe the symptoms of this disease
2. Parkinson’s disease develops over many years, and the initial symptoms are nonspecific
3. Scientists have been looking for an effective therapy in the treatment of this disease for years. Several promising studies have emerged in recent years
4. You can find more up-to-date information on the TvoiLokony home page

Parkinson’s disease – basic information

Parkinson’s disease is a degenerative disease of the brain. In the aforementioned organ of the patient, the nerve cells of the substantia nigra, located in the midbrain of the brain stem, atrophy occurs. The incidence of Parkinson’s disease in the entire population is about 0,15% and increases 10 times in people aged 70 and over. Nevertheless, there are known cases of Parksonism among people under the age of 40. Men suffer from it more often than women.

Parkinson’s disease – causes of formation

A specific cause of the disease has not yet been established. However, it can be assumed that genetic conditions, as well as external factors, are an important element. The latter are substances found in the air, food, and getting into the body as a result of infections and diseases. Doctors have yet to establish why the nerve cells of the substantia nigra begin to decline at some point in life.

There are many theories in the medical community about the cause of the disappearance of substantia nigra cells. Some believe that the cause may be a decrease in dopamine in the body. It turns out that in each decade of life there is about 6% less of it. and by the end of the sixth decade, when signs of disease progression appear, the amount of dopamine in the striatum ranges from 40 to 50 percent.

As a result of biochemical studies, a relationship between aging and Parkinson’s disease was found. In the elderly, there is less dopamine in the caudate nucleus. The role of genetic factors in disease induction is also widely discussed. In 1992, studies were carried out on the basis of which it was established that the disease is inherited from the father.

The course of Parkinson’s disease varies from case to case. The changes caused by cell loss of the substantia nigra of the brainstem do not always manifest themselves in the same way. Much also depends on the individual health problems of patients. Therefore, not everyone with PD has the same experience with it.

Parkinson’s disease – symptoms

A common symptom of Parkinson’s disease in the elderly is deterioration in performance. The patient becomes less physically agile – he makes slow movements with his arm or leg on one side of the body. This may be accompanied by a feeling of muscle stiffness. As a result, the person begins to write awkwardly, makes uncontrolled movements when gesturing and walking. Some patients also begin to limp.

Another typical symptom of Parkinson’s disease is parkinsonian tremor, which is almost invisible in the first stage of the disease. Its reduction occurs during the performance of fine movements – this is referred to as resting tremor. Observation of the type of tremor allows the physician to distinguish Parkinsonian tremor from other types of tremor in neurological disorders – but due to various atypicalities, this is not always easy to determine.

People with PD have slow reactions. It is easy to notice that the problem for them is the very beginning of the movement, and at the same time their facial expressions are limited. Moreover, they start to speak slower, sometimes slower and slower. Another sign of a disease is a change in body shape – it becomes tilted. In addition, patients have problems with maintaining balance – it is especially visible when standing up.

These symptoms do not always appear in all patients. Less common signs of disease development are pain in the entire arm and shoulder pain. It may be accompanied by periods of depression, which often precede motor difficulties. Parkinson’s disease in the first stage of development is often difficult to diagnose. Many patients notice that the disease occurs, for example, after a mentally exhausting period of life or after an accident – stress increases the consumption of dopamine and brain messenger substances.

Parkinson’s disease – symptoms of a developed disease

We can talk about developed parkinsonian syndrome when at least two symptoms from the list below occur simultaneously. They include:

1. parkinsonian tremor,
2. imbalance,
3. body posture disorder,
4. slow movements,
5. increase in muscle tone.

Apart from them, other typical symptoms of the disease are health problems, e.g. low mental mood, problems with defecation, insomnia, memory disorders, slow spatial orientation. The patient may also experience excessive salivation or dry mouth, seborrhea on the face and excessive sweating. The body’s thermal regulation is also disturbed.

Occasionally, the symptoms can become severe. For example, a patient with developed Parkinson’s disease cannot move without the support of third parties, in the middle of the night he experiences stiffness and immobility, which often wake him up from sleep. He also experiences difficulties with performing alternating movements, e.g. he is unable to rotate objects efficiently. It also manifests itself in difficulties with biting and chewing.

Parkinsonian tremor is one of the first symptoms of the disease, but it also has a disease-specific course. Some people also develop this symptom to the other side of the body. It is usually strongest when the arms or legs are at rest, and changes when the person wishes to move or hold a position.

Do you experience any of the above symptoms? Do not hesitate, make an appointment with a doctor. You can use an online teleconsultation with a neurologist at haloDoctor.pl. It is a quick and reliable way to contact a specialist safely.

Parkinson’s disease – treatment in the initial stage

In the treatment of Parkinson’s disease, various methods are used, e.g. pharmacological treatment, rehabilitation and surgery. The choice of method depends on the patient’s state of health, but in each case it is advisable to act as soon as the first symptoms of the disease are noticed – it is a mistake to start treatment when the symptoms become bothersome. Thanks to this, it is possible to restore the proper functioning of the subventricular cortical loops of the brain faster.

Treatment for Parkinson’s disease is most effective when it is started as soon as the first symptoms appear. In the asymptomatic period, only the dopamine deficiency compensation mechanisms are activated – early treatment restores compensation. The choice of the treatment method depends on many aspects, e.g. the patient’s age and the planned duration of treatment.

The first stage of treatment is the least troublesome. Then dopaminergic drugs are started, which significantly improve the patient’s well-being. However, the treatment process should be planned in advance, preferably several months or several years in advance. After the end of treatment with dopaminergic drugs, the patient’s body reacts worse to the drug – then a dose change is recommended.

The dose selection for anti-Parkinson’s disease treatment is also a matter of debate. Moreover, it should be changed as the disease develops, so that it fits the patient’s current state of health. It is important to know that even treatment with dopaminergic drugs has its end – after some time the patient feels trembling and becomes sluggish. That is why the choice of treatment in the initial phase is so important.

There is still no single treatment for Parkinson’s disease. So there is no neuroprotective drug that would inhibit the development of the disease. In the case of people under 65 years of age, drugs from the group of monoaminoxidase inhibitors, e.g. selegilinine and rasgilinine are used. People over 65 start with levodopa treatment with optimal dosages.

Parkinson’s disease – advanced stage treatment

The most problematic is treating Parkinson’s disease in its advanced stage. At this stage, the patient may be very still or have dyskinesias for a large part of the day. What’s more, the duration of drug action is also shortened, which results in the appearance of unpleasant ailments. Another obstacle in advanced Parkinson’s disease are seizures and the shift between good performance and poor performance.

Postural disorders are increasing in patients. As a result, the independence of patients is limited due to the increased risk of injuries and difficulties in walking. Balance problems are by far the most difficult to treat. In addition, patients suffer from vegetative disorders, that is:

1. fainting,
2. falls,
3. persistent constipation,
4. low blood pressure
5. problems urinating,
6. excessive sweating,
7. breathing problems.

Mental problems are another handicap. Patients often think less efficiently, have weaker memories, and have impaired spatial orientation, especially when the condition develops significantly. This makes them less independent and has a problem with driving a car or navigating the places where they are for the first time.

Another treatment strategy is to inhibit the degradation process of dopamine already released from the neuron. This can be done by inhibiting the COMT or MAO-B enzymes responsible for its breakdown. Yet another treatment strategy used is the administration of dopamine agonists – substances that mimic the action of dopamine. Their task is to stimulate dopamine receptors located on neurons in the brain.

Parkinson’s disease – neurosurgical treatment

Neurosurgical treatment began in the 50s. As soon as levodopa was introduced into the therapeutic process, surgical treatment was discontinued, but after some time it was restarted. Neurosurgical treatment was used in cases where the use of levodopa did not produce satisfactory therapeutic results.

Another type of neurosurgical treatment is a substantia nigra fetal transplant. It has been found that thanks to it, the production of dopamine in the patient’s brain is restored, but it is still considered an experimental method. An obstacle in the use of this type of treatment is the need to transplant more tissue.

In Sweden and the United States, procedures involving implanting fetal brain tissue in patients with advanced Parkinson’s disease. Although the use of human fetal cells for therapeutic purposes poses many ethical problems and is ineffective (one transplant requires the use of cells from three to eight embryos), a number of patients treated in this way show significant improvement.

The third method of neurosurgical treatment is pallidotomy. Many years of using this technique have led to conclusions that it primarily helps in alleviating dyskinesia and enables the reduction of the amount of drugs. Nevertheless, a patient participating in such treatment will not maintain satisfactory mobility for a long time.

Parkinson’s disease – drug contraindications

In particular, patients with Parkinson’s disease should not use drugs that suppress the production of dopamine, otherwise the movement disorders will worsen. This group of drugs includes neuroleptics for the treatment of delusions and hallucinations. The harmful effects can be caused by drugs for the treatment of digestive ailments related to abnormal intestinal motility – such a drug is, for example, metoclopramide.

During treatment with levodopa, the patient should be careful about vitamin B6, which increases the conversion of levodopa into dopamine – however, it can be taken, but only in small doses. The course and symptoms of the disease are also unaffected by: vitamin C, multivitamin supplements, melatonin and NADH.

Parkinson’s disease – misdiagnosis of the disease

There are several symptoms that can be mistaken for Parkinson’s disease. One of them is essential tremor. Both younger and older people suffer from them. It is not uncommon to affect several family members. Another such condition is dystonia, which is also hereditary. Parkinson’s disease is also sometimes confused with depression – in both cases the symptoms are sadness, lack of pleasure and physical neglect.

Parkinson’s disease – the correct diagnosis of the disease

Correct diagnosis of the disease is crucial in determining the treatment process. What often makes the diagnosis of Parkinson’s disease difficult is the presence of comorbidities or diseases with similar symptoms. Parskonism is found during a neurological examination – it is important to know that it is not the same as Parkinson’s disease, but this is the term used to describe movement disorders which are manifested by slowness, tremors, stiffness and changes in body posture.

Additional tests that are performed during the diagnosis of Parkinson’s disease include brain computed tomography, electroencephalography, and magnetic resonance imaging of the brain. In this case, there is no need for blood and cerebrospinal fluid tests – because they neither rule out nor confirm the presence of Parkinson’s disease.

Sometimes a complete neurological examination alone can confirm or rule out the disease, and then there is no need for the patient to participate in any other tests. Such patients are those with the typical parkinsonian syndrome and no other diseases – this group of patients can be treated symptomatically and it is not necessary to perform a rapid CT scan of the brain.

Parkinson’s disease – prospects

As mentioned earlier, the primary feature of Parkinson’s disease is the neurodegeneration of dopaminergic neurons in a part of the brain known as the black matter. As a consequence, the dopaminergic deficit causes an imbalance between neurotransmitters within the basal ganglia. As a result, there is a relative advantage of the glutamatergic and cholinergic systems over the dopaminergic system.

There seem to be grounds for anti-Parkinsonian activities substances that block the NMDA receptor (receptors stimulated by glutamic acid). Unfortunately, while animal studies have shown encouraging results, clinical trials using NMDA receptor blockers have not resulted in the proposition of this group of compounds as an alternative therapy to L-DOPA.

While the exact pathomechanism of the degeneration of cells in the substantia nigra in Parkinson’s disease is not clear, it is assumed that free radicals and mitochondrial dysfunction play a major role. Therefore, it seems that in Parkinson’s disease and other neurodegenerative diseases, special attention should also be paid to a proper diet rich in compounds with antioxidant properties and scavenging free radicals, such as coenzyme Q10 or vitamin E. Vitamin C and beta-carotene are also important. strong antioxidants and protect neurons against the toxic effects of many harmful exogenous factors.

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