Parkinson's disease, commonly referred to as parkinson's, is a progressive neurodegenerative disease of the extrapyramidal system, which is responsible for the movement of the entire body. Muscle stiffness, tremors and slower movements are progressing, these are the most noticeable symptoms of parkinson's. What exactly is Parkinson's disease and what are its symptoms and symptoms? How is parkinson's treated?
Parkinson's disease(colloquiallyparkinson ) belongs to a group of neurological diseases, the cause of which is the progressive destruction of nerve cells that build specific structures in the brain. We call such diseases neurodegenerative diseases.
In Parkinson's disease, cells are damaged, the so-called the extrapyramidal system, whose task is to control the movements of the whole body. For this reason, the symptoms of Parkinson's disease are mainly associated with motor disorders - slowing down of movement, the occurrence of muscle tremors and instability of posture.
Importantly, these symptoms can also have other causes that should always be ruled out before a diagnosis of Parkinson's disease.
Włodzimierz Szaranowicz, sports journalist:
-A shadow has been with me for several years. It is Parkinson's disease, which persistently tries to take away from me the things without which I cannot imagine my life - a smile, mental clarity, the ability to talk and move efficiently. However, Parkinson's is also a disease of the spirit, and the only cure for it is hope and inner strength.
World Parkinson's Day is celebrated on April 11th.
The underlying cause of Parkinson's disease
The basis of Parkinson's disease is irreversible and progressive damage to nerve cells located in the so-called the black matter of the brain. This structure is located in the midbrain and belongs to the extrapyramidal system.
The role of this system iscoordinating the movements of the bodybeyond the control of our consciousness. Thanks to it, it is possible to maintain proper muscle tone, maintain a proper body posture and perform automatic movements without having to focus on them.
In Parkinson's disease, the neurons of the substantia nigra are destroyed . Under the microscope you can observe the build-up of wthese are protein molecules, calledLewy bodies . The reason for these changes is unfortunately still unknown.
It is estimated that in Parkinson's disease, about 7% of the cells of the substantia nigra are destroyed every year. The dying of this group of neurons reduces the amount of the substance they produce - dopamine.
Dopamine is a very important neurotransmitter, a type of signaling molecule that transfers information between different structures in the brain. Dopamine deficiency is the main cause of the common symptoms of Parkinson's disease - tremors, muscle stiffness and slower movements. As the disease progresses, it is possible that other areas of the nervous system may also be affected and additional symptoms (e.g. psychiatric or sleep disorders) may appear.
Causes of Parkinson's disease
The cause of Parkinson's disease remains a mystery despite many years of research. The disease most often appears in patients around the age of 60, and it is slightly more common in men than in women.
The cases of the family history of the disease initiated a series of many studies aimed at discovering the genetic factors that may be associated with it.
Many types of mutations have been discovered to underlie family parkinsonism. However, it is a rare variant of the disease, and a specific genetic change that occurs in all Parkinson's patients has yet to be identified.
Currently, it is suspected that the condition is caused by an overlapping of various factors: both genetic and environmental. Contact with certain toxic substances (e.g. pesticides) may increase the risk of disease.
Unfortunately, the exact mechanism of neuronal damage in Parkinson's disease remains unknown. For this reason, it is still not known if and how this disease can be prevented. For now, its causal treatment is also unavailable.
Symptoms and course of Parkinson's disease
The symptoms of Parkinson's disease vary according to the phase of its course. Beforecommon movement disordersdevelop, patients may notice for a long timesubtle complaintsthat are very rarely identified as early stage Parkinson's disease.
The disease is unfortunately progressive - the response to drugs becomes weaker with time, while the symptoms continue to increase. The course of the disease is as follows:
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I. Pre-clinical phase of Parkinson's disease
It is estimated that the typical symptoms of Parkinson's disease only become apparent when as much as 80% of a person's neurons are destroyedblack brain. Previously occurringailments are not very characteristic .
It is now believed that some of the initial foci of the disease are located within the structures responsible for the transmission of olfactory sensations. For this reason, one of the first symptoms of it may be an olfactory disorder.
Depressive states, constipation and sleep disorders (restless sleep combined with excessive physical activity) may be among other ailments occurring in the early stages of the disease development.
Unfortunately, all of these symptoms may be unrelated to Parkinson's disease. For this reason, the diagnosis is usually made only whentypical motor disorders appear .
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II. Parkinson's disease phase - motor disorders
There are 4 typical groups of movement disorders characteristic of Parkinson's disease:
- Muscle tremors
This symptom is commonly equated with the disease, although it does not have to appear in all patients. Tremor most often affects the hands, but can also affect the legs, chin, or the corners of the mouth.
The typical feature of tremor in Parkinson's disease is its occurrence only at rest. For example, the hand trembles when the patient is sitting calmly, but when the patient reaches for an object, the tremor subsides.
Tremor in the hand areaoften takes the form of a symptom of "counting money", i.e. a characteristic rubbing of fingers against each other.
- Bradykinesia
This is the most important symptom of the disease, necessary for its diagnosis. Bradykinesia means slow execution of all movements - the sick, despite being willing, cannot speed them up.
Motor slowing downaffects all muscle groups, therefore it makes everyday functioning very difficult. Bradykinesia results in slower speech, difficulty swallowing food and problems with initiating movements (for example - the patient wants to take a step forward, but his feet are "stuck" to the floor).
- Muscle stiffness
The muscles are all tense, they give up resistance when trying to move. When muscle stiffness coexists with tremors, the medical examination shows the symptom of a "gear", i.e. a feeling of jumping during the movement of the limb.
Increased tension in the facial muscles causes reduced expression and disturbed facial expressions - the face then takes on a masked appearance.
- Postural disorders
There is typically instability in body position, problems withcoordination and balance. While walking, the patient leans forward. Lack of posture control can lead to falls and secondary injuries (including dangerous fractures).
At the beginning of the diseasemotor symptomsmay be mild. Usually one side of the body is affected first - as the disease progresses, after a few years the symptoms also appear on the other side.
The first noticeable symptoms are slowing down of everyday activities (eating, getting dressed), or periodic muscle tremors.
Increased muscle stiffness can causepain syndromes , which are often misdiagnosed.
It may appear quite earlymicrograph- write in smaller and smaller letters.
Parkinson's disease is classified as a hypertonic-hypokinetic syndrome, i.e. associated with increased muscle tension and reduced mobility.
The way patients with Parkinson's disease walk is very characteristic - small steps, "shuffling" of soles on the floor, no accompanying arm movements and sudden stops (the so-called freezing).
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III. Parkinson's disease phase - mental disorders
As Parkinson's disease progresses, patients may experience psychiatric disorders as manifested by changes in behavior, mood and perception of the world around them.
The most common are depressive states, feelings of anxiety and fear, phobias and panic attacks.
Other characteristic changes in behavior belong to the group of obsessive-compulsive disorders - the so-called OCD.
Parkinson's disease is also associated with a progressive impairment of cognitive functions related to receiving, processing and reacting to information from the external environment. Symptoms of these disorders may include problems with concentration, remembering, planning and abstract thinking.
About 40% of Parkinson's patients experience hallucinations (most often visual, although auditory and olfactory are also possible). Later in the disease, there may be a significant reduction in mental performance - the so-called parkinsonian dementia.
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IV. Other complications of Parkinson's disease
Nervous system damage in Parkinson's disease can impair the functioning of many organs. Common ailments include disorders of autonomic functions, i.e. those that are uncontrolled by us consciously.
Constipation and difficulty passing stools are common examplesdysfunction of the sphincters. Similar problems concern the urinary system - urgency for the bladder (also at night) and urinary incontinence are common. These disorders lead to more frequent infections in the urinary tract.
Patients also suffer from loss of sexual function - both associated with decreased libido and erectile dysfunction.
Changes in the nervous regulation within the blood vessels can lead to drops in blood pressure (most often in the form of orthostatic hypotension, i.e. a drop in pressure after changing the body position from lying to standing).
Another group of complications that make everyday functioning very difficult are sleep disorders. Patients often have problems falling asleep, sleep restlessly and wake up at night, while during the day they experience excessive sleepiness.
Parkinson's disease diagnosis and differentiation
The symptoms of Parkinson's diseaseare so characteristic that the diagnosis is made on the basis of them. No additional laboratory or imaging tests are required.
To meet the diagnosis criteria, it is necessary to have a motor slowdown and at least one of the other three symptoms:
- muscle tremors
- muscle stiffness
- posture disorders
Each of them should be assessed in a carefully conducted neurological examination.
If it is enough to identify the presence of typical symptoms, is the diagnosis of Parkinson's disease extremely simple?
The answer is no, because before making this diagnosis, other possible causes of the observed symptoms should be ruled out.
These symptoms constitute the so-called parkinsonian syndrome, which may, of course, be Parkinson's disease. Unfortunately, they can also accompany other diseases, such as:
- strokes
- inflammatory processes
- intracranial bleeding
- brain tumors
- other neurodegenerative diseases
It also happens that they are a side effect of certain groups of drugs.
Drug-induced Parkinsonismrelates mainly to those pharmacological agents that block dopamine receptors. These include antidepressants, certain antiemetics, and drugs for the treatment of schizophrenia.
For this reason, if Parkinson's disease is suspected, the doctor conducts a very detailed interview, with particular emphasis on questions about chronic medications.
At the very beginning of the diagnostic process, it is advisable to perform brain imaging tests(computed tomography or magnetic resonance imaging) in order to exclude other changes that may cause parkinsonian symptoms (stroke, hydrocephalus, cancer, inflammatory changes).
There is also a group of rarer conditions that mimic Parkinson's disease. They are sometimes referred to asparkinsonism-plus ; this means that in addition to the features of Parkinson's disease, they exhibit additional symptoms not found in classic Parkinson's disease.
If the motor symptoms appear immediately on both sides of the patient's body, there are additional neurological disorders or the treatment introduced at the beginning (with L-DOPA, see below) does not bring any results, it is necessary to deepen the diagnosis in order to make a proper diagnosis .
Parkinson's disease treatment
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Pharmacological treatment of parkinson's
The primary mechanism of action of drugs used in Parkinson's disease is the improvement of signaling in those pathways of the nervous system where the signal is transmitted by dopamine. This effect can be achieved with several groups of preparations.
The most important of them is Levodopa (also known as L-DOPA) - the substance from which dopamine is produced in the body. Levodopa is an effective drug because, unlike dopamine itself, it can penetrate directly into the brain and exert its effects there (when taken as a drug, dopamine cannot pass from the blood to the brain).
At the beginning of the use of Levodopa, it is often possible to achievea spectacular improvement in the condition of patients . Unfortunately, its chronic use may be associated with both the occurrence of side effects and a reduction in the effectiveness of the drug.
One of the more serious side effects are the so-called dyskinesias - uncontrolled movements of the body. In order to reduce them, the Levodopa administration schedules are changed, or drugs from other groups are administered.
These may be, for example, substances that stimulate the dopamine receptor (e.g. Ropinirole), increase its release (e.g. Amantadine), or inhibit its breakdown in the body (e.g. Tolcapone).
Unfortunately, none of the drugs are without side effects (nausea, hallucinations, behavior changes).
The choice of a therapy regimen is therefore always the result of balancing the benefits of improving the patient's condition and the emerging side effects.
In the event that oral medications no longer bring the expected effects, it is possible to use alternative methods of their administration. These include: a pump that delivers Levodopa directly into the intestines and subcutaneous injections of Apomorphine (a drug that stimulates dopamine receptors).
In the case of Apomorphine, a continuous infusion pump can also be used (similar to an insulin pump).
The use of this type of systems allows you to maintain a constant concentration of drugs in the body, which translates into their greater effectiveness.
From the point of view of the ailments that most disturb patients in their daily functioning, it is equally importantto treat symptoms not related to the locomotor system . For this purpose, drugs affecting the mental state (antidepressants, antipsychotics) are used, among others. It is also possible to effectively treat erectile dysfunction, urination and constipation.
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Surgical treatment of Parkinson's disease
In advanced forms of Parkinson's disease, when pharmacological treatment remains inadequate, specialneurosurgeryis performed. Their goal is to place electrodes in the brain that send signals to structures that are not functioning properly.
Checking the operation of the electrodes is possible thanks to a special controller (stimulator), usually placed in the area of the chest.
This type of therapy usually gives good results, although it is not applicable to every patient (age, disease advancement criteria, presence of non-motion symptoms decide).
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Parkinson's therapy lifestyle
A very important element of Parkinson's disease therapy is regular physical activity and rehabilitation, adapted to the severity of the disease. Properly selected exercises help to maintain physical fitness and reduce motor symptoms.
In matters of nutrition, patients are advised to eat a high-fiber diet to prevent constipation. If you are taking Levodopa, it is advisable to limit the amount of protein consumed (protein reduces the absorption of this drug).
There are scientific studies that show a reduction in the risk of disease in people who regularly consume caffeine. So drinking coffee is not forbidden, and even advisable.
Speech therapy is recommended in the event of speech disorders.
Parkinson's disease prognosis
Parkinson's disease, like other neurodegenerative disorders, is progressive. Thanks to a fairly good understanding of the mechanism of damage causing clinical symptoms, it was possible to develop drugs with high effectiveness.
The best results are achieved within the first few years of diagnosis. Unfortunately, with the course of the disease, the body's sensitivity tothe therapy decreases and the processes of destroying the structures of the nervous system continue.
Increasing doses of drugs also cause many side effects.
After a dozen or so years, the physical condition of the patient is usually significantly reduced.
Hope remains research using stem cells and gene therapy, which in the future may become the basis of modern therapy methods.
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- Parkinson's rehabilitation and exercise
- Juvenile Parkinsonism: Causes, Symptoms, Treatment
- People Affected by Parkinson's Disease
Krzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.
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