Parkinson's disease What we need to know

10.04.2024

Parkinson's disease is a progressive degenerative disease that affects the nervous system and the functions it controls. The disease has a slow course. The first manifestation may be a barely noticeable tremor of one or both hands. At the early stages of the disease, facial expressions change, speech slows down, limb movement while walking, etc.

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The disease is incurable, although treatment has a significant effect on symptoms.

Symptoms

The beginning of the disease is often imperceptible, it is detected by insignificant changes and is characterized by laterality - that is, it is manifested predominantly in one half of the body.

Tremor: Rhythmic movements of limbs or head are called tremors. It often begins with a tremor of the wrist or fingers (as if the patient were rolling a ball between the fingers), in one or both hands. Tremor is more pronounced at rest. Tremor decreases during motor activity (performance of movement).
bradykinesia- That is, slowing down of movement: with the progression of the disease, it becomes more pronounced and makes it difficult to perform this or that action. It is difficult for the patient to get up from the chair, start moving,
muscle stiffness (Fire): makes it painful and inconvenient and limits the performance of actions
Difficulty maintaining balance and posture: Due to the imbalance between the muscles, the patient often falls or walks unsteadily.
Loss of ability to make automatic movements: Involuntary (unconscious) movements such as blinking, smiling (involuntary) or hand movements associated with walking are rare.
Change in speech: Speech becomes unclear, unintelligible, low-pitched. It is often difficult to start speaking (due to muscle stiffness and tone disorders).
Writing changes: The patient finds it difficult to write, the letters are thinner and have an unclear outline.

When to see a doctor?

In the presence of the symptoms listed above, it is necessary to consult a doctor, not only to diagnose the disease, but also to confirm or exclude other diseases.

reasons

In Parkinson's disease, specific neurons of the nervous system - dopamine-producing cells - are damaged and die. Most of the symptoms are the result of disruption of nerve cells and communication between them.

The exact cause of the development of Parkinson's disease - damage to dopaminergic neurons - has not been fully clarified. The disease is considered multifactorial, i.e. the concurrence of several factors contributes to its development, such as:

genetics. Genetic disorders have been found in patients with Parkinson's disease, although their hereditary nature is not known. However, variations in specific genes increase the risk of developing Parkinson's disease.
Environmental factors – some toxic substances may affect the degeneration-death process of dopaminergic neurons, although this risk is quite small.

Research has established that a number of changes occur in the brain during Parkinson's disease, the causes of which are unexplained:

Lewy bodies are abnormal protein inclusions found in the neurons of patients. The main component of Lewy bodies is the protein alpha-synuclein, which regulates the synaptic connections of brain cells. Normally, synuclein is a soluble protein, but in pathological conditions it forms aggregates (Lewy bodies).

Risk factors

Age - Parkinson's disease is rare in young people. The risk of its development increases from middle age. When Parkinson's disease is detected at a young age, it is necessary to raise the issue of genetic research.
inheritance - The presence of persons suffering from Parkinson's disease in first-degree relatives increases the risk of developing the disease.
gender - Parkinson's disease is more common in men than in women.
Exposure to toxins – Long-term exposure to herbicides and pesticides may increase the risk of disease development.

Complications

Dementia – deterioration of thinking and other cognitive functions characterizes the later stage of the disease. Medical intervention does not improve the condition.
Depression and mood swings (sometimes anxiety and demotivation) - appear in the early stages of the disease. Antidepressants improve the condition more or less.
Difficulty in swallowing - appears during the progression of the disease. Associated with stiffness of the muscles involved in swallowing. Deterioration of swallowing leads to accumulation of saliva and deviations in the trachea.
Chewing and eating disorder - appears in the late stage of the disease. caused by damage to the chewing muscles.
Sleep disturbances – include difficulty falling asleep or frequent awakenings at night accompanied by daytime sleepiness.
Bladder dysfunction - manifested by urinary incontinence or difficulty urinating.
Constipation is the result of slow functioning of the digestive tract.
Fluctuations in blood pressure – when moving from a horizontal position to a vertical position, arterial hypotension may occur, accompanied by dizziness and lightheadedness.
General weakness – sufferers often report lack of energy and weakness.
Pain - often appears in those areas of the body where the symptoms began to appear (tremor, stiffness). The pain is musculoskeletal, dystonic, neuropathic or central.
Sexual Dysfunction - Parkinson's disease is characterized by decreased libido.

Since the exact causes of the disease are still unknown, it is impossible to prevent it.

Some researchers believe that regular physical activity, caffeine, may reduce the risk of developing Parkinson's disease, although there is no evidence-based data on this.

Diagnosis

The disease is diagnosed by a neurologist based on objective, neurological and anamnestic data of the patient.

It is necessary to carry out laboratory studies to identify or exclude concomitant diseases that may cause these or those symptoms.

Neuroimaging studies do not provide an opportunity to confirm the diagnostics, although they are sometimes needed to rule out other pathologies.

A trial dose of carbidopa-levodopa drugs is often used to confirm Parkinson's disease. A significant improvement of the condition against the background of taking medication confirms the diagnostics.

The specificity of the alpha-synuclein protein test reaches 87.7% in patients with Parkinson's disease and in patients at risk of the disease.

Treatment

There is no cure for Parkinson's disease, but current treatments can help control the symptoms.

Physical therapy, speech therapy, and physical activity can also help control symptoms.

Medical treatment is aimed at increasing dopamine concentrations and reducing muscle imbalances, tremors, and stiffness.

During Parkinson's disease, the amount of dopamine in the brain cells decreases, which is supplied by levodopa-carbidopa drugs.

Initiation of treatment significantly reduces symptoms, but over time the effect of treatment decreases or side effects appear.

Drug treatment of Parkinson's disease includes the following group of drugs

Levodopa-carbidofa preparations. After long-term treatment, the therapeutic effect decreases. Long-term treatment with high doses is accompanied by involuntary movements - dyskinesias, hallucinations, drowsiness, compulsive behavior and others. Inhalation and infusion forms of levodopa-carbidofa drugs are used when the oral (tablet) form does not give results.
Dopamine agonists - stimulate dopaminergic neurons and provide dopamine-like effects. The effectiveness of their action is less, however, in combination with levodopa-carbidofa drugs, the therapeutic effect is longer and more stable. Side effects are similar to levodopa-carbidopa drugs.
Monoamine oxidase B (MAO B) inhibitors – This group of drugs prevents the breakdown of existing dopamine by blocking the enzyme monoamine oxidase B. Side effects of monoamine oxidase B (MAO B) inhibitors include: headache, nausea, insomnia. In combination with carbidopa-levodopa drugs, the risk of developing hallucinations increases. Monoamine oxidase B (MAO B) inhibitors are also not used in combination with antidepressants and analgesics.
Catechol-O-methyltransferase (COMT) Inhibitors – These medications moderately prolong the effects of levodopa by blocking the enzyme. Due to the high risk of side effects manifested by hepatotoxicity and dyskinesia, the drug is administered with caution.
Anticholinergic drugs - prescribed for tremors associated with Parkinson's disease. However, the effects of their action are often nullified by pronounced side effects: impaired concentration, constipation, altered consciousness, hallucinations, and urinary disorders.
Adenosine receptor antagonists – this group of drugs act on dopaminergic neurons and stimulate the release of dopamine.
For the treatment of hallucinations, cognitive disorders, constipation, insomnia and other complications, symptomatic treatment is used, the duration and dosage of which is determined by a specialist.

surgical procedures

deep brain stimulation It is a method in which electrodes are placed in the dopaminergic areas of the brain to stimulate the said area. Stimuli are generated in a special device placed under the skin in the area of the heart, which generates impulses of the appropriate frequency and power and sends them to the appropriate areas of the brain. This method stimulates the release of dopamine and helps reduce the symptoms of Parkinson's disease.

This method of treatment is used in patients who have unstable results on antiparkinsonian treatment. The method is effective in regulating dopamine regulation and controlling dyskinesias and tremors. However, this method cannot stop the progression of the disease.