Parkinson's disease: What, Why, How.

Parkinson's disease is a progressive disorder that is caused by degeneration of nerve cells in the part of the brain called the substantia nigra, which controls movement. These nerve cells die or become impaired, losing the ability to produce an important chemical called dopamine.

Dopamine is produced in the back of our brain. The main function of dopamine is firing up the movement centres of the brain and helps them communicate with one another. If the production of dopamine becomes less, the movement centres in the brain don’t communicate and produce the various symptoms

What are the symptoms of the disease?

Stage 1:

Ø  At this stage, there may be symptoms, but they’re not severe enough to interfere with daily tasks and overall lifestyle.

Ø  Noticeable changes in your posture, walk, or facial expressions.

Ø  Tremors and other difficulties in movement are generally exclusive to one side of the body.

Ø  Tremors is maximum  at rest

Stage 2:

Ø  Stiffness, tremors, and trembling may be more noticeable, and changes in facial expressions can occur.

Ø  Difficulties walking may develop or increase and the person’s posture may start to change.

Ø  People at this stage feel symptoms on both sides of the body (though one side may only be minimally affected) and sometimes experience speech difficulties.

The progression from stage 1 to stage 2 can take months or even years. And there is no way to predict individual progression

Stage 3:

Ø  Many of the symptoms are the same as those in stage 2.

Ø  Experience loss of balance and decreased reflexes and movements become slower overall.

Ø  Falls become more common in this stage.

Ø  Parkinson’ssignificantly affects daily tasks at this stage, but people are still able to complete them.

Stage 4

Ø  During stage 4, it’s possible to stand without assistance. However, movement may require a walker or other type of assistive device.

Ø  Many people are unable to live alone at this stage of Parkinson’s because of significant decreases in movement and reaction times.

Stage 5

Ø  Advanced stiffness in the legs can also cause freezing upon standing, making it impossible to stand or walk.

Ø  People in this stage require wheelchairs, and they’re often unable to stand on their own without falling. Around-the-clock assistance is required to prevent falls.

What are the Non-motor symptoms?

However, non-motor symptoms are also common. Some people will develop these symptoms years before developing Parkinson’s, and some will develop them after.

Non-motor symptoms include:

Ø  cognitive changes, such as difficulties with memory or planning, or slowing of thought

Ø  mood disorders such as anxiety and depression

Ø  sleep disorders such as insomnia

Ø  fatigue

Ø  constipation

Ø  vision problems

Ø  speech and swallowing problems

Ø  difficulties with sense of smell

Ø  dribbling of saliva from the mouth

Ø  vivid and fearful dreams

Ø  problems controlling bladder

Ø  tingling  and restlessness of the legs

Is Parkinson’s disease fatal?

No, the disease is not fatal, but it is important to treat it properly as it can restrict day to day activities and disable the patient in the longer run. Patient s can have fatal injuries such as head injuries or fractures.

Parkinson’s disease itself doesn’t cause death.

What is diagnosis of Parkinson’s disease?

Unfortunately there is no test for the disease which can prove it 100%caccuracy. A MRI can be helpful. DaT scan can be helpful along with an MIBG scan.

What are other diseases that mimic Parkinson’s?

·         Progressive Supranuclear Palsy

·         Multiple Systems Atrophy

·         Corticobasal Degeneration

What is the treatment for Parkinson’s disease?

Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised.

The plans vary per patient, and some of these treatment options include.

Medicines that increased Dopamine level:

1)      Levodopa: This is the primary medication used to treat Parkinson’s disease symptoms. Those diagnosed with the disease have been found to have significantly lower levels of dopamine, and levodopa addresses that issue and stimulates the nervous system. Levodopa increases the dopamine levels in your body and aims to reduce issues in the nervous system like tremors, muscle control, and coordination.

Typically, levodopa is taken in conjunction with a drug called carbidopa, which acts as a protector for levodopa so it actually reaches the brain and allows it to be effective. The combination of these medications is taken multiple times per day.

2)      Dopamine agonists: As opposed to taking levodopa, which turns into dopamine, some patients are prescribed with dopamine agonists, which mimic the effects of dopamine.

These agonists activate the dopamine receptors in your brain and make it seem as if your dopamine receptors are acting normally. In some cases, dopamine agonists are taken in conjunction with levodopa to help find a healthy balance between the two medications and limit the side effects from both treatments.

3)      MAO B inhibitors. These medications include selegiline (Eldepryl, Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Side effects may include nausea or insomnia.

4)      Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Surgery/brain stimulation: The primary form of surgery that those with Parkinson’s receive is deep brain stimulation (DBS), which aims to address specific parts of the brain like the cortex.

In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson's disease symptoms. The end goal is to relieve some of the symptoms the disease causes.

Ø  DBS is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesia that doesn't improve with medication adjustments.

Ø  However, DBS isn't helpful for problems that don't respond to levodopa therapy apart from tremor. A tremor may be controlled by DBS even if the tremor isn't very responsive to levodopa.

Ø  Although DBS may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.

Another surgery Parkinson’spatients can get is an implant that consistently emits dopamine agonists or levodopa to make sure the drug is taken on schedule.

Can the disease be prevented?

There isn’t any real way to definitively prevent the disease, either. As with prevention for any disease or malady, it’s suggested that you maintain a healthy lifestyle before and after a diagnosis. Remaining physically engaged through activities like running, yoga, and weight lifting and eating healthy are both ways to provide your body with the best opportunity for a healthy life.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

If you experiencing any of the symptoms associated with Parkinson’s Disease ,please visit our Neurology Department at Wockhardt Hospital for accurate diagnosis and planned treatment.