Parkinson’s disease

Parkinson's disease is a nervous system disorder that causes you to lose control of your movements. The condition typically begins slowly and progresses with time. You may tremble, experience stiffness in the muscles, and have difficulty walking and keeping balance and coordination if you have Parkinson's disease.

As the condition progresses, you may encounter difficulty speaking, sleeping, thinking and memory issues, behavioral changes, and other symptoms.

While there is no cure for Parkinson's disease, drugs can help you feel better by easing the symptoms. In other cases, the doctor or neurologist may recommend surgery to manage your symptoms through the regulation of some areas of the brain. 

 

Signs and Symptoms of Parkinson’s disease 

Parkinson's disease symptoms appear gradually. They usually begin with a minor tremor in one hand and a sensation of rigidity throughout the body. Other symptoms emerge over time, while some people develop dementia. 

The following are some early signs and symptoms of Parkinson's disease:

  • Changes in motion, including tremors 
  • Impairments in balance and coordination that might make on drop items or even fall over
  • A lack of smell sensation
  • Fixed face expressions because alterations in the nerves regulating facial muscles
  • Changes in gait, making one lean a little forward or shuffling when walking
  • A tremble in the voice or a softer tone
  • Handwriting that is more cramped and smaller.
  • Sleep difficulties caused by restless legs and other underlying reasons

Symptoms of movement may begin on a single side of the body and spread to the other side with time. Other prevalent signs and symptoms associated with motion are:

  • Changes in mood, such as depression
  • Chewing and swallowing problems
  • Constipation
  • Fatigue 
  • Skin disorders 
  • Dementia, hallucinations, and delusions can arise over time.

 

Causes of Parkinson’s disease

Parkinson's disease is generally a neurological condition that occurs as a result of abnormalities in the brain. Although the exact reason for this is unknown, scientists have discovered certain variants:

  • Lower levels of dopamine

Low or declining dopamine levels (a neurotransmitter) are the primary cause of Parkinson's disease-associated symptoms. It occurs when dopamine-producing cells in the brain die. 

Typically, dopamine aids in transmitting information to the region of the brain, regulating motion and coordination. As a result, lower dopamine levels might make it difficult to maintain control over their movements. Also, as dopamine levels decline, symptoms become increasingly severe.

  • Low levels of norepinephrine

Damage to the nerve terminals producing norepinephrine, a neurotransmitter that helps with blood flow and other basic physiological activities, may also contribute to Parkinson's disease. In Parkinson's disease, low norepinephrine levels may raise the possibility of both motor and nonmotor symptoms. They can include tremors, depression, anxiety, and stiffness. 

  • Lewy bodies

In the brain of a Parkinson's disease patient, there may be clumps of a protein called alpha-synuclein or Lewy bodies. The buildup of Lewy bodies can lead to nerve cell death, resulting in alterations in motion, behavior, thinking, or mood. Dementia might potentially be a result of it.

Although Lewy body dementia isn’t similar to Parkinson's disease, someone can have both disorders. This is because the symptoms are the same.

  • Genetic aspects

Although mutations in certain genes appear to be linked to Parkinson's disease, experts do not believe it is a heritable ailment. Only 10 percent of instances appear to be caused by genetic aspects, with the majority of cases occurring in patients with early-onset disorders. 

 

Risk Factors of Parkinson’s disease 

Various environmental factors have been linked to an increased risk of Parkinson's disease. These are some of them:

  • Past traumatic brain injury: For instance, head traumas sustained in contact sports may raise the likelihood of developing the disorder.
  • Toxins exposure: Exposure to toxins like pesticides, metals, solvents, and other pollutants increases the risk. 
  • Gender: In most cases, men are 1.5 times likely to get Parkinson's disease than women.
  • Age: Usually, Parkinson's disease strikes between the ages of 50 and 60. It only happens in roughly 4% of instances before the age of 40.
  • Family history: Individuals with close relatives who have Parkinson's disease have an increased risk of developing it. 

 

Parkinson’s disease Diagnosis 

Early symptoms of Parkinson's disease might be confused with those of other conditions. Besides, there are no exact blood or lab tests to detect the disorder. 

So when it comes to Parkinson's disease diagnosis, the physician will start by inquiring about your general medical history and family history of neurological problems. They will also ask about your present symptoms, the drugs you are using, and any toxins exposure. 

The doctor will observe you walk, examine your posture and coordination, and check for motion slowness to determine if you have tremors or muscle stiffness. On the other hand, computerized tomography (CT) or magnetic resonance imaging (MRI) scans might be useful in ruling out other conditions that cause related symptoms.

 

Parkinson’s disease Treatment 

Parkinson's disease cure remains unknown. Medications and other forms of treatments, on the other hand, may be able to alleviate some of the associated symptoms. Exercise can considerably reduce the symptoms of Parkinson's disease. 

Physical therapy, occupational therapy, and speech-language therapy can also help with walking and balancing issues, feeding and swallowing difficulties, and communication difficulties. For some people, surgery might be an alternative.

Parkinson’s disease medications 

Parkinson's disease can be treated with a variety of medications such as; 

  • Levodopa 

Parkinson's disease is most commonly treated with levodopa. It aids in the replenishment of dopamine. Levodopa improves symptoms in about 75% of instances. However, not all the symptoms improve. Hence, carbidopa is usually administered alongside levodopa. 

Carbidopa helps slow the breakdown of levodopa, increasing the amount of levodopa present at the blood-brain barrier. 

  • Anticholinergics

Anticholinergics help obstruct the parasympathetic nerve system. They can aid in the reduction of stiffness. Anticholinergics such as benztropine (Cogentin) and trihexyphenidyl are useful in treating Parkinson's disease.

  • Dopamine agonists

Dopamine agonists are drugs that mimic the effects of dopamine within the brain. They aren't as effective as levodopa, although they can be used as a bridge medicine if levodopa isn't working. Bromocriptine, ropinirole, and pramipexole are examples of drugs in this class.

  • Amantadine (Symmetrel)

Carbidopa-levodopa can be used in combination with amantadine (Symmetrel). It is a glutamate obstructing medication. It provides temporary relief from the uncontrollable motions (dyskinesia), which levodopa can cause (side effect). 

  • COMT inhibitors

COMT (catechol O-methyltransferase) inhibitors extend the impacts of levodopa. COMT inhibitors include entacapone (Comtan) and tolcapone (Tasmar). Tolcapone can, however, harm the liver. Hence, it's normally reserved for those who haven't responded to other conventional treatments. On the other hand, entacapone does not damage the liver. 

Stalevo medication usually contains both entacapone and carbidopa-levodopa in a single pill. 

  • MAO B inhibitors 

Selegiline (Zelapar), safinamide (Xadago), and rasagiline (Azilect) are examples of MAO B inhibitors drugs. They block the enzyme in the brain, monoamine oxidase B (MAO B), which helps stop the breakdown of dopamine in the brain. 

This enzyme breaks down dopamine in the brain. Selegiline administered with levodopa can help prevent the effects of the drug from wearing off. 

 

Surgical Treatments for Parkinson’s disease

Patients who don’t react to medicine, therapies, or lifestyle modifications are candidates for surgical procedures. The neurologist can thus recommend the following surgeries to address Parkinson's disease; 

  • Deep brain stimulation (DBS) 

This entails the placement of electrodes in the brain that transmit electric impulses. These impulses block or alter the abnormal brain activity causing the symptoms. Most significant motor symptoms of Parkinson's disease, including slowness of motion (bradykinesia), tremor, and rigidity, can be treated with DBS. 

On the other hand, DBS doesn’t enhance hallucinations, memory, depression, as well as other non-motion Parkinson's disease symptoms. Only individuals who are unable to control their symptoms despite drug trials and who fulfill additional stringent requirements may be considered for DBS. If this is the proper treatment for you, then your provider will talk about it with you. 

  • Pallidotomy

This is the surgical destruction of a tiny area of the brain that regulates mobility (the globus pallidus). Doctors can recommend the procedure to ease involuntary motions (dyskinesias), tremors, and muscle rigidity. 

  • Thalamotomy

This is the surgical destruction of a small portion of the thalamus. It could benefit a smaller percentage of people with severe arm or hand tremors.

 

Complications of Parkinson’s disease 

These other disorders, which could be treatable, are frequently associated with Parkinson's disease:

  • Problems with thinking
  • Depression and emotional shifts
  • Swallowing difficulties 
  • Sleeping problems or sleep disorders 
  • Feeding and chewing issues 
  • Constipation, especially because of the slow digestive system
  • Bladder disorder like difficulty when urinating and inability to control urine 

 

Conclusion 

Parkinson's disease is a chronic illness that causes neurological abnormalities in the body. Although genetic and environmental aspects might be involved, medical experts are not sure why Parkinson's disease develops. In addition, they have discovered strong correlations between previous traumatic brain injury and toxic exposure. 

Parkinson’s disease has no known cure. However, medications can help most patients sustain a good quality of life. At times, a surgical procedure can help some people with their symptoms.