Parkinson’s disease

Definition

Parkinson’s disease is a progressive disease of the nervous system. In the case of Parkinson’s, nerve cells in particular areas of the brain gradually decay. This disrupts the control of movement and leads to typical symptoms of Parkinson’s: a slow gait, muscle stiffness and tremor.

Parkinson’s is one of the most common neurological diseases. The number of sufferers in Switzerland is estimated at 15,000. It generally affects adults aged 60 or over, but younger people can also get Parkinson’s disease. With modern therapies, life expectancy for Parkinson’s patients is not significantly lower than for healthy people of a similar age.

Causes

For mainly unknown reasons, there is a dopamine deficiency in a particular region of the brain (substantia nigra = black substance, because the nerve cells are a dark colour); previous diseases are rarely the trigger. Dopamine is a so-called messenger substance or neurotransmitter. In simple terms, it serves to transmit orders from one nerve cell to the next.

Risk factors for Parkinson’s disease

There is generally a number of factors involved in its emergence. Alongside hereditary factors, the main ones are:

  • Repeated injury to the head and brain (the most famous example is the boxer Muhammad Ali)
  • Strokes (oxygen deficiency) increase the risk of Parkinson’s
  • Poisoning, e.g. carbon monoxide or manganese
  • Drugs and addictive substances can lead to Parkinson’s-like symptoms
  • Tumours, inflammation (e.g. after encephalitis)
  • Particular psychotropic drugs (e.g. anti-psychotics)
Symptoms

The main symptoms of Parkinson’s disease are linked to coordination and movement control, and include:

  • Pronounced shaking while at rest (resting tremors); different from essential tremor (also known as old-age tremor), which mainly appear when moving about.
  • Slowed movement (bradykinesia); another typical symptom is that the arms no longer swing when moving. facial expressions are no longer lively, speech becomes monotonous.
  • Muscular stiffness (rigour)

In the later stages of the disease, balance is also affected, leading to frequent falls.

Other symptoms:

  • Depression: sufferers from Parkinson’s disease are often sad, have lost hope and are depressed. According to the latest research, depression may even be an early sign of Parkinson’s.
  • Cardiovascular system problems (dizziness, blood pressure variations)
  • Digestive disorders (constipation, frequent need to urinate, incontinence)
  • Heavy sweating
  •  Impotence
  • Sleep disturbances
Diagnosis (tests)

Diagnosis is established clinically based on the symptoms described above, and also includes neurological and physical tests. Using computed tomography (CT scan) and/or magnetic resonance imaging (MRI), other conditions (e.g. tumours) must be excluded. Diagnosing Parkinson’s is very challenging for the patient and doctor, and can take months, because there is no definitive test for Parkinson’s.

Treatment

The aim of treatment is to enable the patient to maintain professional and personal independence and the best possible quality of life for as long as possible, and to manage associated conditions and complications.

General measures

  • Physical activities, e.g swimming, dancing, running, walking
  •  Exercises at home, stretching, muscular strength training
  • Relaxation techniques (meditation, yoga)
  • Physiotherapy
  • Speech therapy
  • Occupational therapy (mobility, agility, dexterity)
  • Psychosocial support
  • Balanced diet, plenty of fluids, potentially nutritional advice
  • Mobility aids at home (a shower seat in the bath, handles and grab bars to facilitate standing up).

Medication

The causes of Parkinson’s disease cannot be treated; at most, its progress can be slowed down. All measures to treat Parkinson’s aim to alleviate the symptoms. When medication should be started is a matter for the patient and doctor to decide between them. Whether so-called neuro-protective drugs (to protect the nerve cells) can be used early on is still being debated.

  • Drug therapy fundamentally aims to compensate for the lack of dopamine in the brain. Various drugs are used in the treatment of Parkinson’s, the main types being:
  • Dopamine or its precursor, L-Dopa
  • Dopamine-like drugs: these mimic the effect of dopamine (dopamine agonists)
  •  MAO or COMT inhibitors: block or slow down the action of the enzyme that breaks down dopamine in the brain
  • Others: anticholinergics, amantadine

Alongside specific drugs for Parkinson’s, other drugs can be used to treat related symptoms, e.g.

  • Antidepressants, potentially sleeping pills
  • Muscle relaxants

Surgical

Parkinson’s disease cannot be cured surgically, either. At best, it is possible to alleviate the symptoms. By using a “brain pacemaker”, particular areas of the brain can be stimulated using electric impulses. This has a positive effect on patients’ involuntary movements in particular. The operation is conducted under local anaesthetic, because the patient’s cooperation is required.

This highly specialised procedure is only carried out at a few centres.

Prevention

To date, there are no effective preventative measures. It is hoped that new treatment strategies – for example, a vaccine against Parkinson’s or neuronal renewal (such as through stem cell transplants) – will help maintain the functioning of the dopaminergic pathways.