Parkinson's disease treatment
Parkinson's disease is a chronic disease of the central nervous system. Typical symptoms are movement disorders such as slow movement, stiff muscles, tremors and unstable posture. Unfortunately, there is no complete cure, but effective treatment options include drugs, surgical interventions, stem cell and gene therapy, and physiotherapeutic methods.
Parkinson's disease (idiopathic Parkinson's syndrome or primary Parkinson's syndrome) is a chronic disease of the nervous system in which nerve cells in the midbrain gradually die off.
There is another similar concept that is often confused. Parkinsonism is a pathological condition manifested by periodic shaking of the head and lower/upper limbs (tremor), impaired motor activity and high muscle tone. A patient with Parkinson's disease also has these symptoms, but these two concepts are different. Parkinson's disease is an independent disease that occurs without recognizable causes. Around 80% of all Parkinson's patients suffer from it. And parkinsonism is a set of symptoms that can appear after a head injury or poisoning, but it is not a disease.
There is also symptomatic or secondary parkinsonism. The cause lies in environmental influences (e.g. toxins), diseases (e.g. circulatory disorders or tumours in the brain) or medication (e.g. neuroleptics).
Hemiparkinsonism is a rare form characterized by body atrophy only on one side. So slowly progressive, Hemi parkinsonian symptoms (bradykinesia, stiffness, and tremor) occur one-sided.
The disease progresses slowly and usually begins after the age of 50. It is estimated that one to two out of 1,000 people suffer from it. Although Parkinson's disease can also affect younger people, in many cases, the first symptoms of the disease do not appear until old age. In addition, unlike many other diseases in old age, Parkinson's affects more men than women.
Causes of Parkinson's
The disease is caused by the death of nerve cells in a midbrain region (substantia nigra). However, it is still unclear why these nerve cells die off in this form of Parkinson's syndrome. Research suggests that genetic factors and environmental causes are responsible for its development.
The single most significant risk factor for developing Parkinson's disease is age. The European Parkinson's Disease Association (EPDA) states that most patients are over 60. Doctors assume, however, that the condition occurs much earlier and that it may take years for those affected to suffer from the first symptoms. As a result, people in their 30s or 40s can already develop Parkinson's disease but do not notice it at first.
Common symptoms related to Parkinson's disease
The classic four primary symptoms of Parkinson's disease are bradykinesia, rigidity, tremor and postural instability:
- Bradykinesia means that those affected moves more slowly and less. For example, difficulty getting up, walking, and turning. In addition, it is sometimes almost impossible to start movements, resulting in a blockage of movement (akinesia).
- Rigidity describes the stiffness of the muscles. Every movement seems to be against tenacious resistance. The neck and shoulder muscles are often affected first, often on one side.
- Tremor is the name for shaking. In Parkinson's disease, there is often a one-sided, slow trembling of the hands and the feet, mostly at rest. It usually disappears during sleep or movement.
- Postural instability describes a disturbance in the holding and righting reflexes. Usually, they allow the body to maintain balance.
Possible first signs and accompanying symptoms of Parkinson's may also include:
- The sense of smell deterioration is often an early sign of Parkinson's disease;
- Sleep disorders that are associated with involuntary and violent movements during dream sleep (sleep behaviour disorder);
- Depressive moods;
- Diffuse muscle and joint pain, especially in the shoulder and arm area;
- Temperature and circulatory regulation, bladder and bowel function and potency can all be disturbed;
- In some cases, symptoms of dementia appear over time.
However, all of the symptoms mentioned can also have other causes. In addition, they do not all have to be present in Parkinson's disease.
Diagnosis is often difficult, especially at the beginning. The doctor makes the diagnosis based on the symptoms of the illness: Parkinson's disease is suggested if there is a lack of movement and other typical signs - such as muscle stiffness, tremors or a disorder of the holding and righting reflexes. Symptoms are often unilateral at first. Some patients notice problems walking early on and fall suddenly. Others injure themselves or their bed partner with violent movements during dream sleep.
Imaging procedures of the brain, such as computed tomography (CT) and magnetic resonance imaging (MRI), are the first options to rule out other causes of neurological problems. For example, with positron emission tomography (PET), a reduction in the dopamine-releasing cells in the brain can be made indirectly visible.
Test procedure: An L-Dopa test can indicate primary Parkinson's syndrome. If there is an improvement in movement disorders or muscle tension about 30 minutes after ingestion, there is a certain probability of Parkinson's disease.
Doctors also use genetic testing to identify familial forms. In addition, they need to examine blood or other body fluids for gene changes and chromosome abnormalities.
A biopsy examines samples of material taken from the skin, including nerves. It allows doctors to assess changes in the chemical and hormonal composition of nerve endings and possible changes in the nervous system.
Establishing a diagnosis of Parkinson's disease is often complex and takes a long time. Very often, the doctor can confirm the diagnosis after starting treatment. Especially in unclear cases, the diagnosis should be made by a specialist with a lot of experience with the disease.
Explore all treatment solutions for Parkinson's
Parkinson's disease is treatable but not curable. The therapy consists of several components. The most important is the use of medication. In this way, the condition can often be well controlled for years. However, the effectiveness of certain anti-Parkinson drugs can decrease over time. It is, therefore, necessary to adjust the medication at certain intervals. The drug treatment aims to bring the substances in the brain back into balance:
- Levodopa (L-Dopa) is a dopamine predecessor that has a positive effect on mobility. It is also used against muscle stiffness and tremors.
- The second group of drugs are dopamine agonists, which increase the effect of the existing dopamine. Newer dopamine agonists ensure a constant level of the active ingredient. Or they release their active ingredient via a patch that has to be changed daily (e.g. rotigotine patches).
- In addition, other groups of drugs reduce fluctuations in dopamine's effects or slow down its breakdown (MAO-B and COMT inhibitors).
- Anticholinergics can effectively reduce tremors.
- The NMDA inhibitor amantadine increases dopamine release and improves mobility.
The various groups of active ingredients can also be combined. Drug management is challenging because the symptoms and side effects can be very different, as can the drug response.
Deep brain stimulation is a modern Parkinson's disease treatment method - surgical interventions on the brain. The procedure should only be used when the drug therapy is insufficient, and the Parkinson's patient loses the quality of life. Small electrodes are permanently inserted under general anaesthesia at precisely calculated points in the brain. As a result, certain brain areas can be electrically stimulated and thus inhibited. In this way, a programmed pacemaker or the patient can specifically alleviate symptoms.
Researchers worldwide are looking for a new way to replace dead brain cells with new, functional cells. One idea is to take stem cells from the patient's bone marrow and plant them in his brain (stem cell injection, stem cell transplantation). According to that, the stem cells are supposed to convert into new, functional nerve cells in the patient's brain.
In the case of hereditary forms, gene therapy is effective. It targets specific damage in the genetic material.
The following methods are no less important in supporting the patient:
- Good physiotherapeutic care is important to maintain mobility for as long as possible.
- Speech therapy measures help if the ability to speak and swallow is impaired.
- Occupational therapy helps patients to be able to cope with everyday life or pursue hobbies independently for as long as possible.
Thus, we see that treating Parkinson's disease requires a consistent, comprehensive approach, correction and supervision. Therefore, it is essential to follow all the doctor's recommendations and undergo regular examinations.
Prognosis of the condition
On average, with early onset (before 39 years), life expectancy is about 35–40 years. If the diagnosis is made at 40-65, the patient can live to an old age of more than 80. The most restrained prognosis for the elderly: Parkinson's disease after 65 years is invariably fatal. Most research shows that the 5-year survival rate of patients after diagnosis and appropriate treatment is about 75%.
Essential factors are early detection of the disease and its timely therapy. Each case is individual, and a treatment scheme successfully selected by an experienced doctor is the best way to improve and prolong the life of patients.
What is the average lifespan of patients with Parkinson's disease?
Since the disease manifests most often in people over 60, the lifespan of such patients can reach 80 years on average. The sooner adequate treatment is started, the longer the life expectancy.
What is the latest therapy for Parkinson's disease?
Currently, the most effective therapy is medication, with the help of various groups of drugs. But scientists and doctors are constantly researching more progressive, new methods. Surgery (deep brain stimulation), stem cells, and gene therapy are among those that show promising results.
Does Parkinson's run in families?
Some data on the occurrence and research of Parkinson's appeared to be (partially) genetic. In these cases, a mutated gene seems to have been passed from one generation to the next, causing the disease to spread to multiple family members. However, it is sporadic for Parkinson's to be inherited.
How quickly does Parkinson's progress?
If Parkinson's disease begins to develop at 20-40, its progression (in the absence of treatment) is very rapid. In older people, the disease proceeds more slowly at the beginning of the disease's development. If the condition develops after 60 years, then sometimes ten years pass from the onset of the first symptoms to the diagnosis.
Can surgery help to cure Parkinson's disease?
Parkinson's disease is currently incurable. Therefore, there are only methods that effectively reduce symptoms and improve the quality of patients' life. Surgery (deep stimulation of the brain) is one such method. Nevertheless, doctors resort to surgery only after the ineffectiveness of drug treatment.
Where can I get Parkinson's disease treatment?
What are the best clinics for Parkinson's disease treatment?
Who are the best doctors for Parkinson's disease?
Prof. Dr. med. Christian E. Elger from Beta Clinic Bonn
Prof. Dr. med. Bernhard Meyer from University Hospital rechts der Isar Munich
Prof. Dr. med. Bernhard Hemmer from University Hospital rechts der Isar Munich
PD. Dr. med. Florian Masuhr from Academic Hospital Bundeswehr Berlin
PD. Dr. med. Axel Lipp from Park Clinic Weissensee Berlin