Parkinson’s: What is it, Symptoms, Diagnosis and Treatment
It is one of the most common neurodegenerative diseases.
It is one of the most common neurodegenerative diseases. There is a chemical substance called dopamine in the body that plays an important role in controlling movement. In the region called “substance nigra”, which is the production site of this substance, effects and losses occur in the dopamine-producing cells. Once there is a certain amount of cell loss, patients begin to experience signs and symptoms. The disease affects people’s quality of life with the symptoms it causes. It is generally more common in older ages. For this reason, it is seen at higher rates as people’s lifespan increases.
There are many reasons that cause symptoms similar to Parkinson’s disease. These are called “Parkinsonism” or “Parkinson syndromes”. Since they can occur due to different reasons, they may not respond to the medications we give in normal Parkinson’s treatment. Some of these are diseases that we call Parkinson-plus syndromes and secondary parkinsonism, in which Parkinson’s findings and other system findings occur together. Secondary parkinsonism; It may be due to vascular diseases, infections, tumors, drugs and some toxic events. Therefore, it is very important to first make a differential diagnosis and plan the treatment accordingly.
What is Parkinson’s?
Parkinson’s is a progressive neurological disease that causes movement problems as the first sign. A healthy body ensures smooth and coordinated muscle movements through a substance called dopamine in the brain. Dopamine is also produced in the part of the brain called “Substantia Nigra”. In Parkinson’s disease, cells in the “Substantia Nigra” section begin to die and dopamine levels decrease. In this case, Parkinson’s disease occurs.
Parkinson’s, which was first described in the literature as tremor paralysis in 1817, occurs most often in people between the ages of 40 and 70. However, its incidence is approximately 55% between the ages of 20 and 40.
What are the symptoms of Parkinson’s disease?
Parkinson’s disease has four main symptoms: slowing down of movements (bradykinesia), tremors that occur especially at rest, stiffness and stiffness in the muscles (rigidity), and decreased posture reflexes. It is a slowly progressive brain disease that may also have many other system findings.
In patients, the findings mostly begin on one side and may spread to the other side of the body over the years. The most important of these symptoms is slowing down of movements. Related to this, the patient’s walking is also affected. They walk with small steps, there is a lack of swinging the arm on the side where the disease is severe, and slow walking is observed. When the same findings occur on the face, a dull facial appearance with reduced facial movements and expressions occurs.
Tremors occur especially when the patient is at rest. It is most commonly seen on the hands, and to a lesser extent on the feet, chin and lips. Although it is a very important symptom, tremor may not be observed in all Parkinson’s patients.
As the disease progresses, other system effects such as bending the body forward and sideways, which we call “flexion posture”, difficulty initiating movement, which we call “freezing”, forgetfulness, psychiatric findings, digestive system findings such as constipation, urological symptoms, and sleep disorders, also occur. Sleep disorders are seen in most patients.
However, in patients without Parkinson’s, there is a stage called “premotor”, in which there are findings that suggest that Parkinson’s may develop in the future. At this stage, constipation, a sleep disorder called “REM sleep behavior disorder”, screaming in sleep, fear, and movement in the arms and legs may also be symptoms of Parkinson’s. In addition, olfactory dysfunction may be a preliminary symptom of the disease. When we look at the history of Parkinson’s patients, we see that most of them have such symptoms. These people have a higher risk of developing Parkinson’s disease, and these disorders may appear years before Parkinson’s disease begins.
How is Parkinson’s Disease Diagnosed?
The diagnosis of the disease is made by neurological examination. There is no laboratory test specific to the disease. Some tests can be performed to support or exclude other diseases.
Is There a Treatment for Parkinson’s Disease?
There is no treatment method that will completely stop the progression of the disease. The disease does not shorten people’s lifespan, and with the treatment of existing findings, patients can be treated for years while keeping their quality of life at a certain level.
If the diagnosis is made correctly, Parkinson’s disease responds very well to treatment. A good response is received over 90%. Treatment; We can classify them as drug treatment, surgical treatment and other methods. It is important that all these treatment plans are made by an experienced Neurologist. Because we have a wide variety of effective medicines at our disposal.
The drugs we give in medical treatment are drugs that aim to reduce dopamine deficiency, prevent the destruction of dopamine in the brain, keep it in the brain for a long time, and act like dopamine, or we can give dopamine itself. Our most effective medicine is the drug whose active ingredient is levodopa and can easily pass into the brain.
Thanks to these treatments and regular check-ups for years, we can keep our patients’ daily lives at a certain level. However, in the following years, we may encounter other problems with both the progression of the disease and the side effects of medications.
In advanced stage patients, various findings such as freezing in walking, shortening of the duration of drug effect, involuntary movements, sleep disorders, autonomic disorders (decrease in TA), some psychiatric findings, and forgetfulness may be added.
In some patients in advanced stages, apomorphine injections (especially short-term effect) or drug infusion with a pump-shaped device that allows the drug to be administered directly from the intestine can be used to improve the symptoms in some patients. If adequate response is not obtained with drug treatment or if involuntary movements occur due to drugs, surgical treatment can be performed.
Surgical treatment today mostly consists of placing electrodes in some special nuclei in the brain and sending stimuli to these places (such as thalamic stimulation, pallidal stimulation and subthalamic stimulation). It is used as a good treatment option, especially in some Parkinson’s patients, but it is very important to decide who and how the surgery will be performed.
