Diseases

Parkinson's symptoms, causes, therapy

Parkinson's symptoms, causes, therapy / Diseases

What is Parkinson's disease??

Parkinson's disease is a disease of the nervous system. Nerve cells die abnormally fast in a specific brain region in the midbrain (substantia nigra). As a result, this region produces less dopamine, a messenger needed to control muscles. Due to the lack of dopamine occur in the affected increasing mobility and movement disorders such as shaking, slowed movements, muscle stiffness, deteriorated balance and gait insecurity. Furthermore, an increased risk of mental illness such as depression, dementia or apathy in those affected can be observed. The disease is not considered curable so far, but can be slowed down by medication, physiotherapy and deep brain stimulation.


contents

  • What is Parkinson's disease??
  • Parkinson's - a quick overview
  • distribution
  • causes
  • early warning Signs
  • symptoms
  • diagnosis
  • therapy
  • history
  • Further information and current state of research

Parkinson's - a quick overview

Here is one of the most important short information about Parkinson's disease at a glance:

  • Synonyms: Idiopathic Parkinson's Disease (IPS), Parkinson's Disease, Parkinsonism, Shaking Palsy, Paralysis Agitans, Parkinson's Disease, Trembling Disease, Shaking Palsy.
  • causes: Fast dying nerve cells in the midbrain region of substantia nigra result in decreased dopamine production, which makes the brain increasingly poorly able to coordinate movement.
  • early warning Signs: Frequent fatigue and fatigue, increased tremors, increasing forgetfulness, emotional irritability, sore muscles in the arms, legs or neck, cumbersome movements.
  • symptoms: Tremor, muscle stiffening, gait insecurity, slowed movements, poor balance, posture instability, sleep disorders, decreased mental performance, speech disorders, skin problems, dysphagia.
  • therapy: Medications such as levodopa or dopamine agonists, physiotherapy, speech therapy, psychotherapeutic measures, deep brain stimulation.
In Parkinson's disease, nerve cells in an area of ​​the brain die abnormally fast. (Image: freshidea / fotolia.com)

distribution

According to the German Society of Neurology (DGN), up to 400,000 patients in Germany are affected by some form of Parkinson's disease. The average age at diagnosis is 60 years. With increasing age, the risk of disease increases. About one percent of 60-year-olds are affected by Parkinson's. The 80-year-olds are already three percent. There is also a rare hereditary Parkinson's form in which show symptoms from the age of 40 years.

causes

According to current knowledge, the lack of dopamine production causes the typical Parkinson's symptoms. Dopamine is a messenger released by the brain region Substantia nigra. This brain region contains about 400,000 cells at birth. In healthy people, about 2,400 of them die each year. In Parkinson's patients, however, this natural process runs off faster for reasons yet to be explained. If more than 60 percent of these nerve cells have died, symptoms of Parkinson's syndrome may occur.

The role of dopamine

As already mentioned, the dopamine is released through the brain region Substantia nigra. As a result of increased cell death in this region, the brain also has less dopamine available. The messenger dopamine is needed so that nerve cells in the brain can pass signals, for example, to coordinate the fine-tuning of muscle movements. Compared with healthy people, Parkinson's disease sufferers who already have symptoms show a 70 to 80 percent reduction in brain dopamine levels.

The lack of the messenger dopamine plays a central role in Parkinson's disease. Dopamine is needed, among other things, to allow the fine-tuning of the muscles. (Pictures: Kateryna_Kon / fotolia.com)

The secondary Parkinson syndrome

Secondary or symptomatic Parkinson's syndrome has the same symptoms as idiopathic Parkinson's disease (IPS), but the cause is different. This is not the premature destruction of the nerve cells responsible. Rather, a number of diseases, injuries or drugs come into question as a cause that require a different therapy. These include, for example:

  • Arteriosclerosis, which has caused constipation below the cerebral cortex,
  • Medications such as chlorpromazine, haloperidol, lithium, metoclopramide or flunarizine,
  • Brain tumors,
  • Brain injuries after serious accidents,
  • stroke,
  • Inflammations of the brain,
  • Metabolic diseases that damage the brain (like Wilson's disease or Gaucher's disease).

Is Parkinson's syndrome inheritable??

There are different forms of the disease. Most of them are not likely to be inherited by today's knowledge. In some families, however, an above-average Parkinson's disease was often found. This is a rare form of the disease, which is characterized by a very early onset of illness from the age of 40 years. In this form, it is believed that genetic factors play an important role.

Except for a rare early onset form of Parkinson's disease, physicians believe that Parkinson's is not hereditary. (Image: Ocskay Mark / fotolia.com)

early warning Signs

Signs of the disease creep in very slowly. To make matters worse, early symptoms of Parkinson's are often confused with normal age-related limitations. Frequent trembling may be a first clue, but not every tremor is cause for concern. According to the German Society of Neurology (DGN), it is only questionable if additional symptoms are added to the restriction of movement. These include:

  • Affected sit a lot and have problems getting up,
  • decreased odor perception,
  • Sleep disorders and vivid dreams,
  • Discomfort when urinating,
  • constipation,
  • depression,
  • quiet speech,
  • swallowing problems,
  • Handwriting seems cramped,
  • Concerned people neglect their hobbies and withdraw,
  • Arms and legs react more slowly and awkwardly,
  • neck tension,
  • general fatigue,
  • inner unrest.

Early treatment is important

Parkinson's disease is an incurable disease. Here an early start of treatment is important in order to obtain the longest possible delay in progression. Therefore, a suspicion should be clarified early with a doctor.

Social withdrawal and apathy can be concomitant symptoms of Parkinson's disease. (Image: Photographee.eu/fotolia.com)

symptoms

In the advanced course of the disease, additional symptoms are added to the already described first signs. This can lead, for example, to excessive sweating and skin problems such as greasy or oily facial skin and dandruff. In particular, Parkinson's disease is characterized by four symptoms, which initially manifest themselves on one half of the body and then extend to the entire body. These complaints include:

  • Lack of exercise (akinese),
  • Muscle Stiffeners (Rigor),
  • Trembling (tremor),
  • Attitude instability (postural instability).

Slow and awkward movements (akinesia)

Slow movements may be signs of Parkinson's. Those affected find it difficult to control their movements. Arms and legs react only hesitantly and cumbersome to a movement impulse. This symptom is called akinese in medicine. It can also be an enormous psychological burden for Parkinson's patients, since everyday things like dressing, brushing, washing and cooking can sometimes take a long time and many sufferers feel they can no longer keep up. This is also reflected in the pace, which is increasingly small-stepping and uncertain.

Stiffening of the muscles (Rigor)

Since the fine control of the muscles is disturbed due to the lack of dopamine, appear in the Parkinson's patients muscle stiffening. The on and relaxation of the muscles can not be properly controlled. During movements, the respective counter-muscle is tense, whereby a counterforce to the desired movement arises. This power must then additionally overcome those affected. The whole process is perceived as stiffness. This symptom is medically termed a rigor.

In the advanced stage, there are more and more problems with posture and walking, which ultimately results in those affected no longer being able to walk unaided. (Image: logo3in1 / fotolia.com)

Trembling hands, feet or jaws (tremor)

Parkinson's is also popularly called dithering disease. The affected suffer mainly at rest from a steady rhythmic tremor that manifests itself in most cases, first by trembling hands. However, it can also occur in the feet or in the jaw. The tremor is so severe that patients can not suppress it, even if they focus on it. There are also forms of Parkinson's syndrome in which no or only a slight tremor occurs.

Postural dysfunction (postural instability)

Disease-related movement disorders also include increasing postural instability. This is manifested by diminished reflexes, for example when intercepting unpredictable movements. Furthermore, it leads to an unsteady gait, lack of balance and coordination difficulties. When walking, sufferers often adopt a disease-typical posture with curved back and slightly bent knees. In the course of the disease, walking becomes more and more difficult until the patients finally have to rely on a wheelchair.

Influence on the psyche

For many sufferers, the psyche is heavily burdened. As a result, symptoms of mental disorders often occur during illness. For example, up to 40 percent of those affected suffer from depressive moods. In addition, the drugs used can lead to the development of psychosis. Other possible mental symptoms are:

  • Listlessness (apathy),
  • reduced determination,
  • nature changes,
  • mental degradation to dementia,
  • restlessness,
  • increased irritability.
The physical limitations that Parkinson's patients experience and the medication can negatively impact the psyche. (Image: logo3in1 / fotolia.com)

diagnosis

The suspicion of Parkinson's syndrome often arises during the questioning of the patient to his history of illness (anamnesis). Often comes after the suspicion of the so-called levodopa test (L-Dopa test) used. In this case, the patient is given a drug that ensures a higher concentration of dopamine in the body. If this leads to a decrease in the symptoms, this is an indication of the presence of Parkinson's disease.

However, it must be clarified whether it is a "true" idiopathic Parkinson's disease (IPS) or a secondary (symptomatic) Parkinson's syndrome, as the therapies are fundamentally different. An imaging technique such as magnetic resonance imaging (MRI) or computed tomography (CT) can provide the necessary evidence.

Hoehn-Yahr scale

To determine the degree of severity, physicians often use the so-called modified Hoehn-Yahr scale, which was named after the American Parkinson's experts Melvin Yahr and Margaret Hoehn. Accordingly, the disease is divided into the following stages:

  • Stage 0: No disease symptoms.
  • Stage 1: symptoms appear on one side of the body.
  • Stage 1.5: Unilateral symptoms involving the body axis.
  • Stage 2: Slight symptoms on both sides of the body without balance disorders.
  • Stage 2.5: Slight symptoms on both sides of the body with compensation during the tensile test (In the tensile test, the doctor checks the stability of the patient)
  • Stage 3: Mild to moderate symptoms on both sides of the body and mild posture instability.
  • Stage 4: Strong disability when walking and standing, independent walking is still possible.
  • Stage 5: The patient relies on a wheelchair without assistance.
During diagnosis, various types of tests are used to determine the form and severity of the disease. (Image: Bojan / fotolia.com)

therapy

If it is an idiopathic Parkinson syndrome, a complete cure is not possible according to the current state of knowledge. The aim of the treatment is to slow down the progression of the disease as much as possible in order to ensure the independence of the patient in all areas of life as long as possible. The focus of the therapy is thus on improving the quality of life of the patient and the family, reducing or delaying the need for care and avoiding possible comorbidities and mental disorders. The following measures are central components of the therapy:

  • Medications like levodopa or dopamine agonists,
  • physical therapy,
  • speech therapy,
  • psychotherapy,
  • Deep brain stimulation.

Levodopa and carbidopa

The right medicines play an important role in Parkinson's therapy. In the election, it often comes to a stalemate in the Parkinson drug comparison. First and foremost is levodopa (L-Dopa), which is currently one of the most effective drugs in this area. The active substance is absorbed into the nerve cells and helps with dopamine production. L-Dopa is commonly used with carbidopa, which prevents the drug from converting to dopamine before it enters the brain. As a result, the dose taken can be reduced and possible side effects such as nausea and vomiting can be reduced.

Side effects of L-dopa

Levodopa is very effective, but it can also cause dyskinesia. These are uncontrollable sudden muscle twitches and jerky movements. If these occur, the side effects often show an aggravation of the side effect. For this reason, levodopa is often used later in the disease. As a first measure usually the so-called dopamine agonists are used.

Dopamine is involved in a complex structure. The right drug treatment must be tailored to each patient individually. (Image: Zerbor / fotolia.com)

Dopamine agonists

The dopamine agonists are drugs that are chemically very similar to dopamine. The active ingredients perform the same tasks as the messenger substance dopamine, but have a weaker effect compared to levodopa. Since this type of medication has many different types with different side effects, patients have the option to choose an agent that has the least impact on them.

COMT and MAO-B inhibitors

While the above-mentioned drugs make more dopamine available, COMT inhibitors and MAO-B inhibitors delay the breakdown of dopamine, which can further increase the effectiveness of the drugs because the dopamine in the brain works longer.

Other medicines

There are also so-called NMDA antagonists and anticholinergics that affect messenger substances that are increasingly active in Parkinson's disease. However, these are used less frequently due to severe side effects and require regular medical checks.

Physio and exercise therapy

Exercise therapy is an important component in the treatment of Parkinson's disease. On the one hand, physiotherapy should improve the mobility, body stability and responsiveness of those affected and prevent muscle and joint stiffening. On the other hand, Parkinson sports groups also have a positive influence on the psyche and counteract, for example, a loneliness or a social withdrawal.

Physiotherapy improves the mobility, body stability and responsiveness of patients and counteracts social isolation. (Image: Ocskay Mark / fotolia.com)

Speech therapy (speech therapy)

Speech therapy can also help maintain the quality of life of patients. Targeted and regular language exercises help to alleviate the disease-related speech disorders. The focus is on breathing techniques, clear pronunciation and the volume of the voice, which is increasingly relieved by the illness. This therapy also counteracts possible mental disorders resulting from social isolation. In addition, the therapy can counteract the dysphagia that occurs in many sufferers.

psychotherapy

To show affected signs of a mental illness such as depression, anxiety or a psychosis, they must be treated as a separate disease and require additional medication and / or appropriate psychotherapy.

Deep brain stimulation (brain pacemaker)

Patients with Parkinson's benefit from a brain pacemaker. In this method, an operation uses electrodes in the brain that stimulate certain areas in the deep brain by electrical impulses. Studies have shown that deep brain stimulation is usually accompanied by years of improvement in symptoms. Also, the side effects of the drugs can be drastically reduced.

However, such an operation is not suitable for every patient. It must be ensured that it is an idiopathic Parkinson's syndrome and contrary to previous assumptions, it makes sense if the patient is still young as possible and not yet severely limited.

history

The disease owes its name to the English physician, pharmacist and paleontologist James Parkinon (1755-1824). He published 1817 An Essay on the Shaking Palsy (A treatise on the shaking palsy), in which he described the disease. Parkinson was also active politically and advocated for the rights of the underprivileged and was considered a proponent of the French Revolution. (tf, vb updated June 11, 2018)

Further information and current state of research

  • What are the causes of Parkinson's memory gaps? Researchers discovered mechanism leading to memory deficits in Parkinson's.
  • Parkinson's partly an autoimmune disease? Autoimmune response plays an important role in Parkinson's disease.
  • Is Parkinson's disease in the stomach? New explanations for the development of Parkinson's.
  • Excess calcium leads to the formation of toxic clusters. Excess calcium is a trigger of Parkinson's?
  • Does Vitamin B12 protect against Parkinson's? Vitamin B12 can slow down the development of Parkinson's.
  • Brain pacemaker can help Parkinson's patients. Brain pacemaker keeps impulsive behavior in check.
  • Diabetes drug can also help people with Parkinson's. Researchers found that a drug to treat diabetes can also help people with Parkinson's disease.

Specialist supervision: Barbara Schindewolf-Lensch (doctor)