Introduction:
Most diseases before its onset have some indications, that there is something wrong with the body. These indications, in medical terms, are called ‘Symptoms’.
In most diseases, we can cure, if we notice the symptoms, diagnose the disease and start treatment early. But in some diseases, symptoms start gradually, and may go unnoticed. And by the time, symptoms become prominent; disease has already reached an advanced stage. Same is the case with Parkinson’s. Its symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand.
Parkinson’s Disease:
Parkinson’s is a progressive disorder of the nervous system that affects body movements of the affected person. This disease is more common in people 60 years old and older. First documented in 1817 by physician James Parkinson, Parkinson’s is the second most common neurodegenerative disease after Alzheimer’s disease.
Symptoms of Parkinson’s Disease:
Parkinson’s disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.
Parkinson’s symptoms may be divided into motor symptoms and non-motor symptoms. Some of the motor symptoms may include:
- Tremor: Tremor is the shaking or involuntary and rhythmic movements of the hands, arms, legs and jaw. It usually begins in a limb, often hand or fingers. The hand may tremor when it’s at rest.
- Slowed movement (bradykinesia): Over time, Parkinson’s disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
- Rigid muscles: Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion. This muscle rigidity is common in arms, shoulders or neck.
- Impaired posture and balance: Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease. A patient may have bending at the elbows, knees and hips.
- Loss of automatic movements: Patient may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. This often leads to decreased mental skill or reaction time
- Writing changes: It may become hard to write, and your writing may appear small.
- Speech changes: You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
- Depression and Dementia: Studies show that 10% to 70% of Parkinson’s patients develop some degree of dementia (loss of brain function). This loss affects memory, thinking, language, judgment, and behavior and creates trouble with decision-making.
- Other Problems: The patient may have difficulty in swallowing, may run a risk of food entering the windpipe and also have saliva drooling.
Causes of Parkinson’s Disease:
In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in the brain called dopamine. The main reason behind the Parkinson’s is the decrease in the dopamine level inside our brain. This lower level of dopamine causes abnormal activity in the brain.
In addition to this, some other factors appear to play a role, which are given below:
- Genetic Reasons: Researchers have identified specific genetic mutations that can increase the risk of Parkinson’s disease. Though these cases are rare.
- Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.
- Presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson’s disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson’s disease.
- Autoimmune factors: In 2017, some scientists found some evidence of a possible genetic link between Parkinson’s disease and autoimmune conditions, such as rheumatoid arthritis. In 2018, researchers investigating health records in Taiwan found that people with autoimmune rheumatic diseases (ARD) had a higher chance of having Parkinson’s as compared to people without ARD.
Treatment – Surgical Procedures
For many patients, medications are effective for maintaining a good quality of life. These medications work by stimulating the remaining cells in the substantia nigra to produce more dopamine or by inhibiting some of the acetylcholine that is produced (anticholinergic medications), therefore restoring the balance between the chemicals in the brain.
However, some patients, with the passage of time, develop variability in their response to treatment, known as “motor fluctuations. During “on” periods, a patient may move with relative ease, often with reduced tremor and stiffness. During “off” periods, patients may have more difficulty controlling movements. Off periods may occur just prior to a patient taking their next dose of medication, and these episodes are called “wearing off.” These problems can usually be managed with changes in medications.
Based upon the type and severity of symptoms, the deterioration of a patient’s quality of life and a patient’s overall health, surgery may be the next step.
As of now, there are 3 major surgical approaches to Parkinson’s Disease. These are as follows:
- Ablative Surgery – i.e. Pallidotomy, Thalamotomy
- Deep Brain Stimulation (DBS) of the thalamus, Internal Globus Pallidus (GPi) and Sub Thalamic Nucleus (STN)
- Duopa Therapy, which is a form of carbidopa/levodopa delivered in gel form – called enteral suspension – rather than a pill.
Deep Brain Stimulation (DBS)
Currently, the most common surgical treatment for Parkinson’s disease is Deep Brain Stimulation. This treatment strategy is best in cases of bradykinesia, rigidity and tremors in patients who are not responding to medication in desired manner, or patients who suffer from medication induced dyskinesias.
DBS offers a safer alternative to other surgical procedures. It utilizes small electrodes which are implanted to provide an electrical impulse to either the subthalamic nucleus of the thalamus or the globus pallidus, deep parts of the brain involved in motor function. Implantation of the electrode is guided through magnetic resonance imaging (MRI) and neurophysiological mapping, to pinpoint the correct location.
The electrode is connected to wires that lead to an impulse generator or IPG (similar to a pacemaker) that is placed under the collarbone and beneath the skin. Patients have a controller, which allows them to turn the device on or off. The electrodes are usually placed on one side of the brain. An electrode implanted in the left side of the brain will control the symptoms on the right side of the body and vice versa. Some patients may need to have stimulators implanted on both sides of the brain.
This form of stimulation helps rebalance the control messages in the brain, thereby suppressing tremor. DBS of the subthalamic nucleus or globus pallidus may be effective in treating all of the primary motor features of Parkinson’s and may allow for significant decreases in medication doses.
Conclusion:
In the early stages of Parkinson’s disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson’s disease symptoms worsen as your condition progresses over time.
Although Parkinson’s disease can’t be cured, medications might significantly improve your symptoms. Occasionally, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.
