Parkinson's: recognize it to face it
Written by:The professor. Giuseppe Meco, a neurologist in Rome , talks about Parkinson's diagnosis and treatment, a neurodegenerative disease with 250,000 cases in Italy
What is Parkinson's Disease?
Parkinson's disease is a neurodegenerative disease. With this term is meant a degeneration of nerve cells resulting in cell death. The part of the Nervous System where this process prevails is the Substantia Nigra nucleus located in the Mesencephalus and an integral part of the circuit of the extrapyramidal system. The name of the disease is due to British physician James Parkinson, who for the first time described her, calling her agitating paralysis. Some indirect estimates show that there are about 250,000 Parkinson's cases in Italy, but as a disease whose frequency increases with age, it is presumed that the number of patients in the coming decades will increase as a result of the increase of the average age of the general population.
What are the causes of Parkinson's Disease?
Parkinson's Disease is due to the chronic and progressive degeneration of nerve cells in some central nervous system structures where dopamine is produced, a major neurotransmitter for motion control. Parkinson's is more common in men and numerous studies have found a high incidence in more developed countries, although this may be due to more efficient health systems and more accurate detection systems. Parkinson's is also referred to as "idiopathic Parkinson's disease": idiopathic term is a disease for which a certain cause has not yet been found and is the most common form of parkinsonism (a group of diseases with similar characteristics and symptoms). Most parkinsonisms are idiopathic, but there are some forms, called secondary parkinsonisms that occur as a result of cranial traumas, brain tumors, exposure to toxic substances, chronic psychotherapy, and cerebral ischemia. The average age of onset of initial symptoms is 60 years, but in about 5-10% of patients occur before 50 years, and in some of these forms, in general, very rare, genetic factors. In rare cases Parkinson's symptoms may occur before 40 years of age and these forms are defined as youth parkinsonisms. The most accredited theories argue that one or more environmental factors may trigger the disease: in the 1980s, parkinsonism was reported in people who used illegal drugs contaminated by MPTP (laboratory chemistry) or previously described Parkinsonism as a result of a severe form of flu as during an 1918 epidemic.
Symptoms of Parkinson's Disease?
Parkinson's is a pathology that causes movement disorders. It is not a deadly disease in itself, but its progress is chronic (persists in time) and progressive (worsens over the years). Parkinson's symptoms do not affect all patients in the same way and the pace of progression differs between subjects: tremor is the main symptom for some, while for others it is non-existent or very mild. The four major motor symptoms are:
- Tremor : a rhythmic movement in which you can locate 4-6 beats per second. It usually appears in the thumb or index of a hand, but can sometimes also hit a foot or mouth. Tremor may become more pronounced a few seconds after the hands rest on the table and usually disappear during sleep
- Stiffness: resistance to movement that affects most parkinsonian people. All the muscles of our body have their opposite and the movements we normally perform are possible not only because a muscle becomes more active but because its opposite relaxes. In Parkinson's disease, muscles remain firm and contracted, and rigidity becomes apparent when it is time to move passively to the patient's arm and feel resistance
- Bradycin: Slow motion that can also prevent simple actions
- Position unstable: unstable equilibrium often causes the fall. Instability manifests itself with the advancement of the disease and can be favored by the forward bent forward position that the patient assumes over time
Often these symptoms occur initially in one half of the body (left or right) and with time they extend to both sides. The first people to notice signs of Parkinson are usually the family or friends of the patient. They may notice the lack of face expressivity (amethic face) or the inability to move normally. People with Parkinson's disease develop a typical course of this disease characterized by the tendency to bend forward, the reduced swing of the arms, and small and fast paces.
Diagnosing Parkinson Disease
The diagnosis of Parkinson's Disease is a clinical diagnosis, that is, done by the Neurologist on the basis of history and neurological examination for the evaluation of symptoms and their severity. All examinations required, such as Magnetic Resonance at Encephalo, serve to exclude secondary parkinsonisms from other diseases. Unfortunately, there is no such thing as an examination that can clearly identify the disease: even SPECT with DAT can only give in some cases a difficult diagnosis of the indications. The diagnosis of certainty can be done through an autopsy, which can highlight the presence of microscopic brain structures called Lewy bodies , considered as a characteristic feature of Parkinson's in the Substantia Nigra. Although the diagnosis for Parkinson's is very refined and sensitive, in about 20% of cases, no proper diagnosis. Lewy's bodies can also be found in the elderly non-parkinson's brain, which is why some experts believe that Parkinson's is much more common than you think, and even there are some who claim that almost everyone would develop the disease if they lived long enough.
Can you cure Parkinson's?
Parkinson's disease therapy is based on pharmacological treatment. There are currently no drugs or substances that can prevent the onset of Parkinson's, so the goal of the last 20 years has been to slow down the evolution and change the course of this disease. The use of an intermediate amino acid, more than 40 years after it was introduced in the therapy of Parkinson's Disease , remained the reference drug in treatment. This is ingested orally and absorbed until it is transformed into dopamine. Dopamine has the function of stimulating the control system of our movements and is lacking in the patient suffering from Parkinson's. However, pharmacological research remains active, in fact in recent years other substances have been discovered that can be a useful therapeutic aids for the neurologist and the patient.
Is Parkinson's treatment exclusively pharmacological?
Parkinson's patients have difficulty in muscle stiffness and motor slowdown. In general, moving is a great both mental and psychological benefit. It is important therefore that the patient performs a rehabilitation consisting of:
- Passive Physiochychotherapy (FKT) cycles to reduce muscular pain and achieve postural realignment
- Training with treadmill
- Active group gymnastics, which can be associated with Musicoterapia Active with the use of musical instruments to improve not only the physical abilities but also the patient's mood
- Rhythmic Ear Rhythm, Biodanza and Danzatherapy to Unlock Leg Movement
Another therapeutic option in the advanced stages of the disease is surgical therapy. Currently, DBS (Deep Brain Stimulation) is recommended, which, by implanting a device in the brain, tends to restore normal motor function by improving both Parkinson's symptomatology and dyskinesias and allowing a significant reduction in Parkinson's drugs. This intervention offers significant benefits to patients and is indicated for those who do not show satisfactory results following drug therapy.
Editor: Marta Buonomano