Parkinson’s disease is a neurodegenerative disorder that affects movement and coordination. Find here all the information you need.
What is Parkinson’s Disease?
Parkinson’s disease is a neurodegenerative disease characterized by damage to the nerve cells, called neurons, in some brain regions, especially in the “substantia nigra.”
From the Shaking Palsy to Parkinson’s disease
Parkinson’s disease was first identified in 1817 by James Parkinson, who named it “Shaking Palsy.” Since then, it has been known by many names, including “Parkinson’s syndrome,” “Parkinson’s disease,” “PD,” and even the colloquial “Mr. P.”
What are the consequences?
It affects the nervous system, causing progressive damage to the brain cells (neurons) that produce a neurotransmitter called “dopamine,” essential to proper movement control.
Indeed, those affected by Parkinson’s experience increasing difficulty controlling their body movements, leading to symptoms like tremors, slowness of movement, difficulties with balance, and muscle rigidity. It usually affects older people, but Young Onset Parkinson’s Disease cases are increasingly frequent.
What doctor should I contact?
The specialist who deals with this disease is a neurologist.
Causes of Parkinson’s.
The origin of Parkinson’s Disease is still unclear. Most people suffer from “idiopathic Parkinson’s,” meaning that the cause is unknown.
However, studies have shown that genetic mutations cause some cases of Parkinson’s and that hereditary causes of this disease are rare: only 15% of Parkinson’s patients have had other cases in their families.
Apart from these, the etiology of Parkinson’s disease is generally unknown.
Research suggests that the cause is a combination of genetic and environmental factors.
When does it appear?
Parkinson’s is no longer a disease affecting only the elderly. Juvenile Parkinson’s is an increasingly important topic. Younger patients face premature aging due to physical degeneration, side effects of Parkinson’s drugs, and a progressive lack of engagement in social relationships and activities.
Today, 10% of Parkinson’s patients are under 40, and 25% are younger than 50. This phenomenon is probably also linked to greater accuracy in Parkinson’s diagnosis, as it is now often identified at very early stages.
Clinical and epidemiological studies have shown that the earliest damage to the brain occurs an average of at least six years before the initial diagnosis.
Young Onset Parkinson’s
Most people do not know that among the parkinsonians, 10-20% are under age 50, and half received their diagnosis before under 40.
Also, 25% of individuals with Parkinson’s are unaware of their condition, primarily because their symptoms are minimal and can be mistaken for other diseases. For this reason, young patients, especially those between 40 and 50, often are undiagnosed or misdiagnosed.
So, it is important to consider the appearance of early Parkinson’s symptoms as a possibility, regardless of an individual’s age, especially when clinical and diagnostic testing does not provide answers or confirm other conditions.
That is because it is crucial to start the treatments as soon as possible to avoid the symptoms from becoming severe.
Parkinson’s disease: the stages.
Parkinson’s is characterized principally by two main stages: presymptomatic and symptomatic.
It is quite challenging to determine precisely when the presymptomatic stage ends and the symptomatic stage begins. Some symptoms of Parkinson’s disease indeed are so mild that no clinical evaluation is possible.
The presymptomatic and the symptomatic stages
The presymptomatic stage is usually characterized by the loss of dopaminergic neurons from the substantia nigra.
The symptomatic stage can, in turn, be divided into two parts: early stage and late stage. The early stage is characterized by motor symptoms onset and usually by the loss of about 70% of the dopaminergic neurons. The late stage consists of the disease progression, when symptoms become more severe, often causing significant disruption in daily activities.
The disease progression differs from patient to patient
The progression of the disease is unique in each case, with primary motor symptoms varying from patient to patient.
There are, thus, different forms of Parkinson’s. For example, some patients exhibit all the cardinal signs, while others only exhibit tremors, akinesia, or rigidity.
Hoehn and Yahr’s five-stage classification
Hoehn and Yahr classified Parkinson’s into five stages.
THIS CLINICAL PICTURE REFERS TO A PERSON WITH PARKINSON’S WHO IS NOT UNDERGOING ANY PHARMACOLOGICAL TREATMENT.
Parkinsonisms and Parkinson’s plus syndromes
Parkinsonism refers to a group of neurological conditions causing movement impairments similar to Parkinson’s, such as slowness and rigidity. It can be difficult to differentiate between idiopathic Parkinson’s and parkinsonism initially.
These syndromes typically progress faster than Parkinson’s disease and have a limited or no response to levodopa treatment. Early-stage treatments are similar to Parkinson’s, as no specific alternatives exist. Parkinsonisms, also called “atypical” syndromes, often differ from Parkinson’s, like the absence of tremors.
Despite this, parkinsonism causes similar issues to Parkinson’s: movement difficulties, balance problems, speech issues, and falls. Accurate diagnosis can be challenging, and some people are labeled with “parkinsonism” due to the lack of specific symptoms.
To diagnose parkinsonism, it’s necessary to see a neurologist who specializes in Parkinson’s disease. Diagnosis is based on observing symptoms, medical history, and sometimes movement tests.
Unfortunately, there is no test that can definitively indicate the presence of the disease, although DatScan can be used to detect dopamine loss and imaging technologies like MRI, SPECT, PET, and cerebral scintigraphy can help rule out other disorders.
However, as all parkinsonism involves a dopamine loss, a DatScan cannot differentiate between Parkinson’s disease and atypical Parkinson’s and often the patient is misdiagnosed, so the diagnosis may need to be revised over time.
New research suggests that specific markers in saliva may help detect Parkinson’s before symptoms appear, but more research is needed to confirm this. If you have concerns, talk to your family doctor, who can refer you to a neurologist if necessary.
How is parkinsonism diagnosed?
Distinguishing between the different types of parkinsonisms is not always easy because:
- the early symptoms of the different forms of parkinsonism are very similar, and
- the symptoms that allow a doctor to make a specific diagnosis may appear only as the condition progresses.
The disease is characterized by three classic symptoms: tremor, rigidity, and slowness of movement (bradykinesia). In addition, these symptoms may be associated with balance impairments, kyphosis (stooped posture), clumsy gait, sudden stops (freezing of gait, Parkinson’s freezing), and, in the late stages, akinesia (total absence of movement).
Minor early symptoms include:
- a decrease in the sense of smell,
- changes in handwriting (becoming progressively smaller),
- changes to the voice (becoming weaker and monotone),
- a fixed stare, and
- a loss of facial expression.
Parkinson’s freezing of gait
Posture tends to become stooped; there is a decrease in pendular arm movements and a reduction in stride length. In addition, patients often present with “festination,” a shortening and quickening of stride until they can no longer move their feet.
Sudden motor blocks, known as freezing of gait or Parkinson’s freezing, may occur beginning in the disease’s middle stages.
In many cases, freezing is a side effect induced by the chronic use of dopamine agonists, one of the principal drugs used to treat Parkinson’s disease.
Festinant and freezing gait can cause falls and, in some cases, render the patient unable to perform routine daily activities.
Gondola AMPS therapy is quite efficient in treating gait impairments and, consequently, Freezing of Gait. Indeed, improving the Parkinsonian gait helps to overcome better the Freezing episodes.
Balance impairments and pain
Suffering from Parkinson’s also means experiencing rigidity and muscle pain (46% of patients), movement disorders, loss of balance, and unsteadiness.
Balance impairments appear during the middle or late stages of Parkinson’s disease. As the disease evolves, patients lose their sense of balance and progressively lose the ability to correct their posture automatically.
Parkinson’s, and quality of life
Cure and Therapy for Parkinson’s
There is no cure for Parkinson’s disease yet, but there are several different therapies to help manage the symptoms. Having proper treatment since the onset of the first Parkinson’s signs makes it possible to slow the progression of the symptoms and have a better quality of life than if treatment began later.
For this purpose, finding a neurologist specializing in Parkinson’s disease and parkinsonism is crucial.
The primary therapy for Parkinson’s disease is pharmacological, but several different surgical approaches have been developed in recent years, as well as rehabilitation-based therapies such as AMPS (Automated Mechanical Peripheral Stimulation).
Drugs, as well as other treatments, can help to reduce Parkinson’s symptoms. However, they are just palliative (they relieve symptoms only) and can neither halt the progress of the disease nor cure it.
Moreover, each patient responds differently to Parkinson’s treatment.
Parkinson’s disease causes a lack of dopamine. So, the primary therapy is based on L-Dopa (levodopa), the drug precursor of dopamine, which can reach the brain, where it performs its therapeutic action.
Dopamine agonists, MAOinhibitors, catechol-O-methyltransferases, anticholinergics, and glutamate blockers are also used in Parkinson’s treatment, in addition to levodopa (L-Dopa), which remains the most effective Parkinson’s drug,
Since the drug’s therapeutic effect tends to decrease progressively, adjusting the posology over time is highly recommended.
Further details of each pharmacological treatment types can be found below:
- Levodopa (e.g., Madopar®, Sinemet®, Stalevo® = Sinemet + Entacapone, Duodopa® = levodopa + Carbidopa Gel) is the most commonly used Parkinson’s drug and is also the most effective in treating symptoms. Taken orally, it can cross the blood-brain barrier and, once it has reached the brain, transform into dopamine. Its most common side effects include involuntary movements (dyskinesia) and orthostatic hypotension, which causes fainting fits and falls.
- Dopamine agonists (dopaminergic) imitate dopamine’s effects by stimulating the neurons. Using these drugs to treat Parkinson’s is not effective in the long term.
Moreover, they can have significant side effects, including hallucinations, orthostatic hypotension, obsessive-compulsive behaviors such as hypersexuality, compulsive gambling, and compulsive eating. Examples of dopaminergic include Bromocriptine: Parlodel®, Cabergoline: Cabaser®, Dehydroergocryptine: Cripar®, Pergolide: Permax®, Pramipexole: Sifrol®, Ropinirole: Requip®, Rotigotine: Neupro®, Pramipexole: Mirapexin, Pramipexole Teva, Oprymea, Pramipexole Accord.
Amantadine (e.g. Mantadan) is a relatively weak dopamine agonist with modest effects. It relieves tremors and rigidity but can generate tolerance and cause confusion and hallucinations.
- Monoamine oxidase inhibitors (MAOIs) serve to prevent dopamine breakdown. MAOIs have serious side effects, including hallucinations, confusion, headaches, and dizziness. Examples of MAOIs include
- Selegiline (e.g., Egibren, Jumex, Seledat).
- Rasagiline (e.g., Azilect) is a drug that blocks the enzyme monoamine oxidase-B (responsible for the breakdown of dopamine in the brain), thereby helping to reduce rigidity and slowness of movement.
- Catechol-O-methyltransferases are drugs used to prolong the duration of the action of levodopa-carbidopa; their interaction blocks the enzyme that destroys levodopa.
- Tolcapone (e.g., Tasmar) is a powerful drug. During the use, monitoring is required for possible liver damage. It is generally prescribed to patients who do not respond to other treatments.
AMPS (Automated Mechanical Peripheral Stimulation)
AMPS therapy, provided by Gondola Medical Device, is a non-invasive treatment that helps treat movement impairments due to Parkinson’s disease.
The treatment consists of applying a sequential mechanical pressure on four specific target stimulation points: the first metatarsophalangeal joint and the head of the big toe of both feet. Activating the cutaneous mechanoreceptors at these target areas triggers a peripheral sensory input that travels towards the brain, increasing sensory integration and brain plasticity. As a result of the treatment, the efficiency of descending pathways increases, and walking performance is immediately improved.
The primary benefits of AMPS therapy are:
- Increasing walking speed
- Increasing stride and step length
- Reducing the risk of falling
- Improving postural stability and dynamic balance
- Improving handling freezing of gait episodes.
Moreover, the clinical efficacy of Gondola AMPS therapy has been documented by multiple scientific articles published in international peer-reviewed journals.
Deep brain stimulation (DBS) treatment
Deep brain stimulation (DBS) is a neurosurgical procedure that consists of implanting a neurostimulator (sometimes called a “brain pacemaker”). It uses implanted electrodes to send electrical impulses to specific brain areas to treat movement and neuropsychiatric disorders.
DBS modifies brain activity in a controlled way, and the effects are reversible. It cannot cure Parkinson’s disease, but it can help to manage some symptoms.
Despite the long history of this treatment, the primary mechanism of DBS is still unclear. Although it has proven effective for some patients, it is a high-risk procedure with the possibility of severe complications and side effects.
A deep brain stimulation system consists of three parts: an implantable pulse generator (IPG), the lead, and the extension. All three parts are surgically implanted inside the body.
Its effect physiology of brain cells and neurotransmitters is currently the topic of much debate. However, sending high-frequency electrical impulses into specific areas of the brain can mitigate symptoms and decrease the side effects caused by Parkinson’s drugs, making it possible to reduce medications or adopt a more tolerable treatment regimen.
The areas stimulated by DBS vary according to the disorder being treated. Each patient must therefore be evaluated individually to determine which areas must be stimulated based on their needs.
DBS surgery is hugely complex and high-risk, with complications linked to the surgical team’s experience. The principal complications include hemorrhage (1-2%) and infection (3-5%).
Rehabilitation in Parkinson’s
A healthy lifestyle and an appropriate amount of exercise make for better management of Parkinson’s disease symptoms.
Clinical studies have proved that exercise, combined with specific rehabilitation treatments, can improve Parkinson’s symptoms by slowing physical decline.
The progressive loss of motor capacity may lead to some consequences:
– Reduced physical activity leads to a progressive loss of muscle tone and decline in overall condition.
– Reduction in the sense of balance and problems of Parkinson’s freezing and festination can cause falls.
– The progressive loss of independence can result in a loss of self-esteem and lead to depression.
Therefore, keeping a good muscle tone and movement capabilities is the key to contrasting the physical decline.
So, for individuals with Parkinson’s, physical rehabilitation is crucial to maintaining good physical condition, and it is essential to do it consistently over time to maintain its benefits.
For this purpose, Gondola AMPS therapy can also be helpful as it improves motor abilities and, thus, allows easier rehabilitation.
Treating for parkinsonisms
Parkinson’s treatments, such as dopaminergic drug therapy (the first-line treatment for Parkinson’s), may be effective for certain aspects of parkinsonism.
Also, regular exercise and rehabilitation are crucial for maintaining muscle tone, strength, and flexibility.
Do the parkinsonism response to Parkinson’s drugs?
The patient’s response to drug treatment is crucial for identifying a specific type of parkinsonism.
If symptoms are unusual and there is no response to Parkinson’s drugs, this does not automatically mean that the patient has another form of parkinsonism; however, the neurologist will probably want to revise their diagnosis.
In such cases, the doctor may use terms such as “atypical parkinsonism” or “Parkinson’s Plus.” This is not a diagnosis; however, it likely indicates a more complex situation than typical Parkinson’s.