2023-04-18 12:28:59
Status: 04/17/2023 5:26 p.m
Parkinson’s disease, formerly known as shaking palsy, is the second most common neurodegenerative disease in Germany after Alzheimer’s disease: symptoms, course, cause and therapy.
People with Parkinson’s increasingly suffer from a slowdown in movement, sedentary lifestyle, gait disorders, and later also trembling of the hands, legs and head or muscle stiffness. Numerous studies show that, in addition to medication, exercise and sport can delay the progression of Parkinson’s disease.
Symptoms and cause of Parkinson’s disease
The cause of Parkinson’s disease is a declining production of the messenger substance dopamine due to the death of the dopamine-producing cells in the so-called black substance (substantia nigra) in the midbrain. This messenger substance is important for signal transmission between the brain and muscles. If there is a lack of dopamine, the movements become smaller and smaller, resulting in tremors or stiffness in the muscles. Other typical symptoms are:
- frozen movements
- schlurfender Walk
- soft language
- a fixed, waxen expression.
Course of the disease: Parkinson’s begins insidiously
Parkinson’s disease often goes unnoticed for decades as more and more cells in the brain are broken down. When the typical tremor occurs, most of the corresponding nerve cells have already been destroyed. However, the motor symptoms are usually preceded by unclear symptoms for years. Later Parkinson’s sufferers suffer about twice as often from constipation and sleep disorders like the general population. A poor sense of smell and depression also often precede Parkinson’s disease – long before the typical motor symptoms.
Special sleep disorder as a precursor to Parkinson’s disease
The precursor to Parkinson’s disease is what is known as REM sleep behavior disorder. With this sleep disorder, those affected move in the dream, they can even hurt themselves or others. The cause is damage to the dream movement center in the brain. The symptoms of the insomnia can be relieved with medication. But 70 to 80 percent of people who thrash about in dreams develop Parkinson’s disease in the next 10 to 15 years.
Therapy: Drugs replace missing dopamine
Several groups of drugs are available for the treatment of Parkinson’s disease. They reinforce each other through their different mechanisms of action. The aim is to replace missing dopamine in the brain. Drugs are selected and dosed individually.
- The most effective remedy for Parkinson’s symptoms is Levodopa (L-Dopa). It crosses the blood-brain barrier and is converted into active dopamine in the brain. In order to achieve a sufficient concentration of the active substance in the brain, the patients must take L-Dopa in high doses. The active ingredient is combined with the enzyme inhibitor Benserazid combined to reduce the required dose. In this way, side effects such as nausea and circulatory problems can be reduced.
- Another important group of active ingredients are the so-called dopamine agonists. They are similar to dopamine but cause side effects such as dizziness. Once the correct individual dose has been found, the medication often achieves a stable improvement. In addition, so-called MAO inhibitor used that delay the natural breakdown of dopamine.
- Also the active ingredient Amantadin may improve Parkinson’s symptoms. The exact mode of action is not known.
Despite all the successes of drug therapy, it is not possible to cure or stop the disease. In addition, the effectiveness of the medication often decreases with the duration of the disease.
With a pump therapy Medication that is no longer effective as tablets can be administered via a so-called PEG tube that is passed through the abdominal wall. The electronically controlled pump ensures the correct dosage. Before the surgical installation of the tube, a nasal probe can be used to test whether the procedure is successful in individual cases.
Surgical therapy: brain pacemaker
The so-called deep brain stimulation is a procedure used to treat movement disorders, including Parkinson’s disease. Neurosurgeons insert thin stimulation electrodes (brain pacemakers) in certain areas of the brain. The electrical impulses are intended to relieve tremors in particular. In general, deep brain stimulation is only used when the drugs are not (or no longer) having a sufficient effect.
First, an MRI scan is performed under general anesthesia. During the operation, those affected must then be awake at times in order to be able to precisely test the improvement in symptoms during the stimulation. The electrodes are then connected to a control device, the brain pacemaker, which is implanted below the collarbone. A few days after the operation, the device is switched on and readjusted for the first time. Fine adjustment is possible at any time in order to achieve the best result.
New surgical procedure with ultrasound
A fairly new therapeutic method in the treatment of Parkinson’s disease is High Focus Ultrasound (HIFU). Ultrasound waves are bundled in the target tissue so strongly that they heat it up and destroy it in a targeted manner. This therapy also focuses on a small node deep in the brain.
Treatment creates tiny scars in the fiber tracts of the brain, in the so-called tremor network. That should reduce the shaking. Using a special helmet, more than a thousand ultrasonic waves are directed into the brain from many directions and focused precisely on the tremor network. During the treatment, those affected lie fully conscious in the MRI – this allows the doctors on the monitor to follow exactly which regions of the brain are heated and to what extent.
Tasks and exercises are then used to get the patient to tremble to the maximum. Several heating phases are necessary to set the scars in the brain. Each time, the temperature is increased by nuances, after which the effect of the treatment is checked, but also possible side effects such as speech disorders, weakness or deafness. It’s not about completely eliminating the tremors. The aim is to reduce the tremors as much as possible without risking worse side effects.
Even if the procedure does not require a scalpel, probes or drills, it is not without risk because the procedure cannot be reversed: once cells in the brain have been destroyed, they cannot come back.
Movement has a positive influence on the course of the disease
Numerous studies prove that sport is very effective: the course of the disease is often more favorable than with medication alone. The symptoms of Parkinson’s disease can already be seen in the early stages intensives Training improve and as the disease progresses, those affected can regain skills they have already lost through targeted training. Leisure activities such as painting, dancing and learning new forms of movement with sweeping movements such as Tai Chi also play a role.
Sports with flowing movements such as swimming, cycling and jogging are suitable for people with Parkinson’s disease. It is important that people suffering from Parkinson’s use every opportunity to exercise, because the brain quickly unlearns the newly acquired skills. Sport can also have a preventive effect: if you exercise regularly in middle age, you reduce your risk of developing Parkinson’s later by up to 40 percent.
BIG therapy for Parkinson’s sufferers
BIG movement therapy can be used in the first stages of Parkinson’s disease. The exercises with large flowing movements stimulate unused areas of the brain. Through intensive repetition and constant monitoring of success, those affected learn to consciously use movements again in everyday life. The therapy makes movements faster and more precise, and balance and body awareness are also promoted. The effects last for several weeks to months.
Progress in finding the cause
Parkinson’s disease is a fatal chain reaction in the body. It probably begins with an endogenous protein (α-synuclein). The protein misfolds in the cells and eventually leads to their destruction. Scientists assume that the disease does not even start in the head, but in the intestines and from there it spreads over many years to the brain. Why the process begins is one of the many unanswered questions. In addition, the variety of symptoms indicates that there may not be just one Parkinson’s disease, but many different forms.
It is already known that various disorders occur in the brain of Parkinson’s patients:
- too much toxic protein
- too much free iron
- inflammation.
Drugs are being tested against these three disorders in order to stop the progression of the disease. If this succeeds, it will be all the more important to detect Parkinson’s disease as early as possible, because once functions are lost, the drugs will not bring them back.
What role does the vagus nerve play?
Animal experiments showed that a misfolded protein molecule (alpha-synuclein) is deposited in the diseased brain cells in Parkinson’s disease. Such deposits also occur in the nervous system of the stomach and intestines, presumably due to environmental influences. From there, the deposits could “migrate” via the vagus nerve and its ramifications to the brain. The researchers were able to slow the progression of the disease in mice by cutting the vagus nerve.
Studies on people who had their vagus nerve severed because of a stomach ulcer confirm the hypothesis: the risk of Parkinson’s disease in this group is 22 to 41 percent lower than in the general population.
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