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Parkinson's disease
About 1 in 500 people in the UK have Parkinson's, which means about 127,000 patients, and makes it one of the leading neurodegenerative diseases in the UK. Every day, dozens of people learn they have Parkinson’s disease, yet it is still a relatively poorly understood illness which affects mainly the elderly.
> Causes of the illness
Parkinson’s disease is a chronic degenerative neurological illness (progressive loss of neurons) that affects the central nervous system. Essentially, it causes problems with motor ability, and evolves progressively. The reason: it affects a structure, a couple of millimetres in size, located at the base of the brain and composed of dopaminergic neurons that progressively disappear. Their function is to produce and distribute dopamine, an indispensable neurotransmitter that controls the body’s movements, especially automatic movements.
The causes of the illness are still relatively unknown. It may be the consequence of the interaction of genetic predisposition - especially in subjects under 50 - and environmental co-factors. For years, environmental toxins, heavy metals and pesticides, methanol (E951) and E621 are notably seen as suspected causes.
> Symptoms
Parkinson’s disease starts between 5 and 10 years before the appearance of the first clinical symptoms, once about half of the dopaminergic neurons have disappeared.
While physical and psychological symptoms linked to Parkinson’s vary depending on the patient, we generally find the following:
• Patients shake while at rest: this symptom affects about two thirds of patients
• Stiff muscles - hypertonia
• Slowed movements
• Signs of Depression
About 50% of patients also show signs of depression as a first sign of the disease. This factor often delays the diagnosis of the disease. Indeed, the cells that produce dopamine and that are destroyed by the disease also control mood.
> Treatments
Today, there is no treatment that can fully cure a patient. The current goal is to improve on the problems caused by the disease, and delay the evolution of the symptoms.
Medication also brings undesirable side effects, and doctors often times prefer to avoid administering treatments at the start of the disease.
By delaying the start of treatment – within reasonable limits nonetheless – doctors can increase the efficiency of medical treatments once started and delay the onset of motor tool complications.
The treatment includes:
- Medication: anti-Parkinson’s medication (L-Dopa, dopamine agonists, and other medications) and medications for problems associated with Parkinson’s disease.
- Non-medication: life hygiene, functional retraining, functional surgery, psychotherapy.
What is neuro-stimulation?Show
It is a surgical treatment, but cannot be offered to all those with the disease. Over the past 15 years, repeated electrical stimulation applied to the two subthalamus glands allows for a marked improvement in alkinesia, rigidity, and shakes.
Thousands of patients in the UK have received this treatment. This stimulation won’t cure Parkison’s disease, but it will improve the symptoms and save on medication.
The method also comes with risks, notably that of bleeding during the operation, or side effects after implantation, such as transitory mental confusion, apathy or speech problems that can prove to be long-term.
What about the patient’s entourage?Show
Individuals suffering from Parkinson’s, beyond dealing with motor tool difficulties caused by the disease, also have to deal with misunderstanding amongst their close ones. They have to suffer the image brought on by the disease, associated with aging and with handicap. Associations, such as Parkinson's UK, are trying to change the image associated with the disease, but also to assist those affected by it, to deal with their day-to-day life and offer council.
What is a Hoehn & Yahr Scale?Show
It is a scale, made up of 5 stages, that allows medical personnel to evaluate the degree of incapacity and severity of the symptoms shown by patient with Parkinson’s disease.
• Stage One – symptoms present in one part of the body
• Stage Two – symptoms present in two parts of the body but no balance problems
• Stage Three – balance problems, autonomous patient with weak to moderate signs
• Stage Four – severe incapacity but can walk and stand without assistance
• Stage Five – incapacity requiring assistance to move
Substantia NigraShow
Control centre for movements and core of the nervous system, its name stemming from the colour of the cells found within. It is composed of dopaminergic neurons (generating dopamine). It is the destruction of these neurons that provokes the symptoms of Parkinson’s disease.
Muscular hypertoniaShow
Permanent and exaggerated increase in a muscle's tone at rest, often times not felt by the patient.
LevodopaShow
Substance used in the treatment of Parkinson’s disease, used to increase the level of dopamine in the brain.
DopamineShow
Neurotransmitter and neuro-hormone, it helps regulates the central nervous system. It controls motor ability. A lack of dopamine is a typical characteristic of Parkinson’s disease.
“On” and “Off” periodsShow
Expression that describes periods where Parkinson's treatments are having an effect ("On" period) and those where the patient shows movement problems, usually between two drug treatments ("Off" period). The appearance of "On" and "Off" periods is characteristic of an advanced stage of the disease or when the treatments are less effective.
Deep Brain StimulationShow
Neurosurgical operation that implants an electric stimulator (like a pacemaker) plugged directly into the brain. The electric stimulator acts to inhibit areas of the brain that provoke the symptoms of Parkinson’s disease. An operation mainly offered when drug treatments don’t work.
BradykinesiaShow
Motor tool problem resulting in muscle rigidity and slows down movements. Bradykenesia particularly shows itself through the loss of fine movements.
Dystonia Show
Symptom that translates into involuntary long-term muscle contractions.
Parkinson’s DiseaseShow
Chronic neurological affliction that affects the central nervous system and brings on motor ability problems. The symptoms of the disease caused by the loss of neurons in the Substantia Nigra, as well as a deficit in dopamine. Dopamine notably regulates motor ability.
AkinesiaShow
Difficult or slow initiation of movement, tending towards immobility, but absence of paralysis. General reduction in all forms of motor ability.
DyskinesiaShow
Disruption of motor skills translating into involuntary movements, lack of coordination or spasms.
United Parkinson’s Disease Rating Scale (UPDRS)Show
Scale that can be used to numerically evaluate the different symptoms of Parkinson’s disease. Usable in all stages of the disease, it can help validate the efficiency of a treatment by establishing pre- and post-treatment scores.
