Parkinson’s Disease - What’s New?
Balance and Walking Problems
Statistics for Parkinson’s Disease
Parkinson’s disease is increasing in numbers, and about 60,000 people are affected in the USA, 145,000 in England and 10 million worldwide. It is the second most common neurodegenerative disease. There is no blood test or other tests for a diagnosis.
Medications are expensive, averaging $2,500 annually, and surgery may cost up to $10,000.
Men are 1.5 times more likely than women to get this disease. There is a genetic component for some people, with about 15% of patients having a relative with Parkinson’s disease. It is thought, while rare, there are some environmental components, such as herbicides or pesticides.
This disease is 50% less likely for blacks and Asians than whites, however, the risk is slightly higher in Hispanics. The risk also increases with age. While research is inconclusive, there is some evidence that head or neck trauma may be a factor. Scientists do not know exactly what causes this disease.
New Parknson’s Disease Treatment
Body and Brain Changes
This is a degenerative disorder that affects the central nervous system causing movement disorders. It is a chronic disorder that is progressive and persists over the years. Nerve cells (neurons) in the brain die or are impaired. The loss of neurons occurs in the base of the brain (substantia nigra).
This area should produce dopamine, which is a chemical messenger that transmits signals between the base area to the corpus striatum, to allow smooth and purposeful movement. The loss of dopamine causes a host of problems related to movement and chronic brain inflammation.
Researchers have found a small substance in Lewy bodies in the brain, which is believed to the cause of Parkinson’s disease, and research is ongoing.
Symptoms and Signs of Parkinson's Disease
The symptoms and signs of this disease may be different for different patients. Some people write off early symptoms to aging. Sometimes the symptoms may start on one side of the body, and that side will remain worse when both sides become involved.
The symptoms typically include:
- A tremor or shaking, which usually begins in one limb and may occur when resting.
- The muscles may become stiff in any part of the body, be painful or limit the range of motion.
- Movements may be slowed (bradykinesia) causing shorter steps, or it may be hard to rise from a chair. Simple tasks may be more difficult. Some even drag their feet when walking.
- Automatic movements may be lost, such as blinking, smiling or swinging your arms when walking.
- Balance and posture may become a problem.
- Speaking may be softer, or speech can be slurred, hesitant or speaking in a monotone is a possibility.
- Writing may become difficult or it may appear much smaller.
Possible Disease Complications
Parkinsons is frequently accompanied by many complications, some of which are treatable.
These complications include:
- Cognitive problems like dementia and thinking difficulties may occur in the late stages.
- Depression and emotional problems may occur in the early stages.
- Difficulty in swallowing and as swallowing is slowed, and saliva may accumulate in the mouth and cause drooling.
- Late stage disease affects the muscles of the mouth, therefore eating and chewing problems may occur. This can cause choking or poor nutrition.
- Sleep disorders, such as insomnia, waking up too early or daytime sleeping may occur.
- Bladder problems include difficulty in urinating or unable to control the urine.
- Constipation can be a problem due to the slower digestive tract.
Other possible problems include lower blood pressure upon standing, smell dysfunctions, fatigue, pain and sexual dysfunction.
Doctors may order an MRI, CT, ultrasound or PET scan of the brain to rule out other neurological diseases as they can only diagnose a patient by their symptoms, and Parkinson's disease is difficult to diagnose.
The most effective medication at this time is Carbidopa-levodopa as it is converted to dopamine in the body. It is typically very helpful, but after several years it is not as effective. The carbidopa is combined with levodopa to reduce nausea. Higher doses can also produce involuntary movements (dyskinesia). Duopa is a brand name for this medication, and it can also be given through a feeding tube that is surgically placed to deliver the medication in the small intestine for more advanced disease.
There are dopamine agonists that mimic the dopamine effects in the brain that are not as effective, but they last longer. These medications include Mirapex, Requip, Neupro (in patch form) and in injection named Apokyn.
Other medications include:
- MAO B inhibitors are sometimes used to help prevent the breakdown of dopamine in the brain.
- Catechol O-methyltransferase (COMT) inhibitors are prescribed to prolong the effect of levodopa therapy.
- Anticholinergics are prescribed to help control tremors.
- Amantadine is used for short-term relief for patients when in an early stage of the disease.
Surgery may be done for patients with advanced-stage Parkinson’s disease. An adjustable generator is implanted in the chest just below the collarbone, and the electrodes are connected to a specific area in the brain. Electrical pulses are sent to the brain to reduce symptoms.
There is an inhaled form of levodopa that will soon be on the market. It has a quicker onset. Researchers are currently studying two types of pumps that would give continuous dopaminergic stimulation. Apomorphine is used in a subcutaneous pump that has been available in Europe for several years. The second pump is a solubilized form of levodopa methyl ester salt used subcutaneously.
There is anecdotal evidence that marijuana helps reduce tremors. This has not been fully researched.
Mayo Clinic is working on an adaptive rhythmic auditory stimulus to improve walking and other new medications. Scientist at the University of Queensland has worked using MCC950, a small molecule, in several animal studies, which stopped the progression of Parkinson's. The human trials will begin in 2020.
Parkinson's Disease: Progress and Promise in Stem Cell Research
Michael J. Fox is probably the best-known celebrity with Parkinson’s Disease, and he was diagnosed at age 29. He has a foundation seeking cures and giving people information. This is a difficult disease for many people as it eventually gets worse, and treatments have not been very successful at this stage.
When I was working as an RN in Cardiac Rehabilitation I had a patient who was so nice, an older man who had suffered a heart attack and had Parkinson’s disease. He had fairly severe tremors in his hands, but he could still walk well. He told me his wife complained every morning because he made too much noise reading the paper, which he certainly could not control. I felt bad for him, and I am sure support from loved ones is always important when dealing with any difficult disease.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 Pamela Oglesby