Diseases

Parkinson's - symptoms, causes, therapy


What is Parkinson's disease?

Parkinson's disease is a nervous system disorder. Nerve cells in a certain brain region in the midbrain (substantia nigra) die unusually quickly. As a result, this region produces less dopamine, a messenger that is needed to control muscles. Due to the lack of dopamine, increasing mobility and movement disorders such as tremors, slowed movements, muscle stiffness, deteriorated balance and gait insecurity occur. There is also an increased risk of mental illnesses such as depression, dementia or apathy among those affected. So far, the disease is considered incurable, but can be slowed down by medication, physiotherapy and deep brain stimulation.

Parkinson's - a brief overview

Here is an overview of the most important brief information about Parkinson's disease:

  • Synonyms: Idiopathic Parkinson's syndrome (IPS), Parkinson's disease, Parkinsonism, shaking palsy, paralysis agitans, Parkinson's disease, tremor, paralysis.
  • causes: Nerve cells that die too quickly in the midbrain region substantia nigra result in reduced dopamine production, which means that the brain is increasingly unable to coordinate movement sequences.
  • Early warning sign: Frequent tiredness and exhaustion, increased trembling, increasing forgetfulness, emotional irritability, sore muscles like pain in the arms, legs or neck, sluggish movements.
  • Symptoms: Tremors, muscle stiffening, gait insecurity, slowed movements, poor balance, postural instability, sleep disorders, reduced mental performance, speech disorders, skin problems, swallowing disorders.
  • therapy: Medications such as levodopa or dopamine agonists, physiotherapy, speech therapy, psychotherapeutic measures, deep brain stimulation.

Distribution

According to the German Society for Neurology (DGN), up to 400,000 patients in Germany are affected by one form of Parkinson's disease. The average age at diagnosis is 60 years. The risk of illness increases with increasing age. Around one percent of 60-year-olds are affected by Parkinson's. It is already three percent among the 80-year-olds. There is also a rare hereditary form of Parkinson's, which shows symptoms from the age of 40.

Causes

According to current knowledge, the lack of dopamine production causes the typical Parkinson's symptoms. Dopamine is a messenger substance that is released by the substantia nigra region of the brain. This region of the brain contains around 400,000 cells at birth. In healthy people, around 2,400 of these die off each year. In Parkinson's patients, however, this natural process runs faster for reasons that have not yet been clarified. If more than 60 percent of these nerve cells have died, symptoms of Parkinson's syndrome can occur.

The role of dopamine

As already mentioned, the dopamine is released by the substantia nigra region of the brain. As a result of the increased cell death in this region, less dopamine is available to the brain. The messenger substance dopamine is required so that nerve cells in the brain can transmit signals, for example to coordinate the fine-tuning of muscle movements. Compared to healthy people, Parkinson's sufferers who are already showing symptoms have a 70-80 percent reduction in brain dopamine levels.

The secondary Parkinson's syndrome

Secondary or symptomatic Parkinson's syndrome has the same symptoms as Idiopathic Parkinson's Syndrome (IPS), but the cause is different. The premature breakdown of the nerve cells is not responsible here. Rather, a number of illnesses, injuries or medications can be considered as the cause, which require a different therapy. These include, for example:

  • Hardening of the arteries, which has caused constipation beneath the cortex,
  • Drugs such as chlorpromazine, haloperidol, lithium, metoclopramide or flunarizine,
  • Brain tumors,
  • Brain injuries after serious accidents,
  • Stroke,
  • Inflammation of the brain,
  • Metabolic diseases that damage the brain (such as Wilson's disease or Gaucher's disease).

Is Parkinson's syndrome inheritable?

There are different forms of the disease. According to current knowledge, most are not likely to be inherited. In some families, however, Parkinson's disease was often found above average. It is a rare form of the disease, which is characterized by a very early onset of illness from the age of 40. This form is believed to have an important role in genetic factors.

Early warning sign

Signs of the disease creep in very slowly. To make matters worse, early symptoms of Parkinson's are often confused with normal age-related restrictions. Frequent tremors can be a first indication, but not every tremor is a cause for concern. According to the German Society for Neurology (DGN), it is only of concern if additional symptoms are added to the movement restrictions. These include:

  • Affected people sit a lot and have problems getting up,
  • decreased smell perception,
  • Sleep disorders and vivid dreams,
  • Discomfort when urinating,
  • Constipation,
  • Depression,
  • speaking softly,
  • Swallowing problems,
  • Handwriting looks tense,
  • Affected people neglect their hobbies and withdraw,
  • Arms and legs react more slowly and awkwardly,
  • Neck tension,
  • general fatigue,
  • inner unrest.

Early treatment is important

Parkinson's is a previously incurable disease. It is important to start treatment early in order to delay the progression as long as possible. Therefore, a suspicion should be clarified with a doctor at an early stage.

Symptoms

As the disease progresses, further symptoms add to the first signs already described. For example, excessive sweating and skin problems such as oily or oily facial skin and dandruff can occur. In particular, Parkinson's disease is characterized by four symptoms that initially manifest themselves on one half of the body and then spread to the entire body. These complaints include:

  • Sedentary lifestyle (akinesia),
  • Muscle stiffness (rigor),
  • Tremors (tremors),
  • Postural instability.

Slow and awkward movements (akinesis)

Slow movements can be signs of Parkinson's. Those affected find it difficult to control their movements. Arms and legs react slowly and clumsily to a movement impulse. This symptom is called akinesia in medicine. It can also be an enormous psychological burden for Parkinson's patients, since everyday things like dressing, brushing teeth, washing and cooking can sometimes take a long time and many sufferers feel they can no longer keep up. This is also reflected in the gait, which is becoming increasingly small-scale and less secure.

Stiffening of the muscles (rigor)

Since the fine control of the muscles is disturbed due to the lack of dopamine, muscle stiffness occurs in Parkinson's patients. The tension and relaxation of the muscles can no longer be properly controlled. During movements, the respective counter muscle is also contracted, which creates a counterforce to the desired movement. Those affected must also overcome this force. The whole process is felt to be stiff. This symptom is medically called rigor.

Tremor on hands, feet or jaw (tremor)

Parkinson's is also commonly known as tremor. Those affected mostly suffer from a steady rhythmic tremor when at rest, which in most cases is first expressed by trembling hands. However, it can also appear in the feet or jaw. The tremor is so pronounced that the patient is unable to suppress it, even if they focus on it. But there are also forms of Parkinson's syndrome in which there is little or no tremor.

Postural disorders (postural instability)

Illness-related movement disorders also include increasing postural instability. This is shown by reduced reflexes, for example when intercepting unpredictable movements. There is also an insecure gait, a lack of balance and coordination difficulties. When walking, those affected often adopt a disease-typical posture with a curved back and slightly bent knees. As the disease progresses, walking becomes increasingly difficult until the patient is finally dependent on a wheelchair.

Influence on the psyche

The psyche of many sufferers is heavily burdened. This is why symptoms of mental disorders often occur in the course of the disease. Up to 40 percent of those affected suffer from depressive moods. In addition, the medication used can lead to the development of psychoses. Other possible psychological symptoms are:

  • Listlessness (apathy),
  • decreased determination,
  • Changes of character,
  • mental degradation to dementia,
  • Restlessness,
  • increased irritability.

Diagnosis

Parkinson's syndrome is often suspected when the patient is asked about his medical history (medical history). The so-called levodopa test (L-dopa test) is often used if it is suspected. The patient is given a medication that ensures a higher concentration of dopamine in the body. If this leads to a reduction in symptoms, this is an indication of the presence of Parkinson's disease.

However, it must be clarified whether it is a "real" idiopathic Parkinson's syndrome (IPS) or a secondary (symptomatic) Parkinson's syndrome, since the therapies differ fundamentally. An imaging procedure such as magnetic resonance imaging (MRI) or computer tomography (CT) can provide the necessary evidence.

Hoehn-Yahr scale

To determine the severity, doctors often use the so-called modified Hoehn-Yahr scale, which was named after the American Parkinson's experts Melvin Yahr and Margaret Hoehn. The disease is divided into the following stages:

  • Stage 0: No symptoms of illness.
  • Stage 1: symptoms appear on one side of the body.
  • Stage 1.5: Unilateral symptoms with involvement of the body axis.
  • Stage 2: mild symptoms on both sides of the body without disturbance of balance.
  • Stage 2.5: Slight symptoms on both sides of the body with compensation in the tensile test (in the tensile test, the doctor checks the patient's stability)
  • Stage 3: mild to moderate symptoms on both sides of the body and slight postural instability.
  • Stage 4: Severe disabilities when running and standing, independent walking is still possible.
  • Stage 5: Without outside help, the patient is dependent on a wheelchair.

Therapy

If it is an idiopathic Parkinson's syndrome, a complete cure is not possible according to current knowledge. The aim of the treatment is to slow the progression of the disease as much as possible in order to ensure the independence of the patient in all areas of life for as long as possible. The focus of the therapy is therefore on improving the quality of life of the patient and family, reducing or delaying the need for long-term care and avoiding possible comorbidities and mental disorders. The following measures are central components of the therapy:

  • Drugs such as levodopa or dopamine agonists,
  • Physical therapy,
  • Speech therapy,
  • Psychotherapy,
  • Deep brain stimulation.

Levodopa and Carbidopa

The right medication plays an important role in Parkinson's therapy. When choosing, there is often a stalemate in Parkinson's drug comparison. Levodopa (L-Dopa), which is currently one of the most effective drugs in this area, should be mentioned first. The active ingredient is absorbed into the nerve cells and helps there in the production of dopamine. L-dopa is commonly used with carbidopa, which prevents the active ingredient from converting to dopamine before it arrives in the brain. This can reduce the dose taken and possible side effects such as nausea and vomiting.

Side effects of L-Dopa

Levodopa is very effective, but it can also cause dyskinesia. These are uncontrollable sudden muscle twitches and jerky movements. If this occurs, the side effect often worsens as you continue to take it. For this reason, levodopa is often used later in the course of the disease. As a first measure, the so-called dopamine agonists are usually used.

Dopamine agonists

The dopamine agonist is an active ingredient that is chemically very similar to dopamine. The active substances take on the same tasks as the messenger substance dopamine, but have a weaker effect than levodopa. Since there are numerous versions of this type of medication with different side effects, patients have the option of choosing a remedy that is least harmful to them.

COMT and MAO-B inhibitors

While the above medications ensure that more dopamine is available, the COMT inhibitors and MAO-B inhibitors delay the breakdown of dopamine, which can further increase the effectiveness of the medication as the dopamine works longer in the brain.

Other drugs

There are also so-called NMDA antagonists and anticholinergics that influence messenger substances that are increasingly active in Parkinson's. However, due to severe side effects, these are used less frequently and require regular medical checks.

Physiotherapy and exercise therapy

Exercise therapy is an important component in the treatment of Parkinson's. On the one hand, physiotherapy should improve the mobility, stability and responsiveness of those affected and prevent muscle and joint stiffness. On the other hand, Parkinson's sports groups also have a positive impact on the psyche and counteract loneliness or social withdrawal, for example.

Speech therapy (speech therapy)

Speech therapy can also help to maintain patients' quality of life. Targeted and regular language exercises help alleviate speech-related speech disorders. The training primarily focuses on breathing techniques, clear pronunciation and the volume of the voice, which gradually diminishes as a result of the disease. This therapy also counteracts possible psychological disorders that result from social isolation. The therapy can also counteract the swallowing disorders that occur in many sufferers.

Psychotherapy

If affected persons show signs of a mental illness such as depression, anxiety or psychosis, they must be treated as an independent illness and require additional medication and / or appropriate psychotherapy.

Deep brain stimulation (brain pacemaker)

Parkinson's patients benefit from a brain pacemaker. In this method, electrodes are used in the brain during an operation, which stimulate certain areas in the deep brain nucleus with electrical impulses. Studies have shown that deep brain stimulation is usually accompanied by a lasting improvement in symptoms. This can also drastically reduce the side effects of the medication.

However, such an operation is not suitable for every patient. It must be ensured that it is an idiopathic Parkinson's syndrome and, contrary to previous assumptions, it makes sense if the patient is still as young as possible and there are no severe restrictions.

History

The disease owes its name to the English doctor, pharmacist and paleontologist James Parkinon (1755-1824). He published in 1817 An essay on the shaking palsy (A treatise on shaking paralysis)in which he described the disease. Parkinson was also active in politics, advocating for the rights of the underprivileged and advocating the French Revolution. (tf, vb)

Further information and the current state of research

  • What are the causes of Parkinson's memory gaps? Researchers discovered mechanism that leads to memory deficits in Parkinson's.
  • Parkinson's partially an autoimmune disease? Autoimmune response plays an important role in Parkinson's disease.
  • Does Parkinson's disease develop in the stomach? New explanations for the development of Parkinson's.
  • Excess calcium leads to the formation of toxic clusters. Is excess calcium a trigger for Parkinson's?
  • Does vitamin B12 protect against Parkinson's? Vitamin B12 can slow the development of Parkinson's.
  • Brain pacemakers can help Parkinson's patients. Brain pacemaker keeps impulsive behavior in check.
  • Diabetes medication can also help people with Parkinson's. Researchers found that a drug to treat diabetes can also help people with Parkinson's disease.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Graduate editor (FH) Volker Blasek, Barbara Schindewolf-Lensch

Swell:

  • Professional organizations of jointly listed professional associations and specialist societies for neurology, psychiatry and psychotherapy, psychosomatic medicine and child and adolescent psychiatry in Germany, Austria, Switzerland and Italy: What is Parkinson's syndrome? (Accessed: 15.07.2019), neurologen-und-psychiater-im-netz.org
  • German Parkinson's Society V .: Background information on Parkinson's disease (accessed: July 15, 2019), parkinson-gesellschaft.de
  • Medical center for quality in medicine: Idiopathic Parkinson's syndrome (accessed: July 15, 2019), patient-information.de
  • Institute for Quality and Efficiency in Health Care (IQWiG): Parkinson (accessed: July 15, 2019), gesundheitsinformation.de
  • Merck and Co., Inc .: Parkinson's Disease (PK) (accessed: 07/15/2019), msdmanuals.com
  • Hacke, Werner: Neurologie, Springer, 14th edition, 2016
  • German Society of Neurology (DGN): S3 Guideline Idiopathic Parkinson's Syndrome, as of January 2016, dgn.org
  • Mayo Clinic: Parkinson's disease (accessed: July 15, 2019), mayoclinic.org
  • Parkinson's Foundation: What Is Parkinson's? (Accessed: 15.07.2019), parkinson.org
  • National Institute on Aging: Parkinson's Disease (accessed: July 15, 2019), nia.nih.gov

ICD codes for this disease: G20-G22ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Pain and Fatigue in Parkinson Disease - 2019 Parkinson Educational Symposium (November 2021).