Parkinson’s the second most familiar neurodegenerative disorder as well.

       Parkinson’s disease is a disorder of the central nervous system that affects a person’s ability to live an abnormal life. While Parkinson’s disease is categorized as the most common movement disorder, it is the second most familiar neurodegenerative disorder as well. It is regarded by advanced loss of muscle control. While at rest, patients can experience trembling of the limbs and head due to loss of muscle control. Stiffness, slowness, and impaired balance can also be symptons of Parkisons Disease. If the symptoms worsen, basic life tasks such as walk and talk, can become a challenge.

     Parkison Disease has been first reported at 5000 BC! At that time, it was called “Kampavata” in Indian Civilization. People who were diagnosed with “Kampavata” were treated with a plants that contain seeds containing therapeutic levels. That plant contained seeds is one of the major medications these days that treat Parkinson Disease called Levodopa! The Disease is named after an English surgeon, James Parkinson, famously described the disease as “shaking palsy” in 1817.

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     Parkinson Disease mostly targets individuals that are 60 years and older. Although, it is more common for adults to be diagnosed with Parkinson’s disease is most common, reports of patients as early as 21 have been recorded! Every patient diagnosed with Parkinson disease may experience it differently. Some patients can live long productive lives, while others become disabled much more rapidly and cannot undertake basic daily tasks.

    How does Parkinson Disease happen and how does it affect physical activity? Dopamine is a neurotransmitter that performs as a messenger between 2 brain areas called substantia nigra and the corpus striatum. It purpose is to produce smooth, controlled movements. Most of the movement-related signs of Parkinson’s disease are caused by a lack of dopamine. Due to the loss of dopamine-producing cells in the substantia nigra, one of the two brain areas that it acts on. When the dopamine level is to low, communication between the substantia nigra and corpus striatum becomes unproductive, and movement becomes weakened. In short, the greater the loss of dopamine, the worse the movement-related symptoms will be experienced by the patient. However, interesting to note that other cells in the brain can also contribute to non-movement related symptoms of Parkinson disease if they wish to degenerate to some.

  Lack of dopamine causes the motor symptoms of Parkinson’s diseases. However, it is not clear why the dopamine-producing brain cells decline and weaken. There’s has been much research followed by extraordinary explanations to this cause. Scientists believe that theres a connection between both- genetic (hereditary) and environmental (ecological) that influences the contribution to dopamine loss. Also, genetic and pathological studies have discovered that inflammation, and stress can contribute to cell damage as well. Also, “Lewy Bodies” also known as irregular clumps (contain protein alpha-synuclein). Patients that have Parkinson disease are found to have irregular clumps in many of their brain cells. To this day, Doctors and researchers cannot find the relation between Parkinson’s disease and the clumps found in the brain cells

     Who is at risk for Parkinson’s disease? Age is the major threat aspect that can influence the development and evolution of Parkinson’s disease is age! Most people who develop Parkinson’s disease are older than 60 years years of age.  Men are affected up to 2 times more often than women! Head trauma, illness, or exposure to environmental toxins such as pesticides and herbicides may be a risk factor. It is very uncommon that family history contributes and increases the risk of getting the disease.

     How is Parkinson’s disease diagnosed? Of course as any other diagnostic, it’s imperative for the goodwill of the patients and treatment that an early and accurate diagnosis be conducted and treated indoor to wish and maintain a high quality of life for as long as possible. However, there is no specific test to diagnose Parkinson’s disease. A diagnosis of Parkinson’s disease can be very challenging from the onset of the diagnostic. This can be because of the many related movement disorders that are similar with PD. Especially in the early phases and other conditions with Parkinson-like symptoms. Therefore, unfortunately, patients can be very highly misdiagnosed as having another disorder while they have Parkinson. While it goes the other way, when individuals don’t have this disease but will be told they do! It is therefore vital for doctors and diagnostic, during the early phases, to re-evaluate individuals on a regular basis. By doing this they can more easily rule out any other conditions that may and can be responsible for the symptoms.

      While there may be many doctors to do a diagnostic test, a neurologist can be a patients very best bet. This can be because they are the most accurate diagnosis in this field because they specialize in movement disorders and can make the most educated decision. The initial assessment in general should include (aside from the symptoms present) the basic medical history which includes the family history of having this disease. Additionally, a neurological exam, and the symptoms present should be included in the exam. The doctor should be notified of what medication have been or were taken prior and whether patient was exposed to toxins or repeated head trauma in the past. A neurological exam (may) include an evaluation of coordination, such as walking, and motor tasks involving the hands.

   The Hoehn, Yahr scale and the Unified Parkinson’s Disease Rating Scale are some several guidelines that may contribute in the diagnosis of Parkinson’s disease. Tests are used to measure mental capacity, behavior, mood, daily living activities, and motor function. They are very helpful in the initial diagnosis in order to rule out other disorders. They can as well monitor the progression of the disease to make therapeutic alterations.

The diagnosis of Parkinson Disease is determined by at least two of the three major symptoms that are present (tremor at rest, muscle rigidity, and slowness); the onset of symptoms started on one side of the body; symptoms are not due to secondary causes such as medication or strokes in the area controlling movement; and symptoms are significantly improved with levodopa, a medication taken by Parkinson Disease patients (as will be mentioned later on).

          What is the treatment for Parkinson’s disease? There is currently no full treatment to cure Parkinson’s disease. However, there are treatment that can treat patients with the disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain. There are several ways including mimicking dopamine, replacing dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.

          The severity of Parkinson’s disease symptoms can greatly vary from patient to patient. It is also not possible to predict how quickly the disorder will advance in the near future with the treatments. Interestingly, Parkinson disease isn’t classified as a deadly and lethal disease and average life expectancy can be the same with patients without it! However, secondary complications can cause major complications and even death. They can include pneumonia, falling-related injuries, and even choking.

        Parkinson’s disease is a progressive neurodegenerative disorder (loss of neurons including death of neurons in a structure). It is characterized by the loss of neuronal dopamine production in the brain, causing motor and non-motor symptoms. While most of the time, various drugs are used to treat the disease, deep brain stimulation has becoming more common and effective at treating it. Which method is true to treat, not cure, Parkinson Disease?

         Although there isn’t any cure for Parkinson Disease, there are two ways to treat it. The two methods are by taking medications and deep brain stimulation. It is widely accepted for patients to start taking medication first (there are several different options of meds and a doctor will advise each patient’s respectively to his health concerns). The latter patients will undergo a DBS- Deep Brain Stimulation. There is no medication to reverse the disease, but only mange the symptoms. As always for every patient, there is a different approach.

A patient with Parkinson Disease needs more dopamine, however we can’t give the patient dopamine because it will never pass the blood brain barrier (BBB). Dopamine promoter including- antidepressant and levodopa act as a carrier and then convert into dopamine once inside the brain. For over 3 decades, Levodopa has been the front line medication that has been widely used to battle Parkinson disease. L-DOPA is converted into dopamine in the dopaminergic neurons by dopa decarboxylase. Since motor symptoms are produced by a lack of dopamine in the substantia nigra, the administration of L-DOPA temporarily diminishes the motor symptoms. Only 5% to 10% of L-DOPA will cross the BBB, the blood brain barrier. The rest of the dopamine that hasn’t been successful in crossing the BBB will metabolize to dopamine elsewhere. (This can case a variety of side effects for this medication). In the brain, they will remove moving symptoms. While there are many drugs that can treat Parkinson’s disease patients, many can include side effects such as  Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, Chest pain, trouble breathing, fast or uneven heartbeat.  (Drugs are generally used at the initial state of Parkinson Disease and only after that doctors and researchers will come to use DBS for the late stages of the disease). The most common to date is the drug, Levodopa. Levodopa medication can lose it effectiveness over time and unfortunately lead to unhelpful side effects. These side effects can include a shortened response to each dose, painful cramps, and involuntary movements. What insures that Levodopa doesn’t break before it reaches the brain? Therefore, Levodopa is taken together with carbidopa (Sinemet). Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects

        In the 1970’s, Deep brain stimulation (DBS) was first used for the treatment of chronic pain- persistent pain in the back, joint, etc. Mixed results and poor electrode design caused a cessation of significant activity in this field in the 1980s, but over the ensuing 25 years, DBS has become a safe and effective treatment for advanced movement disorders, including PD when symptoms are no longer managed adequately with medications. DBS is currently approved by the US Food and Drug Administration for PD and essential tremor, as well as a humanitarian device exception for dystonia and obsessive-compulsive disorder. DBS is used for patients with PD of at least 4 years’ duration and 4 months of motor complications, and can improve tremor, rigidity, slowness of movement, and drug-induced dyskinesias.

        How does this work? Electrodes, a conductor through which electricity enters or leaves an object, are surgically inserted into specific areas of the brain. An impulse generator battery—similar to what is used in pacemakers—is also implanted, under the collarbone or in the abdomen. The battery creates electrical impulses that the electrodes deliver to the brain tissue.

        DBS is considered a form of stereotactic surgery and has become a preferred choice of surgical procedure for Parkinson disease (PD). This can be for various reasons including- it does not involve destruction of brain tissue; it is reversible and can be adjusted as the disease progresses or adverse events occur. (Bilateral DBS can be performed without a significant increase in adverse events).

Surgery may be an option for patients that have advanced, uncontrollable motor symptoms. There’s two different type of surgery involving Deep Brain Stimulation: One where the surgeon implants electrodes to stimulate areas of the brain involved in movement. In alternative form of surgery, the detailed areas in the brain that are the cause of Parkinson’s symptoms are destroyed.

        Deep brain stimulation (DBS) has showed through research that it could extend the life of people with Parkinson’s disease. Researchers at the Edward Hines, Jr. VA Hospital in Illinois found that patients who received deep brain stimulation for treatment with Parkinson disease had a more survival advantage compared with those that were treated medication only.

       Can deep brain stimulation really be the answer for prolonged years ahead? Scientists conducted a research with 611 veterans that were diseased with Parkinson and implanted a device with the method of deep brain stimulation. They also conducted a test with the same group but without the device. They found that the patients with deep brain stimulation survived an average of 6.3 years after the surgery, versus 5.7 years for the non-DBS patients after the date they might have gotten surgery based on their match to a surgery patient—a difference of eight months.

      The average age of Veterans in the study was 69 (reflecting the higher “popularity” of Parkinson’s amongst elderly people). The older age of the study group could have led to more deaths from age-related conditions, but the researchers point out that a majority of the causes of death for those who died during the study period were related to Parkinson’s disease.

       While DBS can help by adding years to Parkinson disease patients, scientists also discovered that the quality of live can also be improved with this method since DBS can help control symptoms such as tremors and rigidity.

       Frances Weaver, PhD, director of the Center for Management of Complex Chronic Care at the Hines VA Hospital, in Hines, Ill conducted another study by randomly assigning 225 Parkinson patient’s to deep brain stimulation including physical therapy, medication, and other appropriate treatment. A quarter of the patients were older than 70.

        Six months after treatment, the deep brain stimulation patients “reported about 4.6 more hours a day of “on” time, meaning time without movement problems; those in the control group showed no “on” time improvement. In all, 71% of the deep brain stimulation patients had improvements in their motor function, compared to 32% of the medical therapy patients”.

Medtronic, the company that makes the stimulation devices, not only partially funded Dr. Weaver research, but also funded Dr. Charles research. Dr. Charles conducted a clinical trial of deep brain stimulation in patients with a very early Parkinson’s disease. His results too were very similar of Dr. Weaver.

          According to the American Association of Neurological Surgeons, more than 35,000 patients have successfully used deep brain stimulation procedures around the world! DBS is still actively being tested to either replace or work together in conjunction with various medications and have great long term life benefits. Depression and other conditions as well are some of the procedure that are being tested together with DBS. Therapy cannot cure but can defiantly help with Parkinson’s disease.

          In earlier stages of Parkinson’s disease, both dopamine agonists ( substances that mimic the action of dopamine) & and monoamine oxidase type B (MAO-B) inhibitors (substances that reduce the breakdown of dopamine) can be very effective in relieving motor symptoms. Patients can experience inopportune side effects including but not limited, to swelling. The swelling is caused by fluid accumulation in body tissues. Drowsiness, constipation, dizziness, hallucinations, and nausea are also other side effects that patients can expiernce.

         The use of dopamine-producing cells derived from stem cells is another study that can be an alternative approach. However, more research is required although stem cell therapy has great potential. Such cells can become of therapeutic value in the treatment of Parkinson’s disease.

            Coping with Parkinson Disease isn’t any easy for any patient. Although Parkinson’s disease progresses slowly, it will eventually affect every aspect of life. From social engagements to work and even performing the simplest daily tasks! This poses a real challenge and loss for those that are diagnostic with it. Patients need to be well informed about the disease and expectantly reduce anxiety about what lies ahead. Support groups are available to offer valuable and informative tips on how to cope with this disorder to Patients and their loved ones. Providing emotional support as well as advice on where to find experienced doctors, therapists, and related information are also included. It is also very important to stay in close contact with health care professionals to monitor the progression of the disease and to adjust therapies to maintain the highest quality of living.

          Can Parkinson Disease be prevented? Scientists currently believe that Parkinson’s disease is triggered through a complex combination of genetic susceptibility and exposure to environmental factors such as toxins, illness, and trauma. Since the exact causes are not known, Parkinson’s disease is at present not preventable.

           There are many treatment options that can reduce some of the symptoms and can prolong the quality of life of an individual with Parkinson’s disease. In addition to medication and surgery, general lifestyle changes (rest and exercise), physical therapy, occupational therapy, and speech therapy can also be very beneficial. I strongly believe, in conclusion, DBS is a more effective way of treating Parkinson Disease. Primarily, because it takes away the drugs and reduces the side effects. It’s keen to the point at doing what it’s supposed and thus easing the life of the patient. Drugs, however, come in different forms and different side effects and it can be challenging if and what the patient is taking is helping him/her. It can result in damaging and causing new problems in the future. DBS may be a latter option for some, but I’m certain that it will overtake the medications and be the official, primary treatment for Parkinson’s disease in the near future.


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