What Is Parkinson's Disease? Symptoms and Treatment Options

What is Parkinson's disease? 

Parkinson's disease is a slowly progressing neurological disorder caused by damage to brain nerve cells that leads to a decrease in dopamine levels. It manifests with symptoms such as tremors in the hands, muscle stiffness, and a lack of control, including loss of balance.

Parkinson's disease is among the progressive and degenerative diseases of the brain, typically seen in individuals aged 60 and over. Dopamine is one of the chemical substances that enables electrical communication between brain cells. The region of the brain that works with dopamine ensures that our movements are performed smoothly and purposefully; in other words, it fine-tunes our movements. Parkinson's disease occurs as a result of the loss of 60-80% of these cells. The symptoms of the disease, especially in the early stages, can vary among patients.

What are the symptoms of Parkinson's disease?

Slowness of movement, tremors in limbs while at rest, muscle rigidity, weakening of reflexes that maintain posture and balance, walking with small steps and sometimes unsteadiness, forward leaning of the body, joint pain, depression, sleep problems, inability to move fluidly and in a coordinated manner, and forgetfulness are among the symptoms of Parkinson's disease.

In general, Parkinson's symptoms can be listed as follows:

A decrease or loss of arm swinging movements while walking over time

Shortening of steps

Difficulty in starting to walk

Difficulty in buttoning or unbuttoning clothes

Difficulty turning in bed or getting up from a sitting position

Mask-like facial expression

Speaking with a low and quiet voice

Shrinking of handwriting

Forward leaning/stooping may occur.

In Parkinson's disease, symptoms and complaints other than movement, originating from the brain, are also observed. These include constipation, a drop in blood pressure, depression, sleep disorders, restless legs syndrome, and loss of the sense of smell. In the middle and advanced stages of the disease, gait disturbances, balance defects, and freezing of movement occur, which may be followed by falls. Rarely, dementia is also added to this clinical picture in some patients.

How is Parkinson's disease treated?

Medication is the primary choice in Parkinson's treatment. Surgical intervention may be considered for patients in whom medications do not show the desired effect or whose effects decrease over time. Drug therapy aims to increase the reduced dopaminergic transmission in the brain; that is, Parkinson's medications are aimed at raising dopamine levels. For this reason, drugs that increase the amount of dopamine in the brain are used in treatment. However, for reasons we do not yet fully understand, the long-term or high-dose use of Parkinson's medications can lead to fluctuations in patients, such as short-term excessive mobility, unresponsive periods (off periods), or involuntary movements (dyskinesia).

If the patient is under 65 and does not have dementia, treatment can also be started with 'dopamine agonists' that mimic the effect of dopamine, or they can be used in addition to treatment. If complaints such as tremors, dementia, depression, or sleep disorders are observed, other treatment strategies can be planned for these complaints.

One-third of patients are individuals who respond well to medication for many years and can live without significant limitations in their lives. In a portion of the remaining group, the response to medication is limited, and as the dose is increased, side effects and, over time, unresponsiveness to the medication may be seen.

For patients who do not benefit from drug therapy, surgical options can be evaluated. In the last 15-20 years, surgical intervention has been recommended more frequently for patients who do not respond to drug therapy. The goal of surgery is to recreate the electrical stimulation that has decreased in the movement centers of the brain with the help of a generator a few centimeters in size placed under the chest wall. This method works on a principle similar to a pacemaker. This application, medically known as "deep brain stimulation," is used in the treatment of Parkinson's patients.

Source: Memorial Group