Parkinson's disease affects that part of the brain that manages how to move the body. In the beginning, the patient does not realize the brunt of the disease; however, it slowly afflicts the entire body. Generally, this disease is seen in people aged about 60 or more.
Although there is no permanent cure to this disease, but, some treatments are available to make the patient comfortable.
At first, Parkinson's disease starts on one side of the body and its symptoms seem to be mild. Voluntary and involuntary functions of limbs of the body of the patient happen are disturbed. In fact, individuals with Parkinson's disease would have lost 60% to 80% or more of the dopamine-producing cells in the brain by the time primary symptoms of Parkinson’s are seen in them. Some characteristic motor symptoms of the disease are:
- Trembling: Trembling is felt in major parts of the body like, fingers, hands, legs, jaw, or head. Generally, tremor occurs when an individual is taking rest, not while engaged in a task. When a victim is excited or stressed, tremors may deteriorate.
- Stiffness: While moving, stiffness of limbs and trunk may increase. Stiffness in hands makes handwriting worse and eating difficult.
- Bradykinesia: The voluntary movement is slowed down. It may become difficult for a patient to start movement and then to finish it.
- Postural shakiness: Impaired reactions can make it difficult to regulate the posture. Postural shakiness may lead to collapses.
- Parkinsonian walk: Patients victimized with more progressive Parkinson's disease have a typical awkward walk with a bent position and an absent arm swing. Walking may become difficult for a patient. It also becomes more difficult for patients to make turns. The victims may stop in mid-stride and seem to collapse while walking.
Regular loss of muscle control and persisted damage to the brain can drive to secondary symptoms. Here are a few of them:
- Insecurity, anxiety, and stress
- Memory loss, and dementia
- Reduced sense of smell
- More sweating
- Skin complications
- Urinary pressure
Causes for Parkinson's
Exact cause of Parkinson's disease is not that clear. However, it has been observed that cells that make the chemical dopamine in the part of an individual's brain called the substantia nigra, start to die. Dopamine has a vital role in the functioning of the brain. It works as a messenger that informs another area of the brain when physical movements are made.When the relevant cells become too low, an individual can't control the physical movements. Parkinson's symptoms start at that time. Scientists say it depends upon one's genes and working environment.
Diagnosis and Tests
There are no specific tests available to diagnose Parkinson's. A neurologist diagnoses Parkinson's disease based on the patient's medical history. The doctor reviews signs and symptoms and generally prescribes a neurological and physical examination. The doctor may also ask for tests, such as blood to rule out other conditions that may be triggering the symptoms.
Tests like MRI, ultrasound of brain, SPECT and PET scans may be made to help discard other ailments. These tests, however, may not be helpful for diagnosing Parkinson's disease.
Parkinson's is not curable, but, medications can help manage the symptoms. Surgery may be advised for patients having major problems.
Doctors may prescribe changes in lifestyle. Balance and stretching physical therapy is advised for some patients. Speech problems can be corrected by taking the help of a speech-language pathologist.
Problems with walking, movement and tremor can be managed by medications, which increase dopamine, a particular signaling chemical in the brain.
A doctor usually prescribes the following:
- Carbidopa-levodopa- It is a natural chemical that goes into your brain and gets converted to dopamine.The side effects may incorporate nausea or lightheadedness.
- Carbidopa-levodopa infusion- This medication contains carbidopa and levodopa. It's given through a feeding tube which delivers the medication in an emollient form to the smaller intestine.The tube is placed through a small surgical procedure.
- Dopamine agonists- These drugs don't change into dopamine. As an alternative, they simulate dopamine effects in the brain.
- Side effects of dopamine agonists include hallucinations, and compulsive behaviors such as hyper sexuality and gambling.
- MAO-B inhibitors- Selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) are two main contents of these medications. They avert the breakdown of brain dopamine by preventing the brain enzyme, monoamine oxidase B (MAO-B). The enzyme absorbs brain dopamine. A patient may have side effects like nausea, insomnia.
- Catechol-O-methyltransferase (COMT) inhibitors- The primary medication in this class is Entacapone (Comtan). This medication can be used along with levodopa therapy. It in fact mildly prolongs the effect of this therapy by helping to block an enzyme that breaks down dopamine.
- Side effects including an increased risk of involuntary movements (dyskinesias) mainly resulting from an enhanced levodopa effect. Other side effects bring in diarrhea.
- Amantadine- For early stage Parkinson's disease, doctors often prescribe amantadine to have short-term relief. A patient may have side effects like a purple mottling of the skin, ankle swelling.
There are a few surgical procedures done for Parkinson's disease. They are-
- Deep Brain Stimulation (DBS)-This surgical treatment for Parkinson's disease involves imbedding a device to stimulate affected spots of the brain with electrical impulses produced by a battery operated neurostimulator.
- Lesioning surgeries- In this procedure the areas of the brain that are responsible for the symptoms are targeted. Named in accordance to the area of the brain that is operated these may be called thalamotomy, pallidotomy and sub-thalamotomy. These procedures take a longer recovery time.They are rarely performed now-a-days.
- Pallidotomy surgery- This surgery helps to relieve muscular rigidity or the involuntary movements that are in fact the primary symptoms of Parkinson’s disease. It is performed on the globuspallidus, which is destroyed easing the symptoms of the patient.
- Thalamotomy Surgery- Tremors in an individual are found due to trouble with the thalamus, a section of the brain, which is required to balance the body. Thalamotomy abolishes part of the thalamus to obstruct the things that cause tremors from reaching the muscles.
Before the surgery
- Prior to the surgery, patients of Parkinson’s undergo wide-ranging tests to ensure whether they are acceptable for it.
- The surgeon also takes the help of other procedures, like magnetic resonance imaging (MRI), computed tomography (CT) scanning to locate the targeted area of the brain.
During the surgery (Deep Brain Stimulation)
The surgery is usually performed in two stages.
- In the initial stage, a local anesthesia is applied to the scalp and then very fine wires with electrodes at the tips are introduced into the brain at the targeted area.
- In the secondary stage, it is done under general anesthesia.
- In this case, a wire is embedded to link the electrodes to a neurostimulator, which produces the electrical pulse that is carried by the electrodes.
- The neurostimulator is usually implanted below the collarbone or in the lower chest.
- After the device is embedded, the symptoms can be observed and the setting of the neurostimulator can be attuned according to the need of the patient.
- Re-programming is not harmful because it is performed wirelessly by an antenna kept near the location of the neurotransmitter.
- A patient should take medications as soon as possible after the surgery because recovery from Parkinson's surgery may take longer time.
- Also, a patient may need to have physical therapy and extra recovery time.
Post Surgery Complications
- Speech issues
- Cognitive decline
- Cranial bleeding.
Factors affecting the Cost of Parkinson's Surgery
- The hospital patient chooses
- Fees for the surgeon
- Cost of tests like, MRI, CT Scan
- Cost of diagnostic procedures
- Cost of surgery
- Cost of follow -up care required
- Cost of relevant physical therapy
- Cost of medications after the surgery