Treatment and Prevention of Parkinson's disease


Although the disease can not be cured, medications may help improve your symptoms. In rare cases, surgery may be recommended to regulate certain regions of your brain and improve your symptoms.

May 2, 2018

Parkinson's disease is a neurodegenerative disorder of the nervous system that affects movement of your body. Sometimes starts with a barely noticeable tremor in just one hand which could develops gradually causing stiffness or slowing of movement.
Progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance are the Characteristics of Parkinson's disease. The symptoms get worsen as your condition progresses over time and it may become difficult to walk, talk, and complete simple tasks.
The progression of Parkinson's disease and the degree of impairment vary from person to person. Parkinson's disease can affect people much more quickly making them disabled in some cases where as many people with this disease can live long productive lives. Falling related injuries or pneumonia which are the most common complications of this disease can cause premature death. Although the disease can not be cured, medications may help improve your symptoms. In rare cases, surgery may be recommended to regulate certain regions of your brain and improve your symptoms.

Treatment of Parkinson's disease:

There is no treatment to cure Parkinson's disease. But often medications can help control your symptoms. In some rare cases, surgery may be advised. Several therapies are available to delay the onset of motor symptoms. These therapies can help increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown.
Starting the therapy in early stage of the disease can delay the onset of motor symptoms, thereby extending quality of life. Lifestyle changes, such as aerobic exercise is recommended to improve symptoms. Physical therapy that focuses on balance and stretching also is important in some cases. A speech language pathologist may help improve your speech problems.

Medications:

Problems with walking, movement and tremor can be managed with medication. These medications increase or substitute for dopamine. Dopamine is a specific signaling chemical often called as neurotransmitter in your brain. Dopamine concentrations is low in the brain of people with Parkinson's disease. As it can't enter your brain, dopamine can't be given directly.
After beginning Parkinson's disease treatment, you may notice significant improvement of your symptoms. Although symptoms usually can continue to be under control, the effectiveness of drugs frequently diminish or become less consistent.
The prescribed medication include:

Carbidopa-levodopa:

The most effective Parkinson's disease medication is levodop which is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa to protect premature conversion of levodopa to dopamine outside your brain. This prevents or lessens side effects such as nausea. Side effects may include nausea or lightheadedness orthostatic hypotension.
Over time the benefit from levodopa may become less stable, with a tendency to wearing off. You may also experience involuntary movements or dyskinesia after taking higher doses of levodopa. In such cases, the doses may be reduced or the times of your doses are adjusted to control these effects.

Carbidopa-levodopa infusion:

A combination of the drugs containing carbidopa and levodopa is called Duopa. The medication is available in a gel form which is administered through a feeding tube directly to the small intestine. Placement of the tube requires a small surgical procedure. Falling out of the tube or infections at the infusion site are common risks associated with having the tube. Duopa is used for patients with more advanced Parkinson's who still respond to carbidopa-levodopa, but who have a lot of fluctuations in their response. Blood levels of the two drugs remain constant as Duopa is continously infused.

Dopamine agonists:

These medication can mimic dopamine effects in your brain. However, dopamine agonists don't change into dopamine and therefore aren't as effective as levodopa in treating your symptoms.These may be used with levodopa. The sometimes off and on effect of levodopa can be made smooth by this medications as they last longer.
Dopamine agonists include pramipexole, ropinirole and rotigotine. Apomorphine is a short acting injectable dopamine agonist used for quick relief. Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa. But hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating can also be the side effects.
Speak to your doctor if you behave in a way that is out of character for you while taking these medications.

MAO-B inhibitors:

These medication help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine. Selegiline and rasagiline are examples of MAO-B. Side effects may include nausea or insomnia.These medications increase the risk of hallucinations when added to carbidopa-levodopa. Due to potentially serious reactions, These medications are not often used in combination with antidepressants or certain narcotics. Therefore, before taking any additional medications with a MAO-B inhibitor, check with your doctor.

Catechol-O-methyltransferase (COMT) inhibitors:

This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine. Entacapone is the primary medication used for the disease. An increased risk of involuntary movements or dyskinesias which mainly result from an enhanced levodopa effect can be the side effect of COMT inhibitor. Other side effects may include diarrhea or other enhanced levodopa side effects.
Tolcapone is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

Anticholinergics:

To help control the tremor associated with Parkinson's disease, these medications were used for many years. Benztropine or trihexyphenidyl are examples of such medications. Impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination are the most common side effects of anticholinergic medications.

Amantadine:

Amantadine is prescribed alone to provide short term relief of symptoms of mild, early-stage Parkinson's disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control dyskinesias induced by carbidopa-levodopa. Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.

Surgical procedures:

Surgery may be an option for some individuals with advanced, virtually unmanageable motor symptoms.

Deep brain stimulation:

Electrodes are implanted into a specific part of your brain in deep brain stimulation (DBS). The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain. This may reduce your Parkinson's disease symptoms.
Your settings can be adjusted by your doctor as necessary to treat your condition. Infections, stroke or brain hemorrhage are the common risk associated with surgery. Some people experience problems with the DBS system or have complications due to stimulation. In such cases your doctor may need to adjust or replace some parts of the system.
Deep brain stimulation is most often recommended for people with advanced Parkinson's disease who have unstable medication responses. DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremor, reduce rigidity, and improve slowing of movement.
DBS is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that don't improve with medication adjustments. However, DBS is not helpful for problems that do not respond to levodopa therapy except for tremor. A tremor may be controlled by DBS even if the tremor isn't very responsive to levodopa.
Specific areas in the brain that cause Parkinson's symptoms are destroyed in some cases. Use of dopamine producing cells derived from stem cells is an alternative approach that has been explored. But still more research is required in this approach.
In addition to medication and surgery, general lifestyle changes, physical therapy, occupational therapy, and speech therapy may be beneficial.
An occupational therapist can show you techniques that make daily life easier by easing the daily living activities such as dressing, eating, bathing and writing. Lifestyle changes, such as aerobic exercise and rest as much as required is recommended to improve symptoms. Physical therapy that focuses on balance and stretching also is important in some cases. A speech language pathologist may help improve your speech problems. 

Alternative Therapies:

Massage:

Massage therapy can reduce muscle tension and promote relaxation.

Acupuncture:

In this process a trained practitioner inserts tiny needles into many specific points on your body to reduce your pain. Specific points are related to the different parts of your body causing pain.

Tai chi:

This is an ancient form of Chinese exercise, which employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are there for people of any age or physical condition.
Tai chi may improve the balance of people with mild to moderate Parkinson's disease. It is more effective than stretching and resistance training.

Yoga:

Gentle stretching movements and poses in yoga may increase your flexibility and balance. You may modify most poses to fit your physical abilities.

Meditation:

You quietly reflect and focus your mind on an idea or image in meditation. Meditation may reduce stress and pain and improve your sense of well-being.

Alexander technique:

This technique focuses on muscle posture, balance and thinking about how you use muscles. It may help reduce muscle tension and pain.

Music or art therapy:

Music or art therapy may help you to relax. Some people with Parkinson's disease have shown improvement in their walking and speech by music therapy. Participating in art therapy, such as painting or ceramics, may improve your mood and help you relax.

Pet therapy:

Having a dog or cat as your pet may increase your flexibility and movement and improve your emotional health.

Coenzyme Q10:

A high doses of coenzyme Q10 may be beneficial for people in the early stages of Parkinson's disease. Q10 is a readily available supplement. But it may take 16 months or longer to show the benefits after taking the supplement.

Prevention of Parkinson's disease:

As Parkinson's disease is triggered through a complex combination of genetic susceptibility and exposure to environmental factors such as toxins, illness, and trauma, it is not preventable. However, regular aerobic exercise may reduce the risk of Parkinson's disease to some extent.

Conditions that resemble Parkinson's disease:

Parkinson's disease can resemble a number of other conditions in its early stage with Parkinson like symptoms known as Parkinsonism. These conditions include multiple system atrophy, progressive supranuclear palsy,  Lewy body dementia, corticobasal degeneration, stroke, encephalitis, and head trauma. Alzheimer's disease and primary lateral sclerosis can also be mistaken for Parkinson's disease. Other similar conditions include essential tremor, dystonic tremor, vascular Parkinsonism, and drug-induced Parkinsonism.
So careful diagnosis is utmost important. Once the disease is diagnosed it is also 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.

Is Parkinson's disease inherited?

In most of the cases Parkinson's disease is idiopathic. However, some of individuals diagnosed with Parkinson's also have family history of the disease. Several genes that are associated with the disorder include:

SNCA (synuclein, alpha non A4 component of amyloid precursor):

SNCA makes the protein alpha-synuclein. This protein aggregates in clumps called Lewy bodies in brain cells of individuals with Parkinson's disease. Mutations in the SNCA gene are found in early stages of Parkinson's disease.

PARK2 (Parkinson's disease autosomal recessive, juvenile 2):

The PARK2 gene makes the protein parkin. Mutations of the PARK2 gene are mostly found in individuals with juvenile Parkinson's disease. Parkin normally helps cells break down and recycle proteins.

PARK7 (Parkinson's disease autosomal recessive, early onset 7):

PARK7 mutations are found in early stages of Parkinson's disease. The DJ-1 protein is produced by PARK7 gene, which may protect cells from oxidative stress.

PINK1 (PTEN-induced putative kinase 1):

Mutations of this gene are found in early stages of Parkinson's disease. The exact function of the protein made by PINK1 is not known, but it may protect structures within the cell called mitochondria from stress.

LRRK2 (leucine-rich repeat kinase 2):

The protein dardarin is produced by LRRK2. Mutations in the LRRK2 gene have been found in later stage of Parkinson's disease.