Parkinson's disease

Parkinson's disease

Definition:

With increasing age, more brain aging chronic diseases appear, Parkinson's disease is one of them. After Alzheimer's disease, Parkinson's disease is considered as the most common devastating neurological diseases (neurodegenerative). This neurological condition (relating to the nervous system) affects the brain and nervous system. The main problem is that patients have no body movement’s control. Parkinson's appear initially mild and gradually becomes severe. In the early years patient can handle life without the need for medicine, then patient slow movement’s becomes the problem. The disease is more common in men 2 to 3 times than women at ages over 50 years and also sometimes occurs in young adults. The disease gradually worsens and the person can live 20 to 25 years with the disease. Each year in America, more than 60 thousand people are added to the number of patients every year and it is currently at about close to one and a half million people in America who suffer from Parkinson's disease.

Transmission:

The main factor for the disease is the decrease in the production of dopamine in the body. Dopamine is a chemical nerve agent that helps to transmit messages between nerve cells. Dopamine is very effective to transfer commands from the brain to the muscles for direct control of body movements and also the smooth muscles movement and prevent shaking. Loss of dopamine causes tremors, motion stiffness and slowness.

Genetic risk is often the underlying cause of the disorder which occurs in multiple genes. Approximately 15% of patients have a family history of disease. According to recent observations respiratory and skin exposure with a variety of fungal pesticides and insecticides, detergents and solvents, including doubled the chance of Parkinson's disease. The intensity and duration of contact will increase the chance to develop the disease. Sometimes carbon monoxide poisoning can also be a cause. Severe traumatic brain injury and repeated blows to the head in boxers are the other factors. Mental sedative and psychotropic drugs like Phenothiazine in acute and chronic causes Parkinson and symptoms can get better with stopping the treatment. The disease can be caused by brain tumors, encephalitis after influenza and virus infection with slow growth.

 Symptoms:

At the beginning, visiting a doctor is often associated with tremor in an arm or leg that gradually becomes concentrated and radiates. Eventually, the patient becomes disabled due to slow movement and impaired balance. Olfactory system disorders have been identified in association with Parkinson's disease. Now, a new study suggests that loss of smell sense can predict the several years in advance. Mood changes, depression, memory loss, sore body and sleep disturbances have been seen in some patients in advanced stages. Patients with medicine treatment run their everyday business for years without the need for help. In advanced stages, muscle rigidity, slowed body movements and postural curvature caused problem for patient movement and people around them and finally patients require help for every type of motion such as dressing and eating. 

Another problem in patients with Parkinson are urination difficulties and frequent urination which occur due to prostate enlargement or bladder spasms. Constipation may occur due to lack of exercise, poor nutrition and reduced autonomic nervous cells in the patient's stomach. About 30 percent of patients with Parkinson's disease are depressed which is caused by social interaction difficulties, restricted activities, being not productive and some chemical changes in the nervous centers.

In general, the symptoms of Parkinson's disease can be divided into two parts:

1.       Early signs and symptoms:
- Shake or jolt
- Impairment of daily activities (such as right walking or eating, etc.) due to vibration.
- Tremor (shaking) may be even worse during rest.
- Speaking difficulty.
- Change in the handwriting (they write smaller than usual)
- Difficulty in moving body parts such as hands, arms, or legs
- They might not be able to hold things stable.
- Facial expressions changes or disappear (Retentive).
- May remain in a fixed position without moving longer than usual.

2.       Late Signs and symptoms:
- Stiff movements
- Dystonia: body and organs rotational movements which usually aggravate with Levodopa.
- Subtle vibration: vibration or Shake in body, hands, head, fingers or jaw at rest or at the movement beginning.
- Slow motion.
- Disturbance in maintaining body position: static imbalance or distraction which can leads to even fall backwards or forwards.

Treatment:

There is no definite cure for Parkinson, but available treatments let many patients manage their daily activities for many years. Treatment of patients with Parkinson are done in several parts. Treatment is not recommended in the mild stages of the disease which handshakes at rest and a brief slow movement are the only symptoms. Exercise, working and relaxation in this case are sufficient.

In advanced stages that the slow movement, muscle stiffness, tremors disruptive activities, equilibrium and social interaction for everyday activities are a big problems, treatment with anti-Parkinson drugs, is recommended. Treatment starts with small and a variety of mild amounts of drugs, and gradually increase them according to the each patient needs.

Patients typically need treatment every day and treating other diseases with Parkinson are critical. Other medical illness such as hypertension, diabetes, depression, arthritis can exacerbate physical and mental disability in the Parkinson patients. Treating physician must consider all the possibilities for person with Parkinson. In some case the use of crutches or a walker is necessary. Every day Exercise, more social interaction, maintain good mental condition and balance, compliance programs, regular sleep, work and study are essential in the treatment of Parkinson's. Parkinson surgery is done for decrease vibration by young people and it has no effect for the slow movement. The stimulating electrodes in the brain is a new and effective method and of course costly.

Drugs used in the Parkinson treatment:
- Anticholinergic compounds: Biperide, Trihexyphenidyl, Benztropine and several other combinations are effective in reducing tremor, but the stiffness and movement slowness, which are a major cause of disability does not work. Also side effects such as dry mouth, increased intraocular pressure, urinary retention, constipation, dizziness and hallucinations caused by them leads to restrictions on their use. 

- Amantadine: An effective way to reduce tremors,rigidity and slowness. It also reduce dystonia and involuntary movements of the mouth as well. It can be given as a single dose in mild and as a supplementary in advanced form. In some cases symptoms such as dizziness, depression, edema, heart rhythm changes and blood pressure are possible. 

- Levodopa: Since the symptoms of Parkinson occurs mainly due to little dopamine in the brain, dopamine supply of levodopa can help on Parkinson's treatment. Usually a combination of L-dopa and Carbidopa which are available under different commercial names, will be suggested depending on the patient tolerance and need. At the treatment beginning, most patients feel they have gastrointestinal disturbances, hypotension so initiation of therapy is with lower doses to develop drug tolerance. 

The major complication of levodopa is dystonia. It is a form of unwanted motion in the extremities, face and back which can be observed especially in peak drug effect times. For patients with mental disorders and glaucoma and in people who use Monoamine oxidase inhibitor, levodopa should not be administered. 

- Dopamine Strengthening: Drugs such as Bromocriptine, Pramipexole and Ropinirole are less recommended due to low treatment effect, high costs and side effects like cardiovascular, gastrointestinal and neurological symptoms. It is prescribed only in mild form and levodopa intolerance. 

-Monoamine oxidase inhibitor (MAOI): Selegiline and Rasagiline are selective MAOI which used as an adjuvant to L-dopa. These medicine must not consumed with serotonin retake inhibitors such as Fluoxetine etc. 

- Non-conventional psychotropic medications and antidepressants: in patients with Parkinson often some cases of depression and obsessive mental disorder is observed. Interact with different antidepressant drugs cause side effects so using them must be with consideration of drug interaction. Quetiapine and Clozapine are effective in the treatment of insomnia, mental stimulation and motion controls.

Prevention:

To prevent the risk of Parkinson's disease a few things are recommend:

- Appropriate use of gloves and masks when using different types of pesticides, insecticides, detergents and solvents.

- Care head trauma specially in childhood and old age, as well in soccer and Boxing. 

- Aerobic exercise such as swimming, walking, consistent jogging (at least 15-30 min daily), low-stress job, a regular and balanced sleep and to minimize stress and anxiety.

- Recent studies have shown that diets containing high amounts of monounsaturated fats had reduced the risk of Parkinson's disease. The monounsaturated are found in vegetables, grains, fruits and vegetable oils. 

- A rich diets in folic acid, vitamin E, vitamin B6.

- Omega-3  which can be found in walnuts and fish 

- A recent study by medical Specialists in America found that those who used to eat a variety of berries, oranges and chocolate are less likely to encounter this disease.

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