What exactly is Parkinson’s disease?
Parkinson’s is a disease of the nervous system that is associated with brain deposits of a protein called synuclein. These protein accumulations are associated with the loss of neurons in very specific brain regions of the brain. The cells that produce dopamine degenerate in the so-called substantia nigra. This dopamine deficit is the cause of the classic symptoms of the disease: slowness of movement and tremor at rest.
Why does Parkinson’s disease occur?
The cause of Parkinson’s is unknown. However, genetic factors are important, since in 20% of cases the disease runs in families and in 5% it is caused by a specific genetic mutation. However, we do not know exactly why synuclein accumulates nor why specific groups of neurons (such as those that produce dopamine in practically the majority of cases) are altered. Very recent studies, however, indicate that the progression of Parkinson’s symptoms would be associated with an extension of synuclein deposits, which would spread from one neuron to another.
What are the symptoms of Parkinson’s? How can we detect that someone in our environment may be suffering from Parkinson’s?
The mobility problems caused by Parkinson’s disease are due to many symptoms. Initially, it can be observed that the subject presents:
- Decreased gesticulation.
- Diminished handwriting.
- Difficulty turning in bed or getting up from a chair.
- Stooped gait.
- Little swinging of arms when walking.
- Loss of facial expression.
- Weakened voice.
- Tremor at rest in one hand.
In addition, Parkinson’s disease can also lead to other problems such as:
- Loss of smell.
- Constipation.
- Sleep problems.
- Urinary urgency.
- Intense nightmares.
Parkinson’s disease worsens over time. There is currently no treatment that slows down the progression of the disease, but numerous drugs and non-pharmacological treatments alleviate patients’ symptoms. Current drug treatment is based on drugs that replace the lack or decrease of brain dopamine.
Levodopa remains the best of these drugs, but other dopaminergic drugs such as rasagiline, safinamide or dopamine agonists (synthetic dopamines) are also frequently used.
These drugs alleviate motor symptoms and somewhat alleviate non-motor symptoms. There is a long list of strategies and drugs to alleviate non-motor symptoms. One example is rivastigmine, a drug (via patch) that enhances cognitive faculties and can be used in later stages of the disease if there are memory problems. In cases where the beneficial effect of levodopa is intermittently lost during the day, with disabling symptoms reappearing at times, more complex treatments are available such as the application of subcutaneous perfusors of apomorphine (a synthetic dopamine), continuous infusions of levodopa into the duodenum or functional neurosurgery (deep brain stimulation), which is very useful in stabilizing patients’ daily symptom control.
What is the current treatment for Parkinson’s disease and is there any innovative therapy to slow its progression?
Exercise is nowadays considered useful in all stages of Parkinson’s disease, including the initial stages. Complementary therapies such as physiotherapy, speech therapy or psychotherapy are also recommended, depending on the specific problems of each subject.
At this point, there are already several new drugs approved by the Medicines Agency that we hope will soon be available in our country. On the other hand, others are under study and are promising, such as:
- The levodopa inhaler.
- The levodopa dermal patch.
- Sublingual apomorphine.
- Etc.
In addition, a great amount of resources are being devoted to achieve a therapy that slows down or prevents the progression of Parkinson’s disease. Numerous clinical trials are underway, such as anti-synuclein vaccines, which aim to reduce the brain’s synuclein load and slow the progression of the disease. We will have to wait a year and a half for the first results of these anti-synuclein studies. At the moment we only know that they are well tolerated.