Parkinson's disease (also called Parkinson's disease, shaking palsy, paralysis agitans or idiopathic Parkinson's syndrome) is, along with Alzheimer's dementia, one of the most common progressive diseases of the central nervous system in older age. Most of those affected fall ill between the ages of 50 and 79.
It is a movement disorder that involves the following. Leading symptoms has:
- Motion deceleration (Hypokinesis), which manifests itself as a small-stepped gait, soft and unclear speech, masked face, reduced typeface
- Muscle stiffness (Rigor) that causes back pain
- Trembling (Tremor), which occurs mainly at rest and diminishes with movement of the affected extremity.
- reduced postural stability (postural instability), which leads to an increased tendency to fall
Parkinson's disease is mainly caused by a deficiency of the nerve messenger substance Dopamine in certain areas of the brain because special nerve cells in the brain gradually die off. Together with other neurotransmitters, dopamine is involved in the control of movement.
A cure is not yet possible, but there are various treatment options that positively influence the symptoms of the disease.
Since life expectancy is constantly increasing in western industrialized countries and Parkinson's disease occurs more frequently in older age, an increasing number of people affected must be expected in the coming years. According to estimates, 150,000 to 200,000 patients in Germany suffer from idiopathic Parkinson's syndrome (idiopathic means: without a tangible cause). Every year, about 15 to 20 out of 100,000 people in Central Europe are newly affected.
A definite cause for Parkinson's disease has not yet been found.
In more than 80 percent of cases, Parkinson's disease occurs without an identifiable cause. However, genetic studies of Parkinson's families indicate that in rare cases the predisposition to the disease can be inherited. Other possible causes include increased exposure to environmental toxins (pesticides, heavy metals).
Even before the disease becomes externally noticeable, the disease process has already begun. In the early stages, cell death occurs in the intestinal nervous system and the olfactory nerve. Thus, in the early stages of the disease, olfactory disturbances, constipation and depression are observed before there are visible motor signs. Only when more than 70% of the dopamine-forming cells have been destroyed does the disease become visible externally in the form of gait disorders, muscle stiffness or tremors.
What is a (symptomatic ) Parkinson's syndrome?
Several conditions can cause symptoms similar to those of Parkinson's disease. They are secondary or symptomatic Parkinson's syndromes. They occur - especially in advanced age - significantly more often than the actual Parkinson's disease. The cause is usually a circulatory disorder of the brain.
Some medicines can cause Parkinson's disease if they are used for a long time. The symptoms usually disappear when the medication is discontinued. However, this should only be done after consultation with the doctor.
Parkinson's disease: diagnosis
In the early stages of Parkinson's disease, diagnosis is often difficult. The first indications of Parkinson's disease can be a reduction in handwriting, impaired smelling, severe muscle tension, difficulties with everyday activities such as brushing teeth, buttoning or computer work.
The doctor makes the diagnosis on the basis of the signs of the disease. Parkinson's disease is diagnosed when at least two typical symptoms (see above) can be detected.
Imaging techniques such as the Computer tomography (CT) and the Magnetic resonance imaging (MRI) serve primarily to exclude other causes. With the Positron Emission Tomography (PET) or the DAT scan a reduction of the dopamine-secreting cells in the brain can be made visible.
Parkinson's disease: therapy
In principle, Parkinson's disease is treatable, but not curable. The therapy consists of several components.
The most important groups of drugs are
- Levodopa (L-Dopa) = precursor of dopamine, use in advanced disease also possible as a pump
- Dopamine agonists = drugs that enhance the effect of L-dopa, application also possible as a patch
- Drugs that reduce the fluctuations in the effect of dopamine (e.g. COMT inhibitors, entacapone, tolcapone) or slow down its degradation (e.g. selegiline, rasagiline)
The different groups of active ingredients can also be combined with each other
Unfortunately, there is no drug yet that can stop or slow the progressive loss of dopamine cells in the brain. ( so-called neuroprotective drugs)
Surgical interventions on the brain (deep brain stimulation)
If pronounced fluctuations in mobility can no longer be controlled by medication, under certain conditions (age, no severe concomitant diseases, responding very well to high doses of L-dopa) a surgical measure, the deep brain stimulation, should be considered. Under general anaesthesia, small electrodes are permanently inserted into precisely calculated areas of the brain. Certain areas of the brain can now be electrically stimulated and thus inhibited. In this way, complaints can be alleviated in a targeted manner. This stimulation can be carried out permanently via a programmed pacemaker or, if required, by the patient himself.
Accompanying therapy measures
- physiotherapeutic care
- Speech therapy if the ability to speak and swallow is impaired.
- Occupational therapy helps people to be able to cope with everyday life or pursue hobbies independently for as long as possible.
- Self-help groups
The Competence Network Parkinson is an association of physicians and researchers who work clinically or scientifically in the field of Parkinson's disease.
German Parkinson Association e.V.
Self Help M.Parkinson