Parkinson'sMuscle stiffness and tremors have earned Parkinson's disease the colloquial name shaking palsy. In fact, the symptoms of Parkinson's disease are more diverse. Unfortunately, this disease of the brain is still not curable. An early diagnosis, however, helps to initiate a treatment that improves the quality of life.
Paralysis agitans, Parkinson's disease, shaking palsy
Parkinson's disease is the abbreviation of the technical term Morbus Parkinson. Other names for this disease are paralysis agitans, Parkinson's disease or shaking palsy. The term "shaking palsy is, however, misleading. Parkinson's does not paralyze in the actual sense, but rather movements are inhibited, which ultimately also leads to a lack of movement.
Parkinson's is a disease of the brain. The disease is characterized by a progressive loss of dopamine-producing nerve cells in the substantia nigra, the black substance of the brain. Dopamine is a messenger substance (neurotransmitter). Nerve messengers such as dopamine are chemical substances that are important for the transmission of excitation in nerve fibers. As a result of the dopamine deficiency, the balance of all neurotransmitters is upset, which causes the typical symptoms of Parkinson's disease. Parkinson's progresses throughout life. Is not curable so far.
The incidence of Parkinson's disease has increased significantly in recent decades, mainly due to increasing life expectancy. The German Parkinson Society estimates that about 280.000 Parkinson's patients in Germany.
Depending on the study, the incidence of Parkinson's is reported to be between 0.3 and 0.5 percent of the total German population. This so-called prevalence increases sharply with age. It doubles to up to 1 percent in people between 60 and 80 years of age. In people over 80, the prevalence is up to 2 percent.
The frequency of new cases (annual incidence) is estimated in recent studies at 11 to 19 cases per 100.000 inhabitants and year. The peak frequency is between 55 and 65 years of age. In people under 45 years of age, the incidence is less than 1 new case per year and 100.000 inhabitants.
The most striking symptom of Parkinson's is the combination of slowed movements and tremors, which have earned the disease the name shaking palsy. Physicians distinguish the following 4 leading symptoms:
1. Slowed movement to complete immobility as the main symptom 2. Stiffened and rigid muscles (rigor) 3. 4. Disturbed holding-. Positional reflexes (postural instability). Disturbed holding and positioning reflexes (postural instability).
1. Slowing of movement (bradykinesia)
The slowing of movement typical of Parkinson's disease manifests itself in a variety of ways. As a rule, the shoulder-arm area is affected first. In many Parkinson's patients, for example, one arm swings when walking. Initially, walking only slightly less than the other arm. This is often accompanied by unilateral arm and shoulder pain. In the course of the disease, these tremors. Other disturbances of the movement sequences more and more clearly from.
Movements such as turning, standing up or walking can no longer be carried out as a matter of course, but require a great effort of will – and become increasingly difficult to perform. Spontaneous and involuntary movements become increasingly rare. As the disease progresses, the steps become smaller and the gait shuffles. Typical is also a more and more forward bent posture.
However, the movement restrictions affect by far not only the gait. Rather, all muscle activities are affected. The increasingly smaller handwriting (micrography) continues to be noticeable. Facial expressions, facial movements and facial emotions also decrease (hypomimia). Due to the reduced muscle play in the face, the face appears rigid, resulting in the so-called mask face. Speech disorders are also possible. Speech flattens out, becomes more monotonous, quieter and less clear (microphonia). Due to dysphagia, many Parkinson's patients salivate more (pseudohypersalivation). Eating is difficult for them. They swallow frequently.
At the end of the development of Parkinson's disease, there is often almost complete immobility (akinesia).
2. Muscle rigidity (rigor)
Second leading symptom of Parkinson's is increasing muscle rigidity. Physicians speak of rigor. Muscle rigidity often occurs on one side and usually affects the shoulder and neck muscles first. These complaints are often misinterpreted as muscle tension. Lead the affected person to the orthopedist. The stiffening typical of Parkinson's disease is called the cogwheel phenomenon. Fluid movement is no longer possible when the doctor tries to stretch the affected person's arm. Instead, the stretching is jerky and choppy, as if one were moving a cogwheel. Muscles close to the body are often more affected than muscle groups far from the body (axial rigor). Parkinson's patients are sometimes observed rubbing their fingers together as if they were counting coins. Manual dexterity also continues to decline.
3. trembling (tremor)
The 3. The leading symptom of Parkinson's is the typical tremor. This tremor also often begins unilaterally. Initially, Parkinson's patients tremble only slowly and at rest. The hands, and later also the feet, beat slowly and rhythmically. Typically, the tremor disappears when the patient moves or sleeps.
4. Postural instability
Due to disturbed positional reflexes, Parkinson's patients can no longer keep their bodies upright in a stable manner. The compensatory movements are missing, so that an increasing gait and stance insecurity can be observed (postural instability). This results in a great fear of falling. During turning maneuvers or turning around one's own axis, affected persons start to trip and need many small steps to carry out the movement. The more uneven the surface and the ground, the more difficult it is for them to walk.
Other symptoms of Parkinson's disease
In addition to the leading symptoms, there are many other signs or. accompanying symptoms of Parkinson's such as sensory, psychological, vegetative and cognitive disturbances. Typical symptoms are, for example, a diminished sense of smell or olfactory disorders with the perception of non-existent bad odors. Odor disorders are also possible long before the onset of the disease. Dysesthesia on the skin or greasy, shiny facial skin due to increased sebum production (ointment face) are further symptoms of Parkinson's disease. In addition, the imbalance of nervous control not infrequently causes disturbances in circulatory regulation and bladder dysfunction.
Mental symptoms of Parkinson's
Dopamine not only plays an essential role in the control of movement. Dopamine deficiency is also manifested by a wide variety of psychological abnormalities. Symptoms such as depression, anxiety disorders or sleep disorders very often appear well before the typical movement disorders.
An example of this is so-called REM sleep behavior disorders. With this sleep disorder, sufferers lash out at night, scream, scratch or bite. According to the Marburg University Hospital, up to 80 percent of people with REM sleep behavior disorder develop Parkinson's disease with bradykinesia, rigor and tremor within 10 to 15 years.
The cause of Parkinson's symptoms is the loss of dopamine-producing nerve cells in the black matter of the brain, the so-called substantia nigra in the midbrain. As a result, there is a progressive deficiency of the nerve messenger dopamine. This dopamine deficiency in turn affects the delicate balance of other nerve messengers in the brain and throughout the organism.
In the search for the cause of Parkinson's, on the other hand, medicine is largely in the dark. The only proven fact is that a hereditary component is involved in a good fifth of all cases of Parkinson's disease. So far, Parkinson's research has identified 13 genes or. Genetic forms of Parkinson's identified, referred to as PARK 1 through PARK 13.
In more than 80% of cases, however, it is still not known why the dopamine-producing brain cells die.
Drugs as a risk factor
In medical circles, there is debate as to whether there are factors that promote Parkinson's. Environmental toxins or drugs are conceivable. Scientists at the University of Utah found evidence in a study that stimulants such as amphetamines could significantly increase the risk of Parkinson's disease. They had data from 5.000 amphetamine users at 34.Compared 000 records of drug-abstinent people. The result: 0.1 percent of the abstinent subjects developed Parkinson's disease during the study period. Among amphetamine users, the morbidity rate was three times higher, at 0.3 percent.
The number of amphetamine users has been increasing for years, according to the German Centre for Addiction Risks (DHS). According to the study, 0.1 percent of adult Germans are considered addicts, and 0.7 percent are amphetamine users.
For the diagnosis of Parkinson's disease, at least one of the leading symptoms must be proven in addition to the characteristic slowing of movement. This is usually followed by imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI).
Another option is the experimental administration of levodopa, a precursor of the nerve messenger dopamine, which is absent in Parkinson's disease. If the symptoms improve after taking levodopa, also known as L-dopa, Parkinson's is probable.
So far, Parkinson's disease cannot be cured. However, the symptoms can be treated relatively well. Parkinson's therapy consists of several approaches: drug treatment, brain pacemakers and physical therapies as well as psychotherapy. Drugs are primarily intended to compensate for the lack of dopamine. Balancing the imbalance of nerve messengers. Drug of choice is levodopa (L-dopa), a dopamine precursor. Another option is the administration of dopamine agonists. These drugs enhance the dopamine effect that is still present. Typical agents are the classic ergot alkaloids lisuride, bromocriptine and cabergoline, as well as the newer selective D2 receptor agonists such as piribedil, pramipexole and ropinirole. COMT inhibitors such as entacapone. Tolcapone reduces dopamine fluctuations. MAO-B inhibitors such as selegiline. Rasagiline slow down dopamine degradation. In the past, anticholinergics such as biperiden or bornaprin were often prescribed to treat muscle tremors. However, due to many side effects, the use of these drugs in Parkinson's disease is decreasing. Improved mobility can be achieved with amantadine.
Brain pacemakers to combat Parkinson's symptoms
If drug treatment is no longer sufficient, surgical procedures can be considered. So-called brain pacemakers are inserted into the patient under general anesthesia. These devices stimulate certain areas of the brain via electrodes. Thus alleviate the symptoms of Parkinson's disease. These brain pacemakers can be permanently programmed or, after an introductory phase, patients can control the pacemaker themselves.
Complementary forms of treatment
Physiotherapy, physiotherapeutic exercises, relaxation techniques, speech and swallowing training, and occupational therapy help to delay immobility as long as possible.
Psychotherapy against Parkinson's-related disorders
More and more experts are advising that more attention be paid to early psychotherapeutic treatment of Parkinson's-related mental disorders. The targeted therapy of depression or anxiety disorders contributes to a favorable influence on the course of Parkinson's disease. It also improves the overall quality of life.
Research approaches in Parkinson's therapy
Doctors and pharmaceutical companies around the world are researching new drug therapies for Parkinson's disease and other age-related neurological disorders such as Alzheimer's. But whether stem cell therapy, immunotherapy or vaccinations: So far, no imminent successes are on the horizon. Research approaches are still many years away from new drugs.
Course of the disease
The course of Parkinson's varies greatly from person to person. Basically, the disease progresses over time. But this also happens differently in each person. In about one third of cases, the symptoms are relatively mild and do not significantly impair quality of life. At times, however, movement disorders develop severely and rapidly. In other people, it is mainly the accompanying psychological symptoms of Parkinson's that severely impair the quality of life.
The life expectancy of people with Parkinson's disease, on the other hand, has improved significantly since the introduction of drug therapy with L-dopa. On average, Parkinson's patients die at around 70 years of age. The most frequent causes of death are cardiovascular diseases, tumor diseases and strokes. Thus corresponding to life expectancy. Causes of death almost the same as for people of the same age.
Since the cause of Parkinson's disease is still unclear, it is not possible to specifically prevent Parkinson's disease. On the other hand, however, Parkinson's is a degenerative neurological disease. Therefore, the active use of the nerve cells in the brain could possibly reduce the risk of the disease. In any case, there is no harm in exercising the gray matter and stimulating the brain with different stimuli. Solving crossword puzzles or Sudoku, traveling, interest in world affairs and also various hobbies pursued with pleasure and joy help in this process.