Surgery For People With Parkinsons Disease
Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons.;When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator.;Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.
The Nervous System & Dopamine
To understand Parkinson’s, it is helpful to understand how neurons work and how PD affects the brain .
Nerve cells, or neurons, are responsible for sending and receiving nerve impulses or messages between the body and the brain. Try to picture electrical wiring in your home. An electrical circuit is made up of numerous wires connected in such a way that when a light switch is turned on, a light bulb will beam. Similarly, a neuron that is excited will transmit its energy to neurons that are next to it.
Neurons have a cell body with branching arms, called dendrites, which act like antennae and pick up messages. Axons carry messages away from the cell body. Impulses travel from neuron to neuron, from the axon of one cell to the dendrites of another, by crossing over a tiny gap between the two nerve cells called a synapse. Chemical messengers called neurotransmitters allow the electrical impulse to cross the gap.
Neurons talk to each other in the following manner :
What Are The Different Forms Of Parkinsonism
There are three main forms of parkinsonism, as well as other related conditions.
Most people with parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.
The most common symptoms of idiopathic Parkinsons are tremor, rigidity and slowness of movement.
Vascular parkinsonism affects people with restricted blood supply to the brain.;Sometimes people who have had a mild stroke may develop this form of parkinsonism.
Common symptoms include problems with memory, sleep, mood and movement.
Some drugs can cause parkinsonism.
Neuroleptic drugs , which block the action of the chemical dopamine in the brain, are thought to be the biggest cause of drug-induced parkinsonism.
The symptoms of drug-induced parkinsonism tend to stay the same only in rare cases do they progress in the way that Parkinsons symptoms do.
Drug-induced parkinsonism only affects a small number of people, and most will recover within months and often within days or weeks of stopping the drug thats causing it.
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Identifying The Two Disease Strains
For the study, the participants included both Parkinsons patients and those at an increased risk of the disease. Each group experienced an initial round of MRI and PET scans, and every few years they were reevaluated to see how Parkinsons develops and spreads.
Based on the findings, the researchers theorize that there are two main types of Parkinsons disease that start in different places in the body and can result in different bodily symptoms. While nerve deterioration eventually happens in both forms of the disease, how the participants got there was very different based on the variant they had.
For some patients, the disease starts in the intestines and spreads from there to the brain through neural connections. For others, the disease starts in the brain and spreads to the intestines and other organs such as the heart, Borghammer said.;
With this information, its no surprise that patients experience such a wide range of symptoms that are all related back to Parkinsons. The researchers explained that this can be especially tricky for patients who have the variant that originates in the brain because the symptoms may not be apparent until the disease has already progressed.;
Different Types Of Parkinsonism
Parkinsonism can be categorized into four different types. These are:
Primary parkinsonism, Familial neurodegenerative conditions causing parkinsonism.
What is Primary parkinsonism?Primary parkinsonism is due to idiopathic Parkinsons disease. It includes sporadic and familial cases and accounts for about 80% of parkinsonism cases.
What is Secondary parkinsonism?This form of parkinsonism, can be caused by a variety of issues. These include drug induced, infections, toxins, vascular, trauma to brain, hemi-atrophy hemi-parkinsonism, brain tumors, normal pressure hydrocephalus, hypoxia, and metabolic dysfunction.
What is atypical parkinsonism?Most experts include Parkinson plus conditions such as progressive supranuclear palsy, multiple system atrophy, and corticobasal degeneration in atypical parkinsonism. The response of these conditions to the dopaminergic medications is usually poor. These cases of parkinsonism may be difficult to distinguish from idiopathic Parkinsons disease especially early in the course the disease.
Two other Parkinson plus conditions are progressive supranuclear palsy and corticobasilar degeneration . They differ from Parkinsons disease in that:
i. their neurons do not contain Lewy bodies, but rather a series of intertwined fragments of tau protein;ii. target neurons in the globus pallidus and putamenin addition to those in the substantia nigraare destroyed;iii. levodopa, typically, elicits no response in these patients.
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Whats The Difference Between Dementia With Lewy Bodies And Parkinsons
In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.
For more information on dementia with Lewy bodies, visit www.lbda.org.
What Is The Treatment For Parkinson’s Disease
There is currently no treatment to cure Parkinson’s disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.
The most effective therapy for Parkinson’s disease is levodopa , which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects , its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with carbidopa , which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects.
In earlier stages of Parkinson’s disease, substances that mimic the action of dopamine , and substances that reduce the breakdown of dopamine inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea.
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Two Forms Of Parkinson’s Disease Identified
- Why can the symptoms of Parkinsons disease vary so greatly from one patient to another? A consortium of researchers is well on the way to providing an explanation. Parkinsons disease is caused by a protein known as alpha-synuclein, which forms aggregates within neurons, killing them eventually. The researchers have succeeded in characterizing and producing two different types of alpha-synuclein aggregates. Better still, they have shown that one of these two forms is much more toxic than the other and has a greater capacity to invade neurons.
What Causes Parkinson’s Disease
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
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Learning About The Secondary Types Of Parkinsons
Theres also a subgroup of Parkinsons types. You may hear this subgroup referred to as atypical or a secondary form of Parkinsons. These types sometimes progress faster than idiopathic Parkinsons disease, or they may involve other types of health conditions that require dual treatments. For instance, drug-induced Parkinsonism is one of the most common secondary forms. This type is often caused by the side effects of medications such as antidepressants. The tremors and challenges a person experiences with this type tend to be less severe than with primary Parkinsons, and they sometimes go away after stopping the medication. However, vascular Parkinsons tends to occur suddenly and with severe symptoms. It often follows a stroke and may require additional treatment for vascular issues to address the symptoms.
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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Research Roundup: Two Types Of Parkinson’s Disease And More
Every week there are numerous scientific studies published. Heres a look at some of the more interesting ones.
Parkinsons Disease is Actually Two Diseases
Researchers from Aarhus Universityin Denmark indicating that Parkinsons disease is actually two types of the disease. This helps explain why there are so many different symptoms and pathways. Parkinsons is marked by slow deterioration of the brain from accumulation of alpha-synuclein, a protein that damages nerve cells. This causes slow, stiff movements. Some patients apparently have damage to the brains dopamine system before damage in the intestines and heart occurs. Other patients have damage to the nervous systems of the intestines and heart before the damage in the brains dopamine system. The research was published in the journal Brain.
With the help of advanced scanning techniques, weve shown that Parkinsons disease can be divided into two variants, which start in different places in the body, said Per Borghammer, professor of clinical medicine at Aarhus University. For some patients, the disease starts in the intestines and spreads from there to the brain through neural connections. For others, the disease starts in the brain and spreads to the intestines and other organs such as the heart.
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
In Patients Where Parkinsons Disease Starts In The Brain:
The order of symptoms will be opposite patients whose Parkinsons disease starts in the gut, Borghammer says. The pathology probably starts inside the brain and doesn’t really create a lot of symptoms initially, he says. The first clear symptom to emerge is the motor symptoms, signifying that the dopamine system is damaged.
The disease then spreads down in the brainstem, where it can cause sleep issues, he says. Finally, the pathology reaches the peripheral nervous system and causes constipation, urinary problems, and blood pressure problems.
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
Stage Five Of Parkinsons Disease
Stage five is the most advanced and is characterized by an inability to rise from a chair or get out of bed without help, they may have a tendency to fall when standing or turning, and they may freeze or stumble when walking.
Around-the-clock assistance is required at this stage to reduce the risk of falling and help the patient with all daily activities. At stage five, the patient may also experience hallucinations or delusions.
While the symptoms worsen over time, it is worth noting that some patients with PD never reach stage five. Also, the length of time to progress through the different stages varies from individual to individual. Not all the symptoms may occur in one individual either. For example, one person may have a tremor but balance remains intact. In addition, there are treatments available that can help at every stage of the disease. However, the earlier the diagnosis, and the earlier the stage at which the disease is diagnosed, the more effective the treatment is at alleviating symptoms.
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How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes; difficulty swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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