How Can Parkinson’s Disease Be Treated

Surgery For Parkinsons Disease

In some cases, people whose symptoms dont respond to medications can benefit from a surgical procedure called deep brain stimulation .

During DBS, the surgeon will implant electrodes into specific areas of the brain. These electrodes are then connected to a small electrical device. The electrodes send small electrical pulses into the brain, painlessly stimulating neurons in order to reduce or eliminate symptoms.

Health care providers typically recommend DBS for people with advanced Parkinsons disease who dont respond well to medications. DBS can help stabilize someones response to medications, reduce involuntary movements, improve slow movements, and decrease tremors and rigidity. Despite these benefits, its important to remember that DBS cant cure or stop the progress of Parkinsons disease.

What Are The Different Stages Of Parkinsons Disease

Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

How And Why Stem Cells Work In Treating Parkinsons Disease

MMSCs can produce a wide range of biologically active molecules , including those with neuroprotective and neurodegenerative properties. Also, in vitro studies showed that MMSCs are potentially able to differentiate into various types of cells, including neurons, and form new synapses with neighbouring neurons. The therapeutic effect is provided also by the immunomodulating effect of MMSCs due to the neuroinflammatory nature of Parkinsons disease.

Picture 2. Through the secretion of neuroregulatory molecules, MMSCs are able to influence processes such as neurogenesis, gliogenesis, remyelination, and neural plasticity.

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How Can Parkinsons Disease Be Treated

Answered by: Dr Rajas Deshpande | M.D. , D.M. Fellowship in Multiple Sclerosis Fellowship in Movement Disorders Consultant Neurologist

Q: I am a 45 years old male experiencing a problem while walking, which started six years back. After consulting a neurologist, I was informed that I have the symptoms of early onset of Parkinson’s. Initially, I underwent physiotherapy only for two years, and later I started taking medicines 12 mg of Ropark and 200 mg of Amantral . In between whenever I felt stiffer, then the doctor suggested me to take but stopped after taking it for 10 days. Recently, I observed that the “on time” duration has reduced from five hours or three hours in between doses. Why am I experiencing a sudden dip in the “on time”? How can Parkinsons disease be treated?

Different Stages Of Parkinsons Disease

Not everyone faces all symptoms of Parkinsons disease. Every person with this disease experiences signs of Parkinsons disease in their unique way. The signs and symptoms of this problem may vary from person to person. There are different stages of Parkinsons disease. Parkinsons disease progresses from early-stage to advanced-stage . These are what usually happens during each of these stages:

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What Are The Symptoms Of The Disease

The four primary symptoms of PD are:

• Tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. The tremor associated with PD has a characteristic rhythmic back-and-forth motion that may involve the thumb and forefinger and appear as a pill rolling. It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep or improves with a purposeful, intended movement.
• Rigidity. Rigidity , or a resistance to movement, affects most people with PD. The muscles remain constantly tense and contracted so that the person aches or feels stiff. The rigidity becomes obvious when another person tries to move the individuals arm, which will move only in ratchet-like or short, jerky movements known as cogwheel rigidity.
• Bradykinesia. This slowing down of spontaneous and automatic movement is particularly frustrating because it may make simple tasks difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easilysuch as washing or dressingmay take much longer. There is often a decrease in facial expressions.
• Postural instability. Impaired balance and changes in posture can increase the risk of falls.

Coping With Alzheimers And Parkinsons Disease

Living with both Alzheimers disease and Parkinsons disease is extremely challenging. The dementia of Alzheimers combined with the movement effects of Parkinsons can make self-care especially difficult.

Rivastigmine is the only medication that is specifically approved for the treatment of Parkinsons dementia. Additionally, you may need medication for the motor symptoms of Parkinsons disease and medication to help with other symptoms, such as dry skin.

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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

What Is A Common Side Effect Of Parkinson Disease Medications

Dyskinesias are uncontrollable body movements that can be forceful and painful. They are a side effect of levodopa, a medication that increases dopamine levels in the body and treats Parkinsons tremors, stiffness, and slowness. The movements may start as small tics but can worsen and lead to serious injury.

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What Doctors Look For When Diagnosing Parkinsons

Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:

• Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving

• Bradykinesia: Slowness of movement in the limbs, face, walking or overall body

• Rigidity: Stiffness in the arms, legs or trunk

• Posture instability: Trouble with balance and possible falls

Once the patient is at the doctors office, the physician:

• Takes a medical history and does a physical examination.

• Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.

• Performs a neurological examination, testing agility, muscle tone, gait and balance.

Parkinsons Disease: Symptoms Stages And Treatment

Parkinson’s disease usually begins after age 60, gradually progressing over the years. Some people can have early-onset Parkinson’s disease, starting in their 30s or 40s. It is primarily a movement disorder characterized by resting tremors and slowness and stiffness of movement.

In the late stages of the disease, Parkinson’s dementia can develop. But most people who have Parkinson’s disease do not develop dementia as a part of the condition.

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New Diagnostic Standards For Parkinsons

Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.

What Is The Future Of Gene Therapy For Parkinsons Disease

The jury is still out on each of the gene therapy strategies discussed above and each is still under investigation in an active clinical trial, although as of publication of this blog, none are currently recruiting participants. Three of APDAs Centers for Advanced Research are participating in gene therapy trials for Parkinsons disease. Emory University School of Medicine and the University of Alabama at Birmingham School of Medicine are participating in trials of Neurturin. The University of Pittsburgh Medical Center and Emory University School of Medicine are participating in trials of AADC.

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Safety Of Stem Cell Therapy

The procedures are usually well tolerated in the majority of patients. Clinical trial results confirmed the safety of local injections and treatment with MMSCs from the perspective of tumour formation after a follow-up period . Individual intolerance , while rare, cannot be excluded. Swiss Medica specialists will monitor your condition for safer and more beneficial results.

What Genes Are Linked To Parkinsons Disease

Several genes have been definitively linked to PD:

• SNCA. This gene, which makes the protein alpha-synuclein, was the first gene identified to be associated with Parkinsons. Research findings by the National Institutes of Health and other institutions prompted studies of the role of alpha-synuclein in PD, which led to the discovery that Lewy bodies seen in all cases of PD contain clumps of alpha-synuclein. This discovery revealed the link between hereditary and sporadic forms of the disease.
• LRRK2. Mutations in LRRK2 were originally identified in several English and Basque families as a cause of a late-onset PD. Subsequent studies have identified mutations of this gene in other families with PD as well as in a small percentage of people with apparently sporadic PD. LRRK2 mutations are a major cause of PD in North Africa and the Middle East.
• DJ-1. This gene normally helps regulate gene activity and protect cells from oxidative stress and can cause rare, early forms of PD.
• PRKN . The parkin gene is translated into a protein that normally helps cells break down and recycle proteins.
• PINK1. PINK1 codes for a protein active in mitochondria. Mutations in this gene appear to increase susceptibility to cellular stress. PINK1 has been linked to early forms of PD.
• GBA . Mutations in GBA cause Gaucher disease , but different changes in this gene are associated with an increased risk for Parkinsons disease as well.

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What New Treatments Are Being Developed

Thanks to the progress we’ve already made, new treatments are being tested in clinical trials that have the potential to slow, stop or even reverse Parkinson’s.

These include:

• stem cell therapies, which aim to use healthy, living cells to replace or repair the damage in the brains of people with Parkinson’s
• gene therapies, which use the power of genetics to reprogramme cells and change their behaviour to help them stay healthy and work better for longer
• growth factors , which are naturally occurring molecules that support the growth, development and survival of brain cells.

And we’re developing treatments that aim to improve life with the condition, including new drugs that can reduce dyskinesia.

Parkinsons Disease: How Could Stem Cells Help

What do we know?

Tremors, muscle rigidity and other symptoms of Parkinsons disease are caused by the death of dopamine-producing neurons in the brain. Dopamine producing neurons throughout the brain are affected, but the substantia nigra is the primary brain region where neurons are lost.

People affected by PD often develop abnormal protein clumps in their brain called Lewy bodies. These clumps are made of a protein called alpha-synuclein.

Levodopa is the primary drug used to treat PD. Levodopa is converted into dopamine when in the body, which compensates for lost dopamine-producing neurons.

What are researchers investigating?

Approximately 5% of people with PD have inheritable gene mutations linked to PD. Researchers are investigating what causes PD in the other 95% of patients in clinical studies, animal models and cell models.

Transplantation of young brain cells from human foetuses into people with PD has shown promising results in previous clinical trials. The current TRANSEURO study is re-examining this treatment method with the aim of minimising side effects and measuring efficacy.

Scientists can now make dopamine-producing neurons from both human embryonic stem cells and human induced pluripotent stem cells . Neurons made from human ESCs and iPSCs mature into human dopamine-producing neurons, survive and function after transplantation into mouse, rat and monkey models of PD.

What are the challenges?

• Acknowledgements and references

Replacing lost cells

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Is Early Diagnosis Possible

Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.

Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.

For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.

Parkinson’s Disease and Movement Disorders Center

Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.

Medical Treatment Of Parkinsons Disease

Enormous progress has been made in the treatment of Parkinsons disease over the past half century, but levodopa remains the most potent drug for controlling PD symptoms . Prior to instituting medical therapy, a correct diagnosis of PD must be established and the level of impairment determined . Each patients therapy is to be individualized, and diverse drugs other than levodopa are presently available. Among these are the dopamine agonists , catechol-o-methyl-transferase inhibitors and nondopaminergic agents . Head-to-head comparisons of drugs within classes are rare, and the differences that have emerged are related to the effects on motor fluctuations, dyskinesias, on/off times and adverse effects of the specific agents within each class .

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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.

Is Parkinsons Disease Inherited

Scientists have discovered gene mutations that are associated with Parkinsons disease.

There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

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