Experts Explore Which Of The Existing Strategies To Slow Down Or Stop The Processes Of Parkinsons Disease Are Most Likely To Be Successful Over The Next 20 Years
Understanding of the processes involved in Parkinsons disease degeneration has vastly improved over the last 20 years. Published in the Journal of Parkinsons Disease, authors Tom Foltynie, MBBS, PhD, Department of Clinical and Movement Neurosciences, UCL Institute of Neurology & The National Hospital for Neurology and Neurosurgery, UK, and J. William Langston, MD, Associate Director, Stanford Udall Center, Department of Pathology, Stanford University, USA, explain the progress of research.
Tremors Yes Parkinson’s Disease No
Essential tremor is often mistaken for Parkinson’s disease, but the two conditions differ in several ways. Essential tremor is an action tremor, meaning that the involuntary shaking increases when you move and try to use your hands. In Parkinson’s disease, tremors occur mainly at rest, and activity reduces the symptoms. Some people with essential tremor develop head nodding or shaking few people with Parkinson’s do. Balance problems and rigidity of the arms and legs are common features of Parkinson’s disease but not of essential tremor. One of the hallmarks of essential tremor, useful in diagnosing the disorder, is that alcohol can temporarily ease symptoms in Parkinson’s, alcohol has little effect on the tremor.
Parkinson’s disease is marked by a progressive loss of brain cells that produce dopamine, a chemical messenger that enables normal body movements. Essential tremor also appears to involve a disruption in the activity of motor pathways, but it’s uncertain whether there is any loss of brain cells. Postmortem examinations of brain tissue taken from people with essential tremor reveal various abnormalities in the cerebellum and brainstem, including the loss of Purkinje cells, which produce an important neurotransmitter, called GABA. But the samples don’t all show the same changes, so the import of these findings is uncertain.
How Is It Diagnosed
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.
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Preventing Or Slowing Parkinsons Progression
Exercise
Thus far, physical activity throughout life is the one lifestyle factor with the strongest research support for reducing the risk of Parkinsons disease.
Aerobic exercise benefits brain health at a cellular level. It gets the heart beating faster, so that more oxygen is supplied to the brain this reduces inflammation and also improves cognitive function.
Studies which follow large groups of people over many years have found that there is a lower incidence of Parkinsons in those who reported moderate to high levels of physical activity in midlife. Persons who exercised regularly and did develop the condition experienced slower progression of symptoms.
Furthermore, studies of people with Parkinsons disease have shown that regular exercise could slow down progression and improve quality of life. It is self-evident that building up endurance, muscle strength, and balance in the early stages of Parkinsons will provide a reserve of physical function as the disease progresses.
Diet
The following are dietary guidelines, backed by some research, which may help to prevent Parkinsons or slow down disease progression:
Stress Reduction
Experts are currently theorizing that prolonged emotional stress might trigger Parkinsons disease. It is known that continuous high levels of adrenalin and cortisol, and the inflammation it causes, damages brain cells.
Who Is Affected By Tremor
About 70% of people with Parkinsons experience a tremor at some point in the disease. Tremor appears to be slightly less common in younger people with PD, though it is still one of the most troublesome symptoms. People with resting tremor usually have a more slowly progressing course of illness than people without tremor.
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How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover
The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.
Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1) Standing up from a chair
2) Free walking
3) Provoked pull test maneuver for balance
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Ways To Reduce Tremors For Parkinsons Disease
5 Ways to Reduce Tremors
Tremors are a common symptom associated with Parkinsons disease, a chronic progressive neurological disorder. Medical management may or may not help with reducing tremors so it is imperative to help patients find a specific way to combat tremors. Therefore, we are going to share with you tips that weve seen improve quality of life with patients, large groups of individuals, and our community. How great would it be for you to feel more confident in a crowd, eating in public, and attend family/grandchild/sporting events? With these 5 ways to reduce tremors for Parkinsons disease you can feel confident when out and about living your life to the fullest.
Each one of these tips can be individualized to you, because everyone has different symptoms. Maybe all, or just one with help you feel better, move better, and look better.
Tip 1: Flicks putting maximum range of motion and opening through the hands, acting as if you are throwing away your tremors with tons of effort. How to do this: close your hands and squeeze tightly, followed by throwing your hands out sideways and opening them maximally. This can be performed with just the hands, or with total arm involvement.
Tip 2: Punching with hands squeezed tightly and in a fist, throw a few punches in front of you giving them your best effort. How to do this: close your hands and squeeze tightly, raise your arms and straighten your elbows as you punch in front of you. Repeat with both arms.
Research To Improve Deep Brain Stimulation
Researchers are working to improve upon existing DBS devices and methods to help treat more symptoms and more people. Some researchers are putting electrodes in a different area of the brain the pedunculopontine nucleus to treat walking and balance problems that don’t typically improve with present-day DBS. Others are developing a “smart” DBS device that can record a person’s unique brain signals and deliver electrical stimulation only when needed, such as when symptoms return, rather than continuously, as the current systems do. This could help reduce side effects such as numbness and weakness and lengthen the battery life of the neurostimulator, which would result in a longer time between battery replacement procedures.
Scientists also are planning to test deep brain stimulation in the first years after a Parkinson’s diagnosis to see if the therapy may slow or stop disease progression. Testing in Parkinson’s models showed the therapy may help protect brain cells, and a small human trial showed motor symptoms improved after early-stage DBS.
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How Are Parkinsons Tremors Treated
Tremor can be unpredictable. Some experts say itâs the toughest symptom to treat with medication. Your doctor may prescribe medication for your tremors:
- Levodopa/carbidopa combination medicines . This treatment is a type of medication called a dopamine agonist. Itâs usually the first treatment for Parkinsonâs.
- Propranolol . This drug is also used to treat high blood pressure, heart disease, and migraine.
- Clozapine . This medication is also used to treat schizophrenia. It requires weekly blood tests for the first 6 months.
Those taking levodopa/carbidopa may occasionally experience OFF periods in which their symptoms return. There are treatment options during these periods including a powder form of levopoda which can be inhaled or the medications istradefylline or safinamide .
Check Medication Side Effects
While tremors occur as a normal symptom of Parkinsons, there are medications that can make them worse, including some antidepressants, tranquilizers, and anti-asthma drugs. If your loved ones tremors have suddenly worsened after starting a new medication, it may be helpful to check the listed side effects and discuss the symptoms with your loved ones physician.
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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.
How Is Essential Tremor Treated And Is There A Cure
Theres no cure for essential tremor, but there are ways to treat it. The main treatment options are medications, assistive devices, botulinum toxin, deep brain stimulation and focused ultrasound. Your healthcare provider may recommend deep brain stimulation or focused ultrasound if other treatments arent enough to help your tremors.
- Medication: The most common medications, taken either on their own or in combination, to treat essential tremor are beta-blockers like propranolol and anti-seizure drugs like primidone.
- Adaptive devices: Many devices have been developed to improve tremor control, such as weighted items, tremor-canceling devices, vibration devices and peripheral nerve stimulation.
- Botulinum toxin: This involves injection into the tremoring muscles to temporarily weaken the muscles and lessen tremor severity.
- Deep brain stimulation: This is a surgery to implant a device that delivers electrical impulses to a specific part of your brain. The electrical impulses interrupt the signals that cause essential tremor muscle movements. This can improve tremors on both sides of your body.
- Focused ultrasound: This procedure uses ultra-high-frequency sound waves focused onto a single point in your brain involved in the production of tremor, destroying the targeted tissue. This destruction can greatly reduce the severity of the tremor and improve hand steadiness. This can improve tremors on only one side of your body.
Complications/side effects of treatments
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Are My Tremors Associated To Parkinsons Disease
Several neurological conditions can cause tremors and having tremors does not necessarily mean you have Parkinsons disease.
Tremors associated to Parkinsons disease are resting tremors, which occur when the body part is inactive. This typically starts in one hand, fingers, or a foot. Tremors can also affect the jaw or tongue, which can lead to communication difficulties.
As with stiffness, Parkinsons tremors mainly affect one side of the body.
If you think you have resting tremors, consult your doctor. They will perform tests to exclude any other condition often confused with 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
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Reprogramming For Compound Validation
Since their initial work focused on patients skin cells, the team needed to validate their findings in dopaminergic brain cells, which are lost in Parkinsons. This can be particularly challenging because we cant easily take a brain biopsy from a patient, says Dr Mortiboys. The team therefore used a reprogramming technique utilising the patients skin cells to generate induced neuronal progenitor cells. We used a slightly modified protocol, which doesnt take the cells all the way back to being stem cells, explains Dr Mortiboys. Our method takes them to an intermediate, which can only become brain cell types. Crucially for us, it doesnt take them back to the embryonic state. The reason for this is that age is one of the biggest risk factors for Parkinsons and many other neurodegenerative conditions. We didnt want to wipe all the age-associated changes in the cell so, with this reprogramming technique, we retained the changes that had happened throughout the cells lifetime while still producing a high percentage of dopaminergic cells.
Once these cells had been cultured, the team studied their mitochondrial function and observed that they were far more defective in the patients brain cells than in their skin cells. This showed us that it did matter which cells we were looking at it really was a problem with the mitochondria in the dopaminergic brain cells, explained Dr Mortiboys.
Hand And Wrist Exercises
Your healthcare provider may refer you to a physical or occupational therapist for treatment or recommend exercises you can do at home.
Squeezing a stress ball or hand grip for two to 10 seconds, releasing, and repeating 10 times on each hand can be an easy exercise to incorporate into your day.
Rotating the wrists in a circular motion can keep tendons and ligaments flexible. Moving the hands with intention can keep synovial fluid from building up, which prevents or reduces tremors.
Curling a light hand weight with arms resting on a table and your palms facing up can also strengthen and fine-tune your muscle control.
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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 Parkinsons. 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.
Supplement Vitamin B1 And Magnesium
The deficiency of vitamin B1 and magnesium is one of the main reason leading to hand tremors. When the magnesium level in the body is low, muscle tremors and twitching can appear, followed by many other severe diseases such as insomnia, foot and leg cramps and shaking hands. Meanwhile, vitamin B1 is required for the nerve stimulation and metabolism of carbohydrates, making it important if you are looking for ways on how to stop hand tremors. You are advised to take in a sufficient amount of vitamin B1 and magnesium through your diet to reduce the shaking hands. These substances can be found easily in many types of food such as dark leafy greens, most types of nuts and pumpkins seeds. By adding these types of food in your daily meal, you can ensure the required intake that will help you to deal with the condition.
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How Soon After Treatment Will I Feel Better And How Long Does It Take To Recover
The recovery time from the various treatments depends on many factors, especially the treatments themselves. The best source of information about your situation is your healthcare provider because they can consider all the factors and give you information thats relevant to your specific case and circumstances.
What Are The Treatments For Tremor
There is no cure for most forms of tremor, but there are treatments to help manage symptoms. In some cases, the symptoms may be so mild that you do not need treatment.
Finding the right treatment depends on getting the right diagnosis of the cause. Tremor caused by another medical condition may get better or go away when you treat that condition. If your tremor is caused by a certain medicine, stopping that medicine usually makes the tremor go away.
Treatments for tremor where the cause is not found include
- Medicines. There are different medicines for the specific types of tremor. Another option is Botox injections, which can treat several different types.
- Surgery may be used for severe cases that do not get better with medicines. The most common type is deep brain stimulation .
- Physical, speech-language, and occupational therapy, which may help to control tremor and deal with the daily challenges caused by the tremor
If you find that caffeine and other stimulants trigger your tremors, it may be helpful to cut them from your diet.
NIH: National Institute of Neurological Disorders and Stroke
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