Who Gets Parkinsons Disease
Estimates vary, but about 1 million people are living with Parkinsons disease in the U.S. Doctors diagnose about 60,000 cases a year, most in people over age 60. Younger people can also get Parkinsons. About 5-10% of patients have young-onset Parkinsons disease, diagnosed before age 50.
About 15% of patients have Parkinsons-plus syndromes, also known as atypical Parkinsons. Medications may be less effective for these syndromes, which can lead to disability sooner.
Risk factors for Parkinsons disease include:
- Age: Risk increases with age. Average age at diagnosis is 65.
- Gender: Men are at higher risk.
- Environmental exposure: Lifetime exposure to well water, which may contain pesticide runoff, can increase risk. So can exposure to air particles containing heavy metals, such as in industrial areas.
- Family history: Having a close relative with the disease could increase your risk. Researchers have identified a dozen genes that may be linked to Parkinsons disease.
- Sleep disorder: People who act out their dreams are up to 12 times more likely to develop Parkinsons disease. Its not clear whether this condition, called REM sleep behavior disorder or RBD, is a cause or symptom of Parkinsons disease.
- Head trauma: Traumatic brain injury increases risk of Parkinsons, even years later.
Medicines For Parkinsons Disease
Medicines prescribed for Parkinsons include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinsons is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinsons should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Sedation And Regional Anesthesia For Deep Brain Stimulation In Parkinsons Disease
Dilek Yazicioglu
1Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Irfan Bastug Caddesi, Dskap, 06330 Ankara, Turkey
Academic Editor:
Abstract
Objective. To present the conscious sedation and the regional anesthesia technique, consisting of scalp block and superficial cervical plexus block, used in our institution for patients undergoing deep brain stimulation for the treatment of Parkinsons disease . Methods. The study included 26 consecutive patients. A standardized anesthesia protocol was used and clinical data were collected prospectively. Results. Conscious sedation and regional anesthesia were used in all cases. The dexmedetomidine loading dose was 1gkg1 and mean infusion rate was 0.26gkg1h1 . Propofol was used to facilitate regional anesthesia. Mean propofol dose was 1.68mgkg . Scalp block and superficial cervical plexus block were used for regional anesthesia. Anesthesia related complications were minor. Postoperative pain was evaluated mean visual analog scale pain scores were 0 at the postoperative 1st and 6th hours and 4 at the 12th and 24th hours. Values are mean . . Dexmedetomidine sedation along with scalp block and SCPB provides good surgical conditions and pain relief and does not interfere with neurophysiologic testing during DBS for PD. During DBS the SCPB may be beneficial for patients with osteoarthritic cervical pain. This trial is registered with Clinical Trials Identifier .
1. Introduction
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How Is Parkinson’s Disease Diagnosed
Someone with the symptoms of Parkinson’s disease may be sent to see a neurologist, a doctor who specializes in the brain, nerves, and muscles. The neurologist may do some tests, including a brain scan and blood tests. These tests will not make the diagnosis of Parkinson’s disease, but the doctor will want to make sure that there is no other problem causing the symptoms. To diagnose Parkinson’s disease, the doctor relies on a person’s medical history, symptoms, and a physical exam.
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 .
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How Is A Diagnosis Made
Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.
The Cerebellum As A Target For Parkinsons Disease Treatment
While cerebellar dysfunction might contribute to some motor and non-motor signs in Parkinsons disease, a possible approach for treating parkinsonian symptoms is to attempt to normalize cerebellar function. Surgical treatment, such as deep brain stimulation of the subthalamic nucleus or globus pallidus improves the motor signs and normalizes cerebellar activation. Levodopa administration can also normalize the activity and connectivity in the cerebello-thalamo-cortical circuit . However, whether it is reduced compensation or alleviation of pathological impairment as a consequence of effective treatment remains unclear. Suppressing cerebellar activity should theoretically answer the question: improvement would mean that the cerebellum is contributing to the manifestations worsening would mean that the cerebellar activity is compensatory. We suppose that if the main efforts of the cerebellum in Parkinsons disease are compensatory, suppression of cerebellar activity should be accompanied by further impairments of Parkinsons disease symptoms.
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How Are Neurons Affected
In general, PD involves damage to neurons throughout the nervous system, and neural damage and death in different areas of the body create unique symptoms:
- Damage to neurons in the brainstem, the area of the brain right above the spinal cord likely contribute to sleep symptoms including REM sleep behavior disorder
- The substantia nigra pars compacta contains dopamine neurons loss of neurons that produce dopamine causes impaired movement and balance
- Neurons of the olfactory bulb loss of olfactory neurons causes reduced sense of smell
- The locus coeruleus contains noradrenergic neurons noradrenergic neurons produce the neurotransmitter norepinephrine, which triggers the fight or flight response in the body damage to these neurons can cause anxiety
- The raphe nucleus contains serotonergic neurons serotonergic neurons produce the neurotransmitter serotonin, which has important roles in the movement of the intestines, sleep-wake cycles, and depression damage to these neurons is believed to cause depression in people with PD
- Amygdala damage to the neurons in the brains amygdala are believed to cause anxiety
- Autonomic nervous system – the autonomic nervous system controls many automatic functions, like breathing, heart beating, blood pressure, and the movements of the intestines damage to the autonomic nervous system can cause symptoms such as constipation, increased salivation and sweat, and reduced blood pressure1,2,5,6
How Is Psp Different From Parkinson’s Disease
PSP is often misdiagnosed as Parkinsons disease, especially early in the disorder, as they share many symptoms, including stiffness, movement difficulties, clumsiness, bradykinesia , and rigidity of muscles. The onset of both diseases is in late middle age. However, PSP progresses more rapidly than Parkinsons disease.
- People with PSP usually stand exceptionally straight or occasionally tilt their heads backward . This is termed axial rigidity. Those with Parkinson’s disease usually bend forward.
- Problems with speech and swallowing are much more common and severe in PSP than in Parkinson’s disease and tend to show up earlier in the disease.
- Eye movements are abnormal in PSP but close to normal in Parkinson’s disease.
- Tremor is rare in PSP but very common in individuals with Parkinsons disease.
Although individuals with Parkinson’s disease markedly benefit from the drug levodopa, people with PSP respond minimally and only briefly to this drug.
People with PSP show accumulation of the protein tau in affected brain cells, whereas people with Parkinsons disease show accumulation of a different protein called alpha-synuclein.
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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.
What Treatments Are Available
Many Parkinson’s patients enjoy an active lifestyle and a normal life expectancy. Maintaining a healthy lifestyle by eating a balanced diet and staying physically active contributes to overall health and well-being. Parkinson’s disease can be managed with self-care, medication, and surgery.
Self careExercise is as important as medication in the treatment of PD. It helps maintain flexibility and improves balance and range of motion. Patients may want to join a support group and continue enjoyable activities to improve their quality of life. Equally important is the health and well being of the family and caregivers who are also coping with PD. For additional pointers, see Coping With Parkinsons Disease.
These are some practical tips patients can use:
Medications There are several types of medications used to manage Parkinson’s. These medications may be used alone or in combination with each other, depending if your symptoms are mild or advanced.
After a time on medication, patients may notice that each dose wears off before the next dose can be taken or erratic fluctuations in dose effect . Anti-Parkinsons drugs can cause dyskinesia, which are involuntary jerking or swaying movements that typically occur at peak dosage and are caused by an overload of dopamine medication. Sometimes dyskinesia can be more troublesome than the Parkinsons symptoms.
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How Is Psp Diagnosed
Currently there are no tests or brain imaging techniques to definitively diagnose PSP. An initial diagnosis is based on the persons medical history and a physical and neurological exam. Identifying early gait problems, problems moving the eyes, speech and swallowing abnormalities, as well as ruling out other similar disorders is important. Diagnostic imaging may show shrinkage at the top of the brain stem and look at brain activity in known areas of degeneration.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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Learn More About Parkinsons Disease
Parkinsons Disease: The Essentials
If youre new to Parkinsons disease and would like a good overview to help you better understand the disease, please view our Parkinsons Disease: The Essentials presentation. Its a great place to get started with reliable and concise information.
Causes
The exact cause of Parkinsons is still unknown, but there is an enormous amount of research being done to learn more. This research has led scientists to formulate a number of theories on the cause of this disease.
Diagnosing
While there is no definitive test that can be taken to determine whether a person has Parkinsons disease, movement disorder specialists look for symptoms and use brain imaging technology to accurately diagnose Parkinsons.
Symptoms
Even though Parkinsons is classified as a movement disorderand its motor symptoms are the most discussed and well-knownthere are many non-motor symptoms that display in people with Parkinsons as well.
Treatments
As of today, there is no cure for Parkinsons disease. But there are many ways in which the disease can be treated to make symptoms more manageable.
The Subthalamic Nucleus A Nerve Center Near The Substantia Nigra
Parkinson s disease brain areas affected. Symptoms generally develop slowly over years. In parkinson s disease certain nerve cells neurons in the brain gradually break down or die. Areas most often affected include. It is named after dr james parkinson who first described the condition in 1817.
When the neurons die or become impaired they produce less dopamine which causes the movement problems of parkinson s. Is responsible for parts of motor control also has other functions. Hence the popular name jitters. People with parkinson s disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements.
Parkinson s disease affected brain regions and associated neurological dysfunctions. Normally these neurons produce an important brain chemical known as dopamine. Parkinson s disease occurs when nerve cells or neurons in an area of the brain that controls movement become impaired and or die. There are three areas of the brain that most affected.
Parkinson s disease occurs because of a deterioration of neurons in an area of the brain called the basal ganglia. Parkinson s is a condition that causes the gradual loss of the dopamine producing brain cells of the substantia nigra an area of the brain located just above where the spinal cord meets the. The disease affects the brain inhibits the body s movement and causes involuntary movement and tremors. It is progressive and symptoms worsen over time.
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How Does Parkinson’s Affect The Body
The telltale symptoms all have to do with the way you move. You usually notice problems like:
Rigid muscles. It can happen on just about any part of your body. Doctors sometimes mistake early Parkinson’s for arthritis.
Slow movements. You may find that even simple acts, like buttoning a shirt, take much longer than usual.
Tremors. Your hands, arms, legs, lips, jaw, or tongue are shaky when you’re not using them.
Walking and balance problems. You may notice your arms aren’t swinging as freely when you walk. Or you can’t take long steps, so you have to shuffle instead.
Parkinson’s can also cause a range of other issues, from depression to bladder problems to acting out dreams. It may be a while before abnormal movements start.
The Substantia Nigra And Movement
The reason that Parkinsons causes movement symptoms is that the substantia nigra makes up part of the circuitry, called the basal ganglia, that the brain uses to turn thought about movement into action.
The structures of the basal ganglia.
The substantia nigra is the master regulator of the circuit, it mainly communicates using the chemical dopamine, but other chemical transmitters are also used to communicate between other areas of the basal ganglia.
The balance of signals being sent between these structures allows us to control movement. But as Parkinsons progresses, and the dopamine-producing brain cells in the substantia nigra are lost, movement symptoms appear. Without enough dopamine, it becomes harder to start and maintain movements, which leads to symptoms such as slowness of movement, rigidity and freezing. And an imbalance of signals in the basal ganglia means people with Parkinsons can experience what is known as a resting tremor.
But while this is the description of Parkinsons you may find in most textbooks, it is now recognised that changes are not limited to the substantia nigra and basal ganglia.
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Living With Parkinson’s Disease
Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:
- choosing to lead a healthy lifestyle
- making informed decisions related to your treatment
- keeping a diary of your symptoms in preparation for meetings with health and social care professionals
- attending a self-management course