Parkinson's Disease: Symptoms, Causes and Effective Strategies 

The human brain is incredibly complex, and Parkinson's disease is a tough opponent that medical experts have studied for a long time. It causes many symptoms that make everyday life difficult for patients and their families.  

India is home to nearly 0.58 million people living with Parkinson's disease as estimated in 2016, with an expected major increase in prevalence in the coming years. Despite the many affected people, insights into the underlying genetic and environmental risk factors specific to the Indian population are limited. 

Similarly, in Thailand, the prevalence of patients with Parkinson's Disease is 0.24%, which means approximately 170,000 Thai citizens have Parkinson's Disease.

Dealing with the challenges of Parkinson's requires a lot of strength and perseverance. The increasing burden of Parkinson's disease represents a significant public health challenge, particularly for developing countries.

What is Parkinson's Disease?

Parkinson's disease, a brain disorder, causes uncontrollable or unintended movements, such as stiffness, shaking, and difficulty with balance and coordination. Early signs of this disorder can include a slight tremor in one hand, stiffness, and slow movements.

Neurological issues are often left unattended in many parts of the world due to a shortage of doctors. This causes some individuals to suffer from increased illness and stigma compared to others.

In the early stages of the disease, your speech may become soft or slurred, your face may show little or no expression, and your arms may not swing when you walk. As the condition advances over time, the symptoms become more severe.

Although the disease cannot be cured, medications might significantly improve your symptoms. Occasionally, the doctor may advise surgery to regulate certain regions of your brain and improve the symptoms.

Watch below Prof. Dr. Ahmet Hilmi Kaya explain Parkinson's Disease & Essential Tremor Surgery:

What are the Symptoms of Parkinson's Disease?

The symptoms are different for everyone. While the early mild symptoms may go unnoticed, the later symptoms are worse and affect the limbs on both sides.

The symptoms of Parkinson's disease may include the following:

• Tremor: Tremors usually begin in a limb, often your fingers or hand. One may rub their thumb and forefinger back and forth, and the hand may tremble at rest.
• Slowed movement (bradykinesia): The disease may slow your movement, making even the simplest tasks difficult and time-consuming. It may be challenging to get out of a chair, or you may drag your feet when you are walking.
• Rigid muscles: Muscle stiffness, occurring in any part of the body, can be painful and limits the range of motion.
• Impaired posture and balance: Parkinson's disease may cause stooped posture and balance issues or falls.
• Loss of automatic movements: You may be unable to perform unconscious movements, such as smiling, blinking, or swinging your arms while walking.
• Speech changes: You may speak quickly, softly, slur, or hesitate before talking.
• Writing changes: Writing may be hard, and your writing may appear small.

What are the Causes of Parkinson's Disease?

Parkinson's disease is characterized by various symptoms resulting from decreased neurons responsible for producing the brain chemical messenger dopamine. The decreased levels of dopamine result in irregular brain activity, further leading to movement problems and other Parkinson's disease symptoms.

The causes of Parkinson's disease are unknown, but several factors appear to play a role, such as:

• Genes: Certain gene variations appear to increase the risk of Parkinson's disease.
• Environmental triggers: It's possible that being exposed to certain toxins or environmental factors could slightly increase the chances of developing Parkinson's disease later on. However, the risk is still relatively low.

Many changes have been reported to occur in the brains of people with Parkinson's disease, which include the following:

• The presence of Lewy bodies: Clumps of Lewy bodies within brain cells are microscopic markers of Parkinson's disease. 
• Alpha-synuclein found within Lewy bodies: In a clumped form, a widespread protein called alpha-synuclein is found in all Lewy bodies. Cells cannot break down this protein.

What are the Risk Factors of Parkinson's Disease?

Risk factors for Parkinson's disease include the following:

• Age: It is uncommon for young adults to suffer from Parkinson's disease. Typically, this condition develops in individuals who are 60 years old or above.
• Heredity: Having a close relative with the disease increases your chances of developing the same. 
• Sex: Women are less likely to develop Parkinson's disease than men.
• Exposure to toxins: Chemicals such as pesticides and herbicides may increase your risk of Parkinson's disease.

What are the Complications of Parkinson's Disease?

Parkinson's disease is often accompanied by some additional problems, which may be treatable, including:

• Thinking difficulties: In the later stages of the disease, you may experience cognitive problems like dementia and thinking difficulties. Medicines don't usually help with such cognitive problems.
• Depression and emotional changes: Sometimes, one may experience depression very early. One may also experience other emotional changes, such as anxiety, fear, or loss of motivation. 
• Eating and chewing and problems: Late-stage disease affects the muscles in the mouth, further making chewing difficult and leading to choking and poor nutrition.
• Swallowing problems: As the condition progresses, you may develop difficulties with swallowing. The saliva accumulating in your mouth due to slowed swallowing leads to drooling.
• Sleep problems and sleep disorders: Patients often have sleep problems, including waking up early, frequently during the night, or falling asleep during the day.
• Constipation: Many patients with Parkinson's develop constipation due to a slower digestive tract.
• Bladder problems: This disease can result in issues with the bladder, such as the inability to regulate urine or experiencing challenges when urinating.

You may also experience:

• Lightheaded or dizzy when you stand due to a sudden drop in your blood pressure.
• Problems with your sense of smell and trouble identifying certain odors.
• Fatigue and loss of energy, especially later in the day. 
• Pain, either in specific areas of their bodies or throughout their bodies.
• Decreased sexual desire or performance.

What is the Cost of Treatment for Parkinson's Disease?

Nearly all patients in India have access to affordable treatment. India, known for its highly skilled medical professionals, gains patients from all over the globe to seek treatment.

Compared to most Western countries, the cost of treatment in India is significantly lower. The cost of treatment in India can be one-third the cost in other countries while giving the same quality of treatment.

Similarly, countries like Thailand or Turkey allow patients to save significant money while benefiting from world-class medical treatment. Patients can access advanced clinical care and top-notch facilities unavailable in many countries. 

Deep Brain Stimulation (DBS) Surgery costs around 13000 USD to 25000 USD in India, while the same costs around USD 25000 in Turkey and costs USD 70000 in Thailand.

What Treatment Options are Available for Parkinson's Disease?

Although the disease cannot be cured, medicines can help control the symptoms. Surgery can also be advised in some more advanced cases.

Medications for Parkinson's Disease

Medicines help manage problems with movement, walking, and tremor. These medicines increase or substitute for dopamine. Medicines your care team may prescribe include:

1. Carbidopa-levodopa (Rytary, Sinemet, Duopa, others):

   • Levodopa, the most effective medicine, is a natural chemical that passes into the brain and gets converted to dopamine.

   • Combined with carbidopa, Levodopa protects from early conversion to dopamine outside the brain. 

2. Inhaled carbidopa-levodopa:

   • This helps manage symptoms that occur when orally taken medications abruptly cease to be effective during the day.

3. Carbidopa-levodopa infusion:

   • Carbidopa and levodopa administered through a feeding tube deliver the medicine in a gel form directly to the small intestine.

4. Dopamine agonists: 

   • These mimic the effects of dopamine in the brain.

   • Although they last longer, they are not as effective as levodopa

   • They may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

5. Monoamine oxidase B (MAO B) inhibitors: 

   • These prevent brain dopamine breakdown by inhibiting the activity of the enzyme monoamine oxidase B.

6. Catechol O-methyltransferase (COMT) inhibitors:

   • These substances slightly extend the duration of the effects of levodopa treatment by inhibiting an enzyme responsible for dopamine breakdown.

7. Anticholinergics:

   • They are used to help control the tremor associated with Parkinson's disease.

8. Amantadine:

   • Amantadine may be prescribed alone to relieve symptoms of mild, early-stage Parkinson's disease temporarily. 

   • It also may be given with carbidopa-levodopa during the late stage of the disease to control involuntary movements induced by carbidopa-levodopa.

9. Adenosine receptor antagonists (A2A receptor antagonists):

   • They target areas in the brain that regulate the dopamine response and allow more dopamine to be released. 

Surgical Procedure for Parkinson’s Disease Treatment

Deep Brain Stimulation (DBS) is mostly offered to patients with advanced disease who have unstable responses to levodopa. The surgical procedure can stabilize medicine fluctuations, reduce or halt involuntary movements, reduce rigidity, reduce tremors, and improve movements.

DBS is not helpful for patients that do not respond to levodopa therapy apart from tremors. 

Although DBS may provide sustained benefits for Parkinson's symptoms, it does not keep the disease from progressing.

Advanced Treatments for Parkinson’s Disease

MRI-guided focused ultrasound (MRgFUS), a minimally invasive treatment, helps manage tremors. A brain MRI is used to guide ultrasound treatment for tremors. The high-temperature ultrasound waves target and burn the specific areas in the brain that contribute to the tremors.

Key Takeaway

Neurological disorders such as Parkinson's display in many ways, often leading to physical, cognitive, and emotional challenges. Advancements in medical science and treatment options offer hope for millions worldwide suffering from Parkinson's disease.