Parkinson’s Disease belong to the Extrapyramidal Syndromes, along with other atypical parkinsonian syndromes. Parkinson’s disease is a common, chronic neurodegenerative disease, with motor and non-motor manifestations. Especially, because there are other parkinsonian syndromes that mimic features of Parkinson’s Disease but need different treatment, the correct diagnosis of the patient in the early stages is a diagnostic challenge. However, it is of great predictive and therapeutic importance and that is why it requires a specialized and experienced Neurologist.
The average age of onset of Parkinson’s is about 60 years and affects about 1% of people of this age. However, in about 10% of patients the diagnosis is made before the age of 50. There is also the juvenile form of the disease that occurs in people under 40 years of age. It is worth noting that 5-10% of total patients with Parkinson’s disease have a genetic background.
Parkinson’s Disease symptoms
The disease manifests itself frequently (about 2/3) but not always, with tremors (trembling – unless it is an idiopathic tremor) and stiffness. Another feature of the disease is the slowness in movements, especially in repetitive ones such as walking, which becomes slow and shuffling, and the decrease in facial expression. Parkinson’s Disease is accompanied by disorders of sleep and autonomic nervous system and can manifest itself with depression and anxiety. In the early stages it is combined with usually mild mental disorders, which with the progression of the disease, intensify.
The clinical picture of Parkinsonism can have many underlying causes such as cerebral vascular lesions (Vascular Parkinsonism), drugs (Drug Induced Parkinsonism), Hydrocephalus, as well as a number of other Neurodegenerative Diseases.
Parkinson’s Disease is a progressive one. Advanced disease has many motor and non-motor manifestations. Patients exhibit longer and more frequent off periods, when their symptoms are not adequately controlled. There are motor fluctuations with periods of inadequate response to oral medications and difficult to control involuntary movements, called dyskinesias. There may be freezing of gait and gait instability, as well as other mobility problems, neuropsychiatric disturbances and cognitive decline.
Diagnosis is based on appropriate history taking and clinical examination by an experienced neurologist since there is no laboratory test to confirm Parkinson’s Disease. Diagnosis is a clinical one.
If clinically indicated the treating neurologist can order further tests such as an MRI, a DAT scan (a nuclear medicine test to detect dopamine deficiency in the brain), etc.
There are many medications currently available. These do not cure the disease but offer considerable improvement in quality of life and stabilize symptoms for several years without delaying disease progression. Medical treatment is mostly, albeit not solely, based on replenishing dopamine levels in the brain using dopaminergic drugs.
Dopamine is a neurotransmitter produced by nerve cells in a specific brain area called substantia nigra. These nerve cells degenerate and slowly die, thereby causing dopamine deficiency. This deficiency is a target for replenishment through dopaminergic agents. The main dopaminergic drug is levodopa (L-Dopa) and other ones such as dopamine agonists. However long-term administration of L-Dopa is involved in complications such as motor fluctuations and dyskinesias.
In atypical parkinsonian syndromes, contrary to Parkinson’s Disease, there is limited or no response at all to dopaminergic therapies.
Invasive therapies for Parkinson’s Disease
There are several approved therapies to treat motor fluctuations in advanced Parkinson’s Disease. Such therapies are the pump for subcutaneous infusion of apomorphine, the pump for intrajejunal (intestinal) infusion of L-Dopa gel and Deep Brain Stimulation.
These therapies improve patient functionality, reduce tremor and dyskinesias.They also improve patient and caregiver quality of life. The surgical procedure for placement of a Deep Brain Stimulation System, in the hands of an experienced and properly trained neurosurgeon, has a favorable perioperative risk profile. After placement of a Deep Brain Stimulation System, the total daily dose of dopaminergic drugs can usually be lowered by about 25-50%, at least for a few years.
About the treatment
Dr Christos Sidiropoulos is highly specialized in the assessment for candidacy for advanced, invasive therapies for Parkinson’s Disease, either pumps or Deep Brain Stimulation. He has managed hundreds of patients with DBS systems. The intrajejunal placement of the port for the DuoDopa pump is managed by an associate Gastroenterologist, whereas the electrode placement for the DBS system is done by a highly skilled associate Neurosurgeon. The pump for subcutaneous apomorphine infusion is less invasive and can be managed by the patients themselves after appropriate training for a nurse educator deployed by APOCARE.