Treatment of Parkinson's disease improves the quality of life of patients. To treat Parkinson's disease, we use drugs that affect the level of the brain, and in this disease we may resort to surgical treatment.
Parkinson's disease
Parkinson's disease (PD) is a neurodegenerative disease (chronic degenerative), and it is known that nerve cells when they die cannot be replaced and therefore there is no cure for Parkinson's disease.
The treatment of Parkinson's disease depends on controlling the symptoms that are caused by the loss of substantia nigra neurons in the brain and the lack of dopamine in the body.
The treatment of Parkinson's disease is classified into pharmacological treatment and surgical Parkinson's treatment, according to the stage of the disease and the severity of its progression.
Read more about: How to prevent Parkinson's disease before it happens.
Pathogenesis of Parkinson's disease
Parkinson's disease is caused by a buildup of mutated (abnormal) proteins produced by the body that lodge in nerve cells located in the substantia nigra region of the brainstem, often beginning in the 60s.
These neurons are responsible for the production of neurotransmitters that control the patient's muscles in the states of movement and rest, so their loss leads to the appearance of symptoms of Parkinson's disease such as tremor (shaking and trembling) and slow movement.
Other diseases and injuries may affect the areas that control movement and cause Parkinson's disease. These injuries include strokes or taking medications that affect chemical neurotransmitters in the brain.
Read more about: Causes and symptoms of Parkinson's disease.
Parkinson's disease diagnosis
Parkinson's disease is diagnosed clinically by listening to the patient's medical history in addition to doing a neurological examination for Parkinson's disease. CT scans and magnetic resonance imaging are not useful in detecting Parkinson's disease.
Early Parkinson's disease may be detected using modern add-on computed tomography (CT) techniques, which are based on detecting dopamine levels in the brainstem of the central nervous system.
If we see Parkinson's disease at an early age, we should suspect some genetic diseases and syndromes, such as Wilson's disease and Huntington's chorea disease.
Parkinson's disease drug treatment
Parkinson's disease is often treated with medication. The goal of treatment is to relieve symptoms, not complete recovery. The treatment is based on replacing the lack of dopamine in the nervous system, and thus the removal of motor symptoms.
Early Parkinson's disease treatment
The early stages of Parkinson's disease are treated with drugs that can enter the central nervous system and act as dopamine to relieve the motor symptoms of the disease.
Treating Parkinson's disease with levodopa
Levodopa works by entering the brain and converting it to dopamine (we don't give dopamine directly because it can't get into the brain).
Levodopa is considered the best drug to treat Parkinson's disease, but it is not given alone. A compound called carbidopa is given with it. This compound prevents the breakdown of levodopa in the peripheral system and ensures its safety until it reaches the brain.
It is given at a dose of 300-600 mg per day divided into 3 or 4 doses, and although it is considered the most efficient among the drugs, levodopa provides a treatment of neurological symptoms for only 4 to 6 years.
Subsequently, the side effects of using the drug appear and include dyskinesia, nausea and vomiting, and we may see orthostatic hypotension or worsening of hallucinations and delirium.
In addition to the lack of benefit from levodopa in improving the non-motor symptoms of the disease, thus, various drugs are prescribed for these symptoms aimed at relieving these symptoms.
MAO-B . Inhibitors
Including selegiline (5 mg per day in the morning), rasagiline, these drugs are used to treat Parkinson's disease by stopping the process of dopamine breaking down (which takes place naturally) in the nervous system and thus increasing its levels in the brain.
It is used in the treatment of early stages of Parkinson's disease and provides milder side effects than levodopa and may last longer than in the treatment of motor symptoms.
Dopamine receptor agonists
Ropinirole, pramipexole provides moderate control of motor symptoms, but it does not have side effects similar to those of levodopa. However, it is not without side effects, as it causes:
- Drowsiness and sleep during the day
- hallucinations
- edemas
Anti-acetylcholine drugs
It is especially effective in treating tremors in Parkinson's patients, but it has many side effects such as dry mouth and difficulty urinating, the most important of which are: Orphenadrine, Trihexyphenidine.
amantadine
An antiviral that has anti-parkinsonian properties, so it is used in the treatment of Parkinson's disease. It is given at a dose of 100 mg per day and gradually increased to 300 mg per day.
neuroprotectors
It is one of the latest methods of treating Parkinson's disease and is still being studied, and its mechanism of action in treatment includes stopping the progression of the disease by ending the death of neurons in the substantia nigra, or at least slowing this process.
It may also be able to reverse the progression of Parkinson's disease by generating new neurons, these drugs are still under trial and not yet on the market.
Treatment of non-motor symptoms of Parkinson's disease
The non-motor symptoms of Parkinson's include depression, sleep disturbances, dementia, loss of mental judgment, impotence, orthostatic hypotension and constipation. The troublesome symptoms of the patient are treated with the following:
- Sildenafil: It is used to treat impotence.
- Polyethylene glycol: treatment of constipation.
- Modafinil: It is used to treat daytime sleep.
- There are studies on the possibility of treating some non-motor symptoms with levodopa.
Late Parkinson's disease treatment
Before resorting to surgical treatment when Parkinson's disease develops, we may also use some medications or change the way they are given and prescribe and a higher dose than them to control its symptoms.
COMT . Inhibitors
This enzyme inhibitors are also used to treat progressive Parkinson's disease. This enzyme breaks down dopamine in the brain (normally) so that stopping its action makes more dopamine available to the nervous system.
Surgical treatment of Parkinson's disease in Turkey
In the past, the surgical treatment of Parkinson's disease included disruptive surgical interventions to specific areas of the brain as a treatment, which leads to the improvement of some motor symptoms, but it may lead to injuries and varying results for patients.
Treatment of Parkinson's disease with deep brain stimulation (DBS) in Turkey
If the Parkinson’s patient has reached advanced stages and the disease has progressed and has become unresponsive to drug treatment or had side effects to the medications used, then he will resort to surgical treatment.
It includes deep brain stimulation Connecting electrical wires to a battery placed in the chest (implantable device). These wires connect to specific areas in the deep brain. These areas contain gatherings of neurons responsible for regulating movements.
By stimulating these areas, we give an order for these cells to either activate or stop and inhibit (not working) according to the therapeutic goal and according to the area in which this wire is implanted.
We reach these areas by drilling small holes in the skull and inserting wires through them (the electrical current passing through is light and harmless and the patient does not feel it). This operation is one of the most famous treatment methods that have been conducted today.
This operation in Turkey has shown great success for the treatment of progressive Parkinson's disease in terms of controlling symptoms and improving the quality of life of people who have had this disease.
Advantages of this medical procedure performed by a neurosurgeon include:
- It does not involve destructive interference with any brain tissue.
- We can remove them if they fail without any significant effect.
- We can adjust the electrical impulses used (harmless) according to the development and progression of Parkinson's disease (disease severity) or if any side effects appear.
- This operation can be performed on both hemispheres of the brain without any disadvantages.
Recently, tests are being conducted to treat Parkinson's disease in Turkey using embryonic (stem) grafts or giving growth factors (a substance to stimulate the proliferation of neurons) in dead places and recovery from Parkinson's disease.
If you are complaining of advanced Parkinson's disease, contact us. Bimaristan Medical Center will guide you to the most experienced and efficient doctors in Turkey to treat your Parkinson's disease. The treatments that the center guides you to are the most advanced.
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