Are there any treatments for Parkinson's disease

Psychiatry, Psychosomatics & Psychotherapy

Therapy or treatment of Parkinson's syndrome

Since idiopathic Parkinson's syndrome is a progressive disease, the goals of treatment are to maintain the patient's independence in family, work and society for as long as possible, to restore the quality of life, to prevent the need for care and to prevent concomitant diseases (e.g. internal or orthopedic nature ) and to avoid further complications.

When choosing the drug, the attending physician takes into account various aspects. The stage of the disease, symptoms, age and activity level of the Parkinson's patient as well as the effectiveness and tolerability of the drug all influence the decision. A good doctor-patient relationship is of fundamental importance in finding the right therapy. The doctor and patient should always decide together which form of therapy is suitable.

The most effective drug for the treatment of true Parkinson's disease is levodopa (L-dopa or chem. L-3,4-dihydroxyphenylalanine). It occurs naturally in plants and animals. However, the drugs used are exclusively manufactured industrially. The body absorbs L-Dopa into the nerve cells and uses it to produce dopamine. Dopamine itself cannot be given as a drug because it does not cross what is known as the blood-brain barrier. This means that the active ingredient reaches the blood vessels of the brain, but cannot complete the last step into the nervous tissue. This is prevented by a special barrier that is supposed to protect the brain from harmful substances. L-dopa is usually combined with carbidopa. Carbidopa prevents L-dopa from being converted to dopamine before it even reaches the brain. This will prevent some undesirable effects such as nausea and vomiting and the amount (dose) of L-dopa needed for treatment may be lower.

The majority of patients experience a significant improvement in their symptoms in the early stages of the disease after one month of therapy with approx. 300 mg L-Dopa per day. A lack of symptom relief speaks against the presence of true Parkinson's disease in its early stages.

L-Dopa can cause so-called dyskinesias. These are involuntary jerks and jerky movements that the patient cannot prevent. The frequency and severity usually continue to increase with continued treatment with L-dopa. Because of this side effect, L-Dopa is usually only used later in the course of the disease in patients under 70, and therapy with a so-called dopamine agonist is recommended beforehand.

As an alternative to L-Dopa therapy, so-called dopamine agonists are often prescribed. These molecules are chemically very similar to dopamine and act in the body like the natural messenger substance or on parallel receptors. Dopamine agonists are less effective than L-dopa. Today dopamine agonists are administered as the sole means (monotherapy) at the beginning of treatment in younger patients. Although dopamine agonists are similar to L-Dopa, they have different side effects from L-Dopa. These differ from dopamine agonist to dopamine agonist. Basically, the multitude of remedies offers the patient the chance to find the drug that is best tolerated for him. Here, side effects that reduce tolerability must be distinguished from complications that seriously endanger the patient's health.

There are other drugs that, among other things, support the effectiveness of L-Dopa and thus reduce its side effects. So-called COMT inhibitors and MAO-B inhibitors delay the breakdown of L-Dopa and dopamine in the body. Active substances (NMDA antagonists, anticholinergics) that influence messenger substances downstream of dopamine (increased glutamate or acetylcholine concentration) are also available for the treatment of Parkinson's disease.

Physiotherapy is a very important part of treating Parkinson's disease. The therapy promotes mobility, body stability and responsiveness. It can also prevent stiffening of joints (contracture) in patients at an advanced stage. Group therapy can also counteract the loneliness of the patient.

Some studies suggest that starting exercise treatments early can even reduce the dosages of drug therapy needed.

Speech therapy is an important therapeutic measure for improving speech disorders in Parkinson's syndromes. The muscles for voice volume, breathing technique and clear pronunciation are trained. Speech therapy improves oral communication with patients, which is an important prerequisite for maintaining social contacts.

If the patient shows signs of depression or psychosis, additional medication and possibly psychotherapeutic therapy is necessary.

Deep brain stimulation DBS is an established therapy method that has been used in around 100,000 patients worldwide for over 25 years. The indication for DBS should be made in a specialized center and can then be used if

  1. In the course of the disease there are fluctuations in mobility with overmobile (dyskinesia) or undermobile (hypokinesia) phases that lead to a reduction in quality of life and / or
  2. when a tremor is in the foreground of the symptom, which cannot be adequately influenced by drug therapy.

In DBS, electrodes are implanted stereotactically into deeper brain regions, and idiopathic Parkinson's syndrome is usually the subthalamic nucleus (STN) or the pars interna of the globus pallidus (GPi). With the help of an implanted pulse generator, individually controllable electrical stimulation takes place in the corresponding regions. This leads to a change in the pathologically disturbed activities of nerve cells, which is then accompanied by a reduction in fluctuations in movement and / or tremors.

In several large studies it has been shown that the symptom reduction achieved is associated with a considerable improvement in the quality of life for those affected. Although deep brain stimulation cannot cure Parkinson's disease, it usually provides many years of symptom relief. In addition, it is now known that a possible operation should be carried out at an early stage, i.e. before patients are restricted in their professional and social / family activities by the above-mentioned complaints. The treating neurologist will refer you to a specialized DBS center for treatment clarification and further information.

Early treatment beneficial

A cure for Parkinson's disease is currently not possible. However, through the use of medication and surgical procedures, a significant reduction in symptoms and an associated improvement in quality of life can be achieved. There is also scientific evidence that early use of the drug group of MAO-B inhibitors can even slow down the progression of the disease. In principle, effective treatment should therefore be started in good time, especially since this can also prevent accompanying complications (e.g. falls, pain, skeletal changes). The beginning and the choice of therapy should be discussed in detail with the patient by the treating neurologist. For example, the following aspects can be decisive:

  • To what extent does the disease lead to impairment at work or in everyday life,
  • Do social restrictions occur or
  • is there a decrease in the quality of life?

 

The drug and surgical treatment options can in part be very effectively accompanied by the use of physiotherapy and, if necessary, occupational therapy and speech therapy.

With well-adjusted therapy and an active and healthy lifestyle, the life expectancy of a Parkinson's patient is almost the same as that of a healthy person. It takes about 20 years on average to become dependent.

Technical support: Prof. Dr. Alfons Schnitzler and Priv.-Doz. Dr. Martin Südmeyer, Düsseldorf (DGN)