Parkinson's disease

Parkinson's disease is a disease of the central nervous system disorder that causes the body movements, including:

• tremors

• Muscle stiffness (increase in muscle contraction)

• slow body movements

• unstable posture

• difficulty in walking

Parkinson's disease develops when certain nerve cells (neurons) die brain. These neurons produce a chemical known as dopamine helps to transmit messages between areas of the brain that control movement of the body. When these dying neurons are produced abnormally low levels of dopamine, which complicates the control of muscle tension and movement.

Parkinson's disease can manifest itself from the age of 40, being more frequent after 60 years. A small number of patients have Parkinson's disease with early onset, which is characterized by onset of symptoms before age 40. This disease can affect more than 12,000 patients in Portugal and is more frequent in males.

Having a close relative who has been diagnosed with Parkinson's disease at an early age increases the risk of suffering from this disease. The risk is less if the family is affected older at diagnosis.

Prevention

There is still much to discover about the cause of Parkinson's disease and there is no known way to prevent this disease.

Treatment

There is no cure for Parkinson's disease but its symptoms can be treated with various types of drugs.

When the forms are not very disturbing medication may not be required. Early treatment can increase the likelihood of side effects and other late complications of medication but on the other hand, it is known that some patients treated early outperform later.

Treatment usually starts when:

• manifestations interfere with work, carrying out household chores and other activities

• difficulty in walking and loss of balance are significant.

Medicines

The medications used to treat Parkinson's disease:

• increase levels of dopamine in the brain

or

• mimic the effects of dopamine.

The most effective drug for Parkinson's disease is levodopa, which is converted to dopamine in the brain. In general, levodopa is prescribed in combination with another drug that increases the amount of levodopa reaches the brain and which decreases the side effects of levodopa: carbidopa or benzerazida. There are combinations of levodopa + carbidopa and levodopa + benserazide in a single tablet.

Virtually all individuals with Parkinson's disease improve after they started taking levodopa. However, long term use may eventually have side effects and complications, particularly loose effectiveness and cause involuntary movements that can be debilitating and painful (dyskinesias). Often, doctors need to adjust the frequency and dose of levodopa for the patient to continue taking this medicine.

Different drugs may be used alone or in combination with levodopa to treat the symptoms of the disease.

For minor manifestations of Parkinson's disease, amantadine may be useful by blocking glutamate receptors, which is a neurotransmitter that can contribute to motor dysfunction that occurs in this disease.

Anticholinergic medicines (tri-hexifenidilo and biperiden) also help relieve mild manifestations of Parkinson's disease at an early stage. The anticholinergic drugs are particularly effective against tremor but may cause side effects, including confusion and hallucinations, particularly in elderly patients.

Another option for treating Parkinson's disease at an early stage is a monoamine oxidase B (MAO-B) such as selegiline and rasagiline. The MAO-B inhibitors potentiate the efficacy of the dopamine that is still produced by the brain and may delay the need to administer more potent drugs. Finally, people being treated with an inhibitor of MAO-B will eventually need a drug containing levodopa.

The drugs called protease inhibitors of catechol-O-methyltransferase (COMT) inhibitor may be used in combination with levodopa. The COMT inhibitors such as entacapone, prolong the action of dopamine in the brain and also increase the effectiveness of levodopa. When it is assigned a COMT inhibitor, the physician generally reduces levodopa.

Dopamine agonists stimulate dopamine receptors, increasing its ability to capture this neurotransmitter. Some of the commonly prescribed dopamine agonists are bromocriptine, ropinirole, piribedil the, pramipexole and dihydroergocryptine? may be used alone to delay or need to administer levodopa may be administered concomitantly with levodopa to improve their efficiency and reduce their dose. Elderly patients are particularly sensitive to these drugs, which can cause confusion, hallucinations and weakness due to a decrease in blood pressure.

Depression is a common problem in Parkinson's disease, many patients may benefit from treatment with antidepressant drugs.

Regular exercise and a balanced diet can help improve the overall feeling of well-being and control the patient's body.

Surgery

Surgery is considered when patients fail to respond well to medications. Surgical options include:

• Deep brain stimulation, electrodes are placed (a kind of pacemaker) in the basal ganglia of the brain (which is the origin of Parkinson's Disease). It is possible to activate the system according to the manifestations of the patient. If surgery does not work and does not improve the complaints, it is possible to remove the electrodes.

• destruction needs certain area of ​​the basal ganglia of the brain: the nucleus pallidus (pallidotomy) or the thalamus (thalamotomy). Allows generally reduce motor dysfunction.