Idiopathic Parkinson's Disease - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Parkinson’s disease is a neurodegenerative disorder. The symptoms of Parkinson’s disease are bradykinesia (slow movements), resting tremors, rigidity, stiffness, and difficulty with posture and balance. The exact cause of Parkinson’s disease is unknown. Many genetic and environmental factors are involved in the causative factors. Environmental factors such as smoking, pesticide, and caffeine are the risk factors of the disease. The substantia nigra consists of the dopaminergic neurons that produce dopamine. Substantia nigra is present in the midbrain dopaminergic nucleus. Parkinson's disease is due to damage in the dopaminergic neurons of the substantia nigra. Symptoms appear gradually and worsen over time. The symptoms include difficulty in walking and talking, mental and behavioral changes, insomnia, depression, fatigue, and loss of memory.

What Is Idiopathic Parkinson’s Disease?

The term ‘idiopathic’ means unknown cause. The neurotransmitters play a role in the etiology of the disease. The damage in the brain cells is the cause of the disease. This can worsen over time. The causative factor of the disease is unclear. Idiopathic Parkinson’s is the most common cause of Parkinson's disease. However, scientists suspect that the deficiency in the neurotransmitters (dopamine) responsible for transmitting electrical impulses between the nerve cells is the reason behind the disease. Parkinson's is an idiopathic Parkinson's disease that can cause tremors (shaking movements of the body), rigidity (stiffness), and slow movement (bradykinesia). Medications are available to help control the condition.

What Causes Parkinson’s Disease?

In Parkinson's disease, there is damage in the basal ganglia (a group of structures in the brain's center that allows different brain areas to work together). Usually, these nerve cells produce dopamine. It is a group of structures located near the brain's center. The connections help different areas of the brain to work together. It manages the signals of the brain to move the muscles. The basal ganglia control the voluntary movements of the body. When the nerve cells are damaged or impaired, they produce less dopamine. Dopamine is essential for movement in the body. There are movement problems associated with the disease because of less dopamine. The brain cells of Parkinson's disease have Lewy bodies. Lewy bodies are abnormal clumps of a protein called alpha-synuclein. Parkinson’s disease can also be hereditary and is traced by specific genes. These brain functions are as follows -

1. Substantia Nigra - The substantia nigra contains a midbrain dopaminergic nucleus that is major in motor functions of the body. It is a part of the basal ganglia. The basal ganglia forms connections in the brain. The substantia nigra produces dopamine which is crucial for the body's movements.
2. Dopamine - It is a monoamine neurotransmitter that is produced in the brain and acts as a chemical messenger. It plays a critical role in the body, such as memory, movement, pleasure, reward, motivation, and learning. The dopamine levels are very low in Parkinson’s disease.
3. Norepinephrine - Norepinephrine are low molecular weight neurotransmitters communicating between nerve cells. It is released from the central nervous system and kidneys. Norepinephrine is part of the sympathetic nervous system. It is the fight-or-flight hormone. Norepinephrine functions are maintaining blood pressure and affecting the mood, memory, and sleep-wake cycle. Stress triggers epinephrine release. The reaction causes a fight-or-flight response in the body.

What Are the Signs and Symptoms of Idiopathic Parkinson’s Disease?

The symptoms can occur throughout the body or on one side of the body. As time passes, it can gradually involve the whole body. The patients experience changes in heart rate, blood pressure, breathing, depression, and anxiety. The signs and symptoms of the disease are-

• Balance and coordination problems.

• Speech difficulties.

• Muscle spasms.

• The trouble with swallowing or chewing.

• Excessive sweating.

• Sleeping problems.

• Urination problems.

• Rigidity (stiffness of the arms or legs).

• Bradykinesia (slow movement).

• Tremors (rhythmic shaking movements).

• Changes in posture.

What Are the Diagnostic Tests for Parkinson’s Disease?

Specialists such as neurologists diagnose the condition for appropriate treatment. The planning for the treatment begins after the diagnosis. The diagnosis requires a multidisciplinary approach. Because few symptoms of Parkinson’s disease are similar to other medical conditions. A medical history and physical examination are made to detect the signs and symptoms. The following imaging tests are done for diagnosis -

• Positron-emission tomography (PET) scan

• Computed tomography (CT scan)

• Single-photon emission computed tomography scan

• Magnetic resonance imaging (MRI) test

What Is the Treatment for Idiopathic Parkinson’s Disease?

A multidisciplinary approach is needed to manage the condition There is no permanent treatment for Parkinson’s disease. The medicines for Parkinson’s disease help increase dopamine levels in the brain and help control movement symptoms. Levodopa (precursor of dopamine) is used as a dopamine replacement. The nerve cells use levodopa to make dopamine. Levodopa is usually taken along with another medication called carbidopa. Carbidopa prevents the side effects of levodopa therapy, such as vomiting, nausea, low blood pressure, and restlessness. People with Parkinson’s should never stop taking levodopa without telling their doctor. Stopping the drug suddenly may cause serious side effects, like difficulty moving or breathing.

• Dopamine agonists stimulate the brain parts that are influenced by dopamine.

• Anticholinergic drugs treat tremors and muscle rigidity.

• Enzyme inhibitors increase the amount of dopamine by reducing the enzymes that break down dopamine in the brain. They include MAO-B inhibitors and COMT inhibitors.

• The doctor may recommend deep brain stimulation for patients who do not respond well to medications. The electrodes are placed into a part of the brain and are connected to a small electrical device implanted in the chest. The device painlessly stimulates specific areas in the brain that control movement to stop movement-related symptoms such as slowness, tremors, and rigidity.

• A healthy diet supports overall wellness.

• Exercise strengthens muscles and improves balance, flexibility, and coordination.

• Massage therapy to reduce tension.

• Yoga therapy increases stretching and flexibility.

• Occupational therapists help treat disabled patients through the therapeutic use of daily activities.

• Antioxidants and vitamins help reduce the symptoms.

• Addressing depression and anxiety feelings can help a great deal.

Conclusion:

Parkinson’s is difficult to control when it progresses to the advanced stage. The treatment will change according to the patient’s requirements. New medications with dosage adjustments are given. Additional treatments, such as psychotherapy and occupational therapy, are given to the patients till they can cooperate safely as long as they are able.