As of: April 5, 2024 12:45 p.m. | from the Norddeutscher Rundfunk logo
Parkinson’s disease, formerly known as shaking paralysis, is the second most common neurodegenerative disease in Germany after Alzheimer’s disease: symptoms, course, cause and therapy.
People with Parkinson’s disease increasingly suffer from slowed movement, lack of exercise, gait disorders, and later tremors in the hands, legs and head or muscle stiffness. Numerous studies show that, in addition to medication, exercise and sport can delay the progression of Parkinson’s disease.
Symptoms and cause of Parkinson’s disease
The cause of Parkinson’s disease is a decreasing production of the messenger substance dopamine due to the death of the dopamine-producing cells in the so-called black substance (substantia nigra) in the midbrain. This messenger substance is important for the transmission of signals between the brain and muscles. If there is a lack of dopamine, movements become smaller and smaller and the muscles tremble or become stiff. Other typical symptoms are:
frozen movements of shuffling gait, quiet speech, a rigid, waxy facial expression.
Further information
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Course of the disease: Parkinson’s disease begins gradually
Parkinson’s disease often goes unnoticed for decades while more and more cells in the brain are broken down. When the typical tremor occurs, most of the corresponding nerve cells have already been destroyed. However, the motor symptoms are usually preceded by unclear symptoms for years. Those who later develop Parkinson’s suffer from constipation and sleep disorders about twice as often as the general population. Poor sense of smell and depression also often occur in advance of Parkinson’s disease – long before the typical motor symptoms.
Specific sleep disorder as a precursor to Parkinson’s disease
A so-called REM sleep behavior disorder is considered a precursor to Parkinson’s disease. With this sleep disorder, those affected move in their dreams and can even injure themselves or others. The cause is damage to the dream movement center in the brain. The symptoms of the sleep disorder can be alleviated with medication. But 70 to 80 percent of people who lash out in dreams develop Parkinson’s disease in the following ten to 15 years.
Therapy: Medication replaces missing dopamine
Several groups of medications are available to treat Parkinson’s disease. They reinforce each other through their different mechanisms of action. The aim is to replace missing dopamine in the brain. The selection and dosage of medication is individual.
The most effective remedy for Parkinson’s symptoms is Levodopa (L-Dopa). It crosses the blood-brain barrier and is converted into active dopamine in the brain. In order to achieve a sufficient concentration of the active ingredient in the brain, patients must take L-dopa in high doses. The active ingredient is combined with the enzyme inhibitor Benserazid combined to reduce the required dose. In this way, side effects such as nausea and circulatory problems can be reduced. Another important group of active ingredients are the so-called Dopamine agonists. They are similar to dopamine, but cause side effects such as dizziness. Once the correct individual dose has been found, the medication often achieves stable improvement. In addition, so-called MAO Inhibitor used to delay the natural breakdown of dopamine. Also the active ingredient Amantadin can improve Parkinson’s symptoms. The exact mode of action is not known.
No matter how successful drug therapy is, it is not possible to cure or stop the disease. In addition, the effectiveness of the medication often decreases with the duration of the illness.
With a Pump therapy Medications that are no longer effective as tablets over time can be administered via a so-called PEG tube passed through the abdominal wall. The electronically controlled pump ensures the correct dosage. Before the tube is surgically installed, a nasal probe can be used to test whether the procedure is successful in the individual case.
Surgical therapy: brain pacemaker
The so-called deep brain stimulation is a procedure used to treat movement disorders, including Parkinson’s disease. Neurosurgeons insert thin stimulation electrodes (brain pacemakers) into certain areas of the brain. The electrical impulses are intended in particular to relieve tremors. In general, deep brain stimulation is only used when the medication no longer has a sufficient effect.
Magnetic resonance imaging is first carried out under general anesthesia. During the operation, those affected must be awake at times in order to be able to accurately test the improvement in symptoms during the stimulation. The electrodes are then connected to a control device, the brain pacemaker, which is implanted below the collarbone. A few days after the operation, the device is switched on and readjusted for the first time. Fine adjustment is possible at any time to achieve the best result.
New surgical procedure with ultrasound
A fairly new therapeutic method in the treatment of Parkinson’s disease highly focused ultrasound (HIFU). Ultrasound waves are concentrated in the target tissue so strongly that they heat it and destroy it in a targeted manner. This therapy also focuses on a small node deep in the brain.
Treatment creates tiny scars in the fiber tracts of the brain, in the so-called tremor network. This is supposed to reduce the tremors. Using a special helmet, more than a thousand ultrasound waves are directed into the brain from many directions and focused precisely on the tremor network. During the treatment, those affected lie fully conscious in the MRI – so the doctors can use the monitor to monitor exactly which regions of the brain are heated and to what extent.
The patient is then made to tremble to the maximum through tasks and exercises. Several warming phases are necessary to create the scars in the brain. Each time the temperature is increased slightly, then the treatment effect is checked, but also possible side effects such as speech disorders, weakness or deafness. The aim is not to completely eliminate the tremors. The aim is to reduce tremors as much as possible without risking worse side effects.
Even if the procedure does not require a scalpel, probes and drills, it is not without risk because the procedure cannot be reversed: once cells in the brain are destroyed, they do not come back.
Exercise has a positive effect on the course of the disease
Numerous studies show that exercise is very effective: the course of the disease is often more favorable than with medication alone. Even in the early stages, the symptoms of Parkinson’s disease can be improved through intensive training, and as the disease progresses, those affected can regain lost skills through targeted training. Leisure activities such as painting, dancing and learning new forms of movement with sweeping movements such as Tai Chi also play a role.
Sports with flowing movements such as swimming, cycling and jogging are suitable for people with Parkinson’s disease. It is important that people with Parkinson’s take advantage of every opportunity to exercise, because the brain quickly forgets the newly acquired skills. Sport can also be effective as a preventive measure: those who exercise regularly in middle age reduce their risk of later developing Parkinson’s disease by up to 40 percent.
BIG therapy for Parkinson’s sufferers
BIG exercise therapy can be used in the early stages of Parkinson’s disease. The exercises with large, flowing movements stimulate unused areas of the brain. Through intensive repetition and constant monitoring of success, those affected learn to consciously use movements again in everyday life. The therapy makes movements faster and more precise, and balance and body awareness are also promoted. The effects last for several weeks to months.
Progress in finding the cause
Parkinson’s disease is a disastrous chain reaction in the body. It probably begins with a protein produced by the body (α-synuclein). The protein folds incorrectly in the cells and ultimately leads to their destruction. Scientists suspect that the disease does not begin in the head, but rather in the intestines and from there travels up to the brain over many years. Why the process begins is one of the many still unanswered questions. In addition, the variety of symptoms suggests that there may not be just one Parkinson’s disease, but many different forms.
It is already known that various disorders occur in the brains of people with Parkinson’s disease:
too much toxic protein too much free iron inflammation. Medications are being tested against these three disorders to stop the progression of the disease. If this is successful, it will be even more important to detect Parkinson’s disease as early as possible, because once functions have been lost, medication will not bring them back.
What role does the vagus nerve play?
Animal experiments have shown that a misfolded protein molecule (alpha-synuclein) is deposited in the diseased brain cells in Parkinson’s disease. Such deposits also arise in the nervous system of the stomach and intestines, presumably due to environmental influences. From there, the deposits could “migrate” via the vagus nerve and its branches to the brain. The researchers were able to slow the progression of the disease in mice by cutting the vagus nerve.
Studies on people whose vagus nerve was severed because of a stomach ulcer confirm the hypothesis: the risk of Parkinson’s disease in this group is 22 to 41 percent lower than in the general population.
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