What are the treatments that can improve the quality of life of people with Parkinson's

Parkinson's is a progressive disease of the nervous system that affects movement. Symptoms begin gradually. Sometimes, it starts with a barely noticeable tremor in one hand. Tremors are common, although the disease also often causes stiffness or decreased movement.

“This is a condition of the central nervous system caused by the loss of dopamine-producing cells in the brain. It is considered a neurodegenerative condition because the nerve cells (neurons) in the brain that control movement deteriorate and are lost. The lack of dopamine causes brain messages not to be transmitted properly, resulting in movements, coordination, muscle tone and balance being drastically affected, among other things. It is also considered a progressive disease, which means that the symptoms appear gradually and slowly worsen,” explained Dr. Carlos Alberto Ciraolo, specialist in neurosurgery (MN 70,603), head of the adult and pediatric functional and stereotactic neurosurgery section of the Italian Hospital of Buenos Aires.

In the early stages of Parkinson's disease, the face may have a slight or no expression. Your arms may not swing when you walk. Speech can become soft or incomprehensible. The symptoms of Parkinson's disease worsen as it progresses over time.

In Argentina, it is estimated that around 120,000 people suffer from Parkinson's, the largest proportion of adults over 65 years of age - approximately 1-2% of this population group suffers from it - and it is the second most common chronic and progressive neurodegenerative disease in the world.

“Parkinson's disease manifests itself with motor and non-motor symptoms. The main motor symptoms are slowness or bradykinesia, stiffness and tremor. In more advanced stages, there may be postural, balance and gait alterations. Sensory disturbances (loss of smell, various pain), gastrointestinal (constipation), mood (depression, anxiety, etc.), sleep (insomnia, vivid or acted dreams) or autonomic (urinary disorders) may also occur. In more advanced stages, cognition can also be affected. These symptoms usually begin after the age of 60, but there are 5% of children under 40 who are also affected. It is estimated that 1 in 100 individuals over 60 years old suffer from Parkinson's disease,” added the specialist.

How is it diagnosed?

In the absence of a specific test for the condition, Parkinson's disease is difficult to diagnose. Symptoms vary from person to person, and several diseases have similar symptoms. Therefore, sometimes incorrect diagnoses are made.

When a person suspects the disease, it is important to see a neurologist who specializes in movement disorders early, who will order a series of imaging, laboratory or genetic tests that allow for a diagnosis. The most important thing is to seek medical advice as soon as possible for early detection.

Symptoms of Parkinson's Disease include those that affect movement: tremor, muscle stiffness, and slowness. But they also include symptoms that begin on one side of the body: change in facial expression (staring, absence of blinking), failure to swing an arm when walking, hunched position (flexion), frozen shoulder, with pain, lameness or drag of a leg, numbness, tingling, pain or discomfort in the neck or limbs, soft voice, small writing, feeling of inner tremor, loss of sense of smell, depression or anxiety.

Treatments for the disease

There are currently no curative treatments for Parkinson's, but there are different options for treating the disease. It is important to understand that each patient is different, so it is necessary to analyze and understand each patient's needs, individually when selecting an option.

-Pharmacological treatments: There are several drugs used to treat the motor symptoms of the disease. These drugs are useful in the early stages of the disease, but their effectiveness usually decreases over time; it may also require higher doses of medication over time to get control of motor symptoms, which may cause side effects in the future.

-Surgical treatments: When medications no longer work as well for patients' motor symptoms, deep brain stimulation (DBS) surgery may be an option to improve the quality of these patients. DBS therapy is a form of treatment that sends electrical impulses to specific areas of the brain that control movements. This involves a surgical procedure to implant electrodes into the brain, connected to a neurostimulating device located under the chest or abdomen. DBS is highly effective in properly selected patients.

-Complementary therapies: In the early stages of Parkinson's diagnosis, your doctor may recommend lifestyle changes and therapies that may improve some symptoms of the disease, or may help you in your daily life. Some commonly recommended complementary therapies are: Diet Change, Speech Therapy, Physical Therapy, and Occupational Therapy.

“Among the surgical ones, Deep Brain Stimulation stands out, a procedure that has been performed in the country for several years and with which there is already a great deal of experience. A selected proportion of patients with Parkinson's could benefit from the results of this medical technology, depending on age, the manifestations of the disease and the presence or otherwise of other associated conditions,” said Ciraolo, staff physician neurosurgery and pediatric neurosurgery, and president of the Argentine Association of Radiosurgery.

He added: “One of the most advanced therapies recognized for its effectiveness in minimizing the movement disorders typical of the disease is Deep Brain Stimulation (DBS). This treatment involves implanting electrodes deep in the brain that are connected to a pulse generator or electrical device - similar to cardiac pacemakers - placed in the chest or abdomen. Its mechanism of action is fundamentally based on the ability to modify the functioning of the nervous system through electrical stimuli. The device is programmed externally through software that defines and regulates the stimuli that the patient receives.”

According to the expert, the implant procedure is a multidisciplinary process where neurologists, neurosurgeons and bioengineers collaborate, among others. The accuracy of the implant is achieved through various methods, among which the recording of the neural activity of certain regions of the brain during surgery stands out.

“Deep Stimulation Therapy seeks to control patients' motor symptoms, as well as likely complications and fluctuations that may develop due to drug therapy,” Ciraolo said. “Each case must be rigorously analyzed to ensure that it is the right choice for the patient, although this therapy is one of the most advanced in treating the condition. In these cases, the goal is always to improve the quality of life, the level of independence and the functionality of our patients. Family and patient support also play a fundamental role,” he added.

For her part, patient Graciela Chiale tells about her experience when she learned that she had a disease such as Parkinson's: “I am aware that we have to face the limitations it imposes as soon as possible. Being progressive and degenerative, postponing implies getting worse.” “My doctor sent me to talk to the neurosurgeon, who told me that I was a candidate for surgery, which is not for everyone. It was the best alternative to improve the quality of life,” added Chiale, a graduate in Sociology, who continues to write today about her field of study.

Some attention figures:

- Currently, 175,000 people worldwide receive Deep Brain Stimulation (or DBS) therapy.

- PD is one of the most common age-related neurodegenerative diseases, affecting 1% of patients over 60 years of age and 0.3% of the general population, with a prevalence close to twice that of today's estimated by 2030, according to the University of Texas School of Medicine.

- It is estimated that in Argentina more than 90,000 people live with this disease, according to the Argentine Parkinson's Association.

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