Parkinson´s disease

Parkinson’s disease / PD

Parkinson’s disease is one of the most frequent neurological movement disorders. About 400.000 people in Germany are suffering from Parkinson’s disease. This chronic disease mainly afflicts elderly people but can also emerge from the 40th year or even earlier. The idiopathic Parkinson’s disease is the most frequent kind of PD. Idiopathic means that there is no direct, identified cause of the disease. Besides idiopathic Parkinson’s disease, there are also rarer forms having genetic or other causes. PD can cause different symptoms.

Symptoms Parkinson’s disease / PD

The typical movement-related symptoms of Parkinson’s disease are shaking (tremor), rigidity of the muscles, slowness of movement (Bradykinesia) and an instability related to hold a posture or balance (postural instability). PD symptoms often start in one half of the body and may become more frequently or more intense over the years.

A slight trembling may become strong shaking, a simple stiffness of the muscles a strong rigidity, a slowness of movements a complete standstill and the initial problems to hold a posture an instability of the body necessitating a wheel chair.

The slowness of movement does also affect facial expressions, talking, swallowing and especially moving the hands, fine motor skills in general (e.g., writing) but also walking. In case of muscular rigidity, the muscles tone is increased without wanting to contract a muscle. As a consequence, muscle pain, tension and false posture may occur. The shaking is quite calmly and slowly if, for example, arms or hands are in their starting position. If PD patients then start to move them, the shaking increases significantly. Postural instability may begin with minor balance-related problems while standing or walking but may also make turning around or changes of the directions impossible or even cause the person to fall.

Besides these typical movement-related symptoms of Parkinson’s disease, further symptoms like paresthesia, bladder or gastrointestinal disorder, sexual dysfunction, mood swing, depression or sleep disorders may also emerge.

Symptoms of Parkinson’s disease in short:

  • initial symptoms often in only one side of the body
  • shaking (tremor)
  • muscle rigidity
  • slowness of movements (Bradykinesia)
  • instability related to hold a posture or balance (postural instability)
  • further symptoms like paresthesia, bladder or gastrointestinal disorder, sexual dysfunction, mood swing, depression or sleep disorders

Causes Parkinson’s disease / PD

The typical movement-related symptoms of Parkinson’s disease do mainly express the loss of brain cells regulating and coordinating motion sequences by transmitting the messenger dopamine. But the cause behind the loss of these brain cells is uncertain for the neurodegenerative forms of PD to which the most frequent idiopathic Parkinson’s disease belongs. However, certain factors have been identified that may trigger or start the disease processes. But these factors are still subject of research.

In very rare cases accompanied by an early outbreak of PD, the disease is caused by genetic mutations (PARK2, PARK6 and others) to be identified with a blood test.

Other forms of Parkinson’s disease are caused by an apoplectic stroke, drugs or the impact of toxic substances in some cases.

Diagnostics Parkinson’s disease / PD

The diagnosis Parkinson’s disease necessitates a comprehensive neurological-orthopedic examination. Often imaging procedures like MRI are used to differentiate different diseases that may cause similar or the same symptoms like PD.

Therapy Parkinson’s disease / PD

Today we have a big amount of efficient drugs to control the symptoms of PD. Accompanying treatments like physiotherapy, speech-language pathologists or occupational therapy play a crucial role. Movement-related symptoms, and speaking does also belong to them, are treated this way.

The individual treatment strategy depends on one hand on the PD type (idiopathic, genetic, drug-related, caused by toxic substances, etc.) and on the other hand on the emerging symptoms, the state of PD and also side effects of the drugs. These side effects may cause movement-related on-off fluctuations (on = improved condition and mobility, off = worsened condition with lack of mobility). They may also result in drug-related writhing of movements (dyskinesia) but also affect vegetative functions, sleep and the psychic condition.

Especially patients suffering from progressive Parkinson’s disease, severe gait disorder, shaking and dyskinesia (writhing of movements) benefit from deep brain stimulation (DBS). DBS treats pathologically changed brain structures by transmitting electrical impulses that stimulate or deactivate the corresponding area of the brain. The necessary electrodes are implanted during the minimally invasive, stereotactic brain surgery.

Read more about deep brain stimulation (DBS) as a treatment option of Parkinson’s disease