Parkinson Disease, The Neurodegenerative disease

Parkinson’s is a disease that attacks the central nervous system, slowly and inexorably degenerating the primary functions of physical control and equilibrium. Its core pathology is defined by the death of neurons in the brain, some of which produce dopamine, an essential neurotransmitter that normally controls movement. As the dopaminergic neurons slowly die off, motor control inevitably diminishes, and when the loss reaches 60-70%, symptoms become apparent.

History of the Parkinson Disease

The earliest known description of Parkinson’s is found in a medical manuscript from India, dating to around 5,000 BC. Another mention is present in a Chinese document about 2,500 years old. The disease is named after James Parkinson, a 19th-century London pharmacist-surgeon, who first described most of Parkinson’s symptoms in his booklet entitled An Essay on the Shaking Palsy (1817).

Who are Parkinson’s Sufferers?

According to data from the AIP – the Italian Parkinson’s Association – the disease is found around the world in all ethnic groups. There are no significant distinctions in incidence among genetic backgrounds or between the sexes, although it is slightly more prevalent among men than women. The average age at which the first symptoms appear is around 58-60, although in about 5% of Patients, it may manifest as early as 21 years of age. Onset before the age of 20 is extremely rare. Above the age of 60, it strikes 1-2% of the population, while the percentage rises to 3-5% above the age of 85.

According to the latest report by the Istituto Superiore de Sanità, in Italy in 2015, there were approximately 230 thousand people living with the Parkinson Disease, with 5% of those under the age of 50.

The First Symptoms

Parkinson’s early signs include tremors, muscular rigidity, and postural instability, which generally affect one side of the body more than the other. The trembling is involuntary while at rest, and the muscular rigidity makes it difficult or impossible to move easily, such as when getting up from an armchair. After the stiffness phase, there follows the gradual slowing of movements (bradykinesia), changes in handwriting (micrography), significant salivation (sialorrhoea), and loss of facial expressivity (faciès figé). It becomes difficult to initiate an action, such are starting to walk, and loss of balance becomes more and more of a danger.

From Pharmaceuticals to Surgery

To manage the symptoms, drugs are used, such as dopamine agonists, dopa carboxylase inhibitors, and COMT inhibitors, all of which aim to enhance dopamine function. The problem arises after 8 to 10 years of use, when the effects become unstable and the treatment must be terminated. At that point, surgery may be an option, providing deep brain stimulation. This procedure involves inserting electrodes into specific areas of the brain – in effect, a sort of pacemaker. However, such an operation is indicated for only a tiny fraction of Patients, some 2-3% of cases.

Still, one thing is certain: Science is always moving forward. Even though at present there are no certainties, the near future will bring ever more encouraging achievements.

© Domedica s.r.l.

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