Treatment for Parkinson’s disease in India | GetWellGo

What is Parkinson's disease?

Parkinson’s disease is also known to be a progressive disease that mainly affects a body movement and has no cure. It occurs if some of the nerve cells in the substantia nigra part of the brain degenerate or gets destroyed. These neurons usually secrete a chemical called dopamine which plays a part in controlling smoothening of muscle movements.

Types of Parkinson's disease

Primary Parkinson’s disease (Idiopathic Parkinson’s Disease)

• Most common type.
• Ipa is an abbreviation stands for ‘’Idiopathic’’ which means that the cause of the condition cannot be determined.
• The characteristic features of these diseases include tremor, bradykinesia or slowness of movement, rigidity and postural instability.
• It typically has a good outcome to medicines such as Levodopa.

Secondary Parkinsonism

• Such injury is not a result of any natural deteriorating effect on the brain; it is caused by something else.

Possible causes:

• Medications (like certain antipsychotic drugs)
• Infections (like encephalitis)
• Stroke
• The non-mechanism-related features are the same, but some may not demonstrate the same level of response to traditional Parkinson’s drugs as primary Parkinson’s.
• It is also known as Parkinson’s Plus Syndromes
• It is diseases that may mimic Parkinson at the beginning but evolve differently and manifest additional symptoms.

Examples:

• Multiple System Atrophy (MSA) is a progressive neurodegenerative disorder that causes symptoms affecting movement, blood pressure, the bladder, digestion and other aspects.
• PSP also knows as Richardson Syndrome or Steele-Richardson-Olszewski Syndrome which is an uncommon neurological disease that is characterized by difficulty in balance, walking, and disorders of eye movement.
• CBD: it mainly affects one side of the body than the other side and also includes symptom of memory and thinking disorders.
• Lewy Body Dementia (LBD): In addition to features of Parkinson’s disease, it entails memory loss, confusion, and hallucination.

Juvenile Parkinsonism

• Very rare.
• It occurs in the young individuals more specifically under the age of 20 years.
• Often linked to genetic mutations.
• They are related but manifest at an earlier age.

Causes and Symptoms

Causes of Parkinson’s disease:

The exact cause which can lead to them is unknown, though there are several possible causes for this condition:

Loss of Dopamine-Producing Cells

• Substantia nigra is a region of the brain, and what happens is that some of its neurons either die from the onset or they die after being damaged by certain elements.
• These cells produce dopamine; this is the neurotransmitter responsible for the regulation of the movement. Low dopamine = movement problems.

Genetic Factors

• Between 10% and 15% of patients have specific genetic factors related to development of the diseases.
• It is worth mentioning that if others in your family have Parkinson’s, your risk of developing the disease is slightly higher.

Environmental Triggers

• Pesticides/ herbicides or even heavy metal toxicity may be related to it if a person has long term exposure of the two.
• Hence the people who live in the rural areas drink water from wells, or work with particular chemicals are affected.

Age

• The probability increases with age and this is high for patients who are over the age of 60 years.

Other Factors

• Oxidative stress (damage from free radicals)
• Mitochondrial dysfunction (energy problems in cells)
• May be under genesis of infection or head injury (although more studies need to be carried out in this regard).

Common Symptoms of Parkinson’s disease:

Motor (Movement-Related) Symptoms
Tremor:

• Trembling, especially of the hands (pilot wheel or pill rolling tremor).
• It occurs when the body is stationary and requires energy to be supplied to the body up to the operating level and this energy is derived from food.

Bradykinesia:

• Slowness of movement.
• Stiff to initiate any task or inability to make small movements.

Rigidity:

• Clamp like stiffness in the arms, legs or the trunk.
• May result in muscles aches and reduced mobility of the affected joint.

Postural Instability:

• Trouble balancing and frequent falls.
• This will include shuffling walk and movements where the affected person will walk in small steps while having a hunched posture.

Non-Motor Symptoms

• Depression and anxiety
• Sleep problems (like insomnia, vivid dreams)
• Loss of smell (early symptom)
• Constipation
• Soft or slurred speech
• Small handwriting (micrographia)
• Memory issues (later stages)
• Fatigue
• Dizziness or fainting (due to low blood pressure)

Treatment for Parkinson's disease

Medications

• Initially, people use drugs for increasing dopamine or replicating it in some aspects

Physical and Occupational Therapy

• Physical therapy: Improves balance, flexibility, and strength.
• Occupational therapy: Engage in meaningful tasks within identified roles, for example, fastening shirt buttons, writing, among others.
• Audiology: Aids in cases of difficulty in speaking softly, eating or drinking, as well as in the projection of one’s voice.

Surgical Options

Sometimes it is always necessary to replace drugs that fail to work effectively as expected:

Deep Brain Stimulation (DBS):

• Surgeons implant electrodes into specific parts of the brain.
• A pacemaker for example is an object that transmits electrical impulses that assist in controlling the symptoms.
• It is true that DBS may very effective for tremors, rigidity, and slow movement and does not treat the illness.

Lifestyle Changes

• Take a walk, swim, practice Tai chi, or yoga as a way of exercising.
• Credit: Should eat healthy diet/meals with fiber foods for constipation and antioxidants foods for the brain.
• Physical Activity (jigsaws, crosswords, books, games).

Future Treatments (Research Ongoing)

• Gene therapy
• Stem cell therapy
• Fung‘s talks about new drugs aimed at quelling the inflammation of the brain and shielding the nerves.

Deep Brain Stimulation for Parkinson's

• DBS is a surgical procedure where electrodes are placed in certain parts of the brain which is thought to be the cause of some symptoms.
• These electrodes are able to use mild electrical current in treating some of the symptoms of Parkinson’s disease through regulating the abnormal brain signals that would otherwise manifest such symptoms.
• It is a small item that is surgically operated near the chest wall like an operating pacemaker for regulating the signals.

How DBS Works

• Parkinson’s disease disrupts the normal flow of brain signals as they appear to be more chaotic or crowded.
• DBS can suppress activity of these signals by sending a regulated electrical current.

This helps reduce symptoms like:

• Tremors
• Slowness (bradykinesia)
• Muscle stiffness (rigidity)
• Some walking and balance problems

Stem Cell Therapy for Parkinson's disease

What is Stem Cell Therapy?

• Stem cells can be done by stating that they are special cells with the distinct ability to develop into any form of cell of the body.
• In Parkinson’s disease, it is aimed to replace that was diminished with the death of dopaminergic neurons and hence the symptoms.
• Researchers believe that stem cells could be used to grow normal dopamine producing tissues and place it in the brains.

How It Works

Collect stem cells

• There are embryonic stem cells, adult stem cells, or they can be directly manufactured in a laboratory that is known as iPSCs: induced pluripotent stem cells.

Turn them into dopamine neurons

• There are instructions given to scientists to guide the stem cells to become dopamine-producing brain cells.

Transplant into the brain

• Hence the new dopamine cells are directly transplanted into the required region, for example, the substantia nigra or striatum.

New cells produce dopamine

• When treatment is successful, one’s dopamine levels rise and such symptoms are not seen again.

Alternative Treatments for Parkinson's disease

Exercise Therapy

• It is important to note that exercise is probably one of the best natural therapies that can be done for Parkinson’s disease.

Benefits:

• Improves balance, strength, and flexibility
• Reduces stiffness and slowness
• Boosts mood and reduces fatigue

Physical, Occupational, and Speech Therapy

Physical Therapy:

• Helps with walking, balance, posture.

Occupational Therapy:

• It also facilitates functionality in other routines in life such as dressing, or even cooking.

Speech Therapy:

• Improves strength and relieves difficulties with swallowing or speaking.

Diet and Nutrition

• It should also be noted that there is no such thing as a “Parkinson’s diet,” but it is precisely the question of what is good for the patient’s health that can make a great impact.

Good choices:

• Mediterranean diet (lots of fruits, veggies, whole grains, olive oil)
• Foods rich in antioxidants (like berries, spinach)
• Fiber (they are importance in preventing constipation which is frequent in Parkinson’s disease)

Supplements 

• Coenzyme Q10 – for energy production – there is only poor to moderate evidence for some benefit.
• Vitamin D (for bone health)
• Omega-3 fatty acids (for brain health)

Mind-Body Practices

• Reduce stress, sleep issues and change in moods:
• Meditation
• Deep breathing exercises
• Mindfulness training
• Massage therapy (for muscle pain and stiffness)

Acupuncture

• Several small scale research times have supported that acupuncture could be useful in minimizing typical signs such as tremors and discomfort.
• Still, it is not considered a cure for this condition, although it can help enhance the lives of some patients.

Music and Art Therapy

Music and art therapies can:

• The decrease in inflammatory protein, reduction in UTI common symptoms, and overall better management can help with managing moods, improving memory, and experience better movement.
• As with the other therapies, some patients may experience improvement in the parts of the brain that is affected by Parkinson’s.

Medical Marijuana / CBD (Cautious Area)

• Cannabidiol or cbd oil is taken by some patients for sleep disorders, anxiety or pain.
• Currently and despite its use, it has not been found to offer any obvious benefits, to-date, it is not clear how much people should take daily.
• For this reason, it is wise to consult your doctor always before using it.