Therapy of Parkinson's disease

Synonyms in a broader sense

  • Paralysis
  • idiopathic Parkinson's syndrome
  • Tremble
  • Tremor sickness
  • Parkinson's disease

introduction

This topic is the continuation of our topic Parkinson's disease. General information on the disease, diagnosis and spread can be found under our topic: Parkinson's disease.

therapy

The therapeutic options for treating Parkinson's disease can be roughly divided into 3 main categories:

  • Medical therapy
  • Own measures
  • Operations

Medication

Illustration of a nerve cell

  1. Nerve cell
  2. Dendrite

A nerve cell has many dendrites, which act as a kind of connecting cable to other nerve cells in order to communicate with them.

The Parkinson's Disease / Parkinson's Disease is not curable today, but treatable.

The mechanisms responsible for the symptoms are known and this leads to the following conclusion:

So if you now know that Parkinson's disease is the messenger substance Dopamine absent, one should actually be able to assume that one is only offering something to the patient Dopamine from the outside and he would feel better.

However, there is a natural limit to this idea in the truest sense of the word:
The main "transport tool" for Medication and nutrients in our body is blood. In this way, however, unwanted pathogens (viruses, bacteria, fungi and poisons) also reach almost every part of the body. Since the brain, as the body's control center, has to be protected against pathogens and the like in particular, it is naturally "Blood-brain barrier"Protected. Many harmful, but also some very useful substances cannot easily pass through this barrier. Dopamine typically cannot overcome this barrier."

Nevertheless, all drug approaches revolve around the idea that the body is adequately supplied with dopamine.

Note: Compliance

For a drug therapy to be successful, however, the most important requirement is that the Medication be taken regularly and in the prescribed dosage.


The theoretical drug approaches here are:

  1. L-dopa:
    L-Dopa is a "biochemical precursor" of the actual dopamine. In contrast to dopamine, it can very well cross the "blood-brain barrier".
    You can think of this mechanism as a fence, in which there are gaps, but through which a car would never fit. But if you pass the individual parts and assemble the car on the opposite side, the car can drive there.
    One problem with this type of treatment is that the body doesn't really know that the L-dopa is only supposed to be "rebuilt" in the brain. For this reason, it is important to inhibit the mechanism that is responsible for the breakdown of the (peripheral) L-dopa that is not in the brain. For this purpose an enzyme inhibitor (dopa decarboxylase inhibitor) is administered.
    This inhibitor (benserazide) now ensures that you have to add significantly less L-Dopa overall. This protects the patient (especially with regard to side effects).
    The first therapeutic successes are usually visible within days. in addition, L-Dopa is generally well tolerated.
    As an important tip from clinical application, the following must be observed:
    L-Dopa should be taken about half an hour before a meal, since taking it at the same time while eating can impair metabolism!
  2. Dopamine agonists:
    The group of dopamine agonists are substances that are very similar to actual dopamine and, thanks to this similarity, are able to imitate the effects of dopamine.
    Adjusting to such preparations requires a certain amount of patience. Overall, the onset of action is quite slow. in addition, it is not uncommon for nausea and dizziness to occur.
    Furthermore, hallucinations and disruptions in orientation can also occur in some cases.
    The advantage of this group of active ingredients, however, is that they usually bring about a stable improvement over the years if the setting is good.
  3. Catechol-O-methyltransferase (COMT) inhibitors:
    This complicated name describes a group of active substances that inhibit another enzyme (note: the ending "-ase" actually always means enzyme).
    As already mentioned, when taking L-Dopa you should make sure that it is not "converted" too early and should therefore inhibit the corresponding enzyme.
    Today we know, however, that in addition to the already mentioned enzyme (dopa decarboxylase) there is also a second "remodeling path" for L-dopa, which, so to speak, "branches off" and remodels part of the L-dopa before it passes through the blood Brain barrier enters the brain.
    This is the enzyme catechol-O-methyltransferase. If you inhibit this e.g. with entacapone (Comtess), added L-Dopa works better.
    Without L-Dopa, such an inhibitor naturally has no effect on Parkinson's disease.
  4. Anticholinergics:
    As already mentioned, Parkinson's disease leads to a "too much" amount of acetylcholine due to the reduction in dopamine, which then leads to rigors and tremors. The anticholinergics counteract this mechanism.
    On the positive side, it should be emphasized that there have been very good experiences with the treatment of tremor. Rigor is also positively influenced.
    In this context, however, it should be noted that other systems in which acetycholine plays a role are also affected by the anticholinergics. Dry mouth and the like occur relatively regularly. Constipation, but also urinary retention. It must therefore be added very carefully.
  5. Mono-Amino-Oxidase Inhibitors:
    The ending "-ase" reveals to the attentive reader that this complicated name also stands for an enzyme that has to be inhibited.
    The basic mechanism is as follows:
    When the L-Dopa is finally used at its destination (the brain), like everything organic, it is broken down into its individual parts again after a while by enzymes to ensure that there are always new, "fresh" and fault-free active ingredients there and no accumulation occurs. The mono-amino-oxidase inhibitors (MAO-inhibitors for short, active ingredient name "Selegelin") ensure that this breakdown of dopamine is now somewhat delayed and that dopamine can thus work a little longer (dopamine expander).
    Patients often report sleep disorders and restlessness as side effects.

Note: Selegelin

As a family member or person affected, you should definitely talk to your doctor about a balanced diet in connection with this medication, as certain foods come with it Selegelin should not be taken.


6. Amantadine:
The mode of action of this substance is still not fully understood. Guesswork goes in the direction of that Amantadine intervenes in the above-mentioned imbalance of the messenger substances and in particular influences the effect of glutamate.
However, today we know for sure that amantadine helps! It can have a positive effect on all symptoms of Parkinson's disease. Further advantages are that patients usually tolerate it very well and that it can also be administered in liquid form.
The disadvantage is that other groups of active ingredients (especially L-Dopa) have a much better and stronger effect.

7. Budipin:
The Budipin influences a number of Neurotransmitters. Particularly noteworthy, however, is the dopamine-promoting and glutamate-inhibiting effect.
It is particularly suitable for treating the severe tremors.
Unfortunately, when using Budipin, side effects such as dizziness, nausea and occasionally cardiac arrhythmias occur quite often.
In many cases a doctor will sooner or later suggest a combination therapy of 2 or 3 different drugs.

Own measures

It has been shown that there are a number of things that Parkinson's patients can do themselves to positively influence their illness.

Move:
As with many diseases, regular exercise helps with Parkinson's disease. It is true that there is a progressive limitation in mobility, but a patient does not have to give in to it.

Regular running or walking can have a positive effect, especially with back pain that is common during the illness.

Exercise has also been shown to have a positive effect on mood.

Even light gymnastics exercises can improve the overall picture.

However, you should be careful not to overdo it. Competitive sport is not a particularly recommended measure for Parkinson's disease.

Occupational therapy:
In occupational therapy, exercises are carried out in which, in particular, fine motor skills are trained. This is primarily intended to train the so-called "everyday practical skills" (tying shoes, buttoning a shirt, etc.).


Speech Therapy:
One of the first symptoms is a decrease in the volume at which a patient can speak. This is due to the increasing rigidity of the Respiratory muscles. You can counteract this with regular training and breathing exercises.

This can either be done with the guidance of a speech therapist (speech therapist), but it can also be trained at home with reading aloud.


Psychotherapy:
There are trained therapists who can support patients in dealing with the disease.Most of the depressive episodes are easily treatable.


Mental requirements:
Also regular "Brain jogging"can keep a patient very active. Although the disease can lead to a slowdown in thought processes, this development can be countered.

A wide variety of intellectual activities are suitable here: be it crossword puzzles or Sudoku tasks, magazines or arithmetic problems. Anything that stimulates the brain and is also fun is recommended in the treatment of Parkinson's disease.

Operations

For decades there have been approaches to tackle individual symptoms of Parkinson's disease surgically. In the past one operated on different areas of the brain with the help of heat sclerotherapy (Thermocoagulation).

However, such a procedure was only found in certain types of Parkinson's disease (one-sided tremor that cannot be adjusted with medication) Application.

Attempts to perform such an operation even with bilateral complaints have often led to in the past Speech disorders or Reduction of the ability to motivate of the patient.

Derived from this type of operation, one nowadays implants a so-called in certain areas of the brain (e.g. thalamus and subthalamic nucleus). "external pacemaker ", with which in the best case the Akinesia can be significantly improved. This allows the L-dopa Significantly reduce dosage. Such a pacemaker can improve the inhibitions in the "communication" of different brain areas caused by illness.

There is also the (ethically much discussed) surgical approach to brain tissue from human embryos to be implanted in the patient's brain in order to "repair" lost areas.