[쉬운 신경질환사전]is a series of articles designed by neurologist Hanseung Lee (Herb Neurology Clinic) and Hidak on the topic of neurological diseases in everyday life. Common but vague symptoms such as ‘eyelid tremors’, ‘dizziness’, ‘numbness of hands and feet’, and ‘various headaches’ are explained in an easy-to-understand manner for the general public.
People who experience hand tremors following middle age are the most concerned regarding Parkinson’s. Parkinson’s disease is one of the most common diseases of old age, and is as common as high blood pressure. It is known that the majority of patients are in their 70s, 15% or more in their 70s, 50% or more in their 80s, and 70% or more in their 90s. In 1990, when life expectancy was 71.7 years, it was not a very common disease.
Parkinson’s disease is not a disease caused by aging of the nervous system, but rather a disease caused by the rapid aging of certain parts of the brain. That’s why, strictly speaking, hand tremor is not a key symptom of Parkinson’s. The most common symptoms observed in patients with suspected Parkinson’s disease are slow and stiff movements. Because these changes in the body occur very slowly, in most cases, neither the patient himself nor his family is aware of the disease in the early stages. However, once the disease has progressed to some extent, all Parkinson’s patients have typical symptoms of Parkinson’s disease, including markedly slowing of the body.
Hand tremors are experienced by only 75% of all Parkinson’s patients. Also, there is a difference between hand tremor in patients with Parkinson’s disease and normal hand tremor. People with Parkinson’s disease have different types of hand tremors at the same time. The typical tremor in Parkinson’s disease is rest tremor or tremor at rest, but postural tremor that appears in essential tremor is also commonly accompanied. To better understand Parkinson’s disease, let me introduce a case.
“A 78-year-old male, A, visited the outpatient department with symptoms of hand tremor. Upon entering the treatment room, he was observed to walk frequently with a slouched posture and short strides. I mightn’t get up at once and I was able to get up following two or three attempts. There was no expression, and the voice was small, so they talked slowly. When I checked the first position, the font size was very small, and general cognitive abilities such as orientation Pill-rolling tremor, which is similar to holding a pill between the thumb and index finger of the right hand and turning it gently, even when there is no force when Mr. A is asked to place his hand comfortably on the table. In addition, extremity muscle spasm was severe, movements of the hands and feet were difficult, and the corrective reflexes were also poor, and when the doctor pulled back slightly from a standing position, he easily lost his center of gravity. It has been regarding 3 years since these body changes started, but he did not visit the hospital because he did not feel any discomfort in life. I was diagnosed with idiopathic Parkinson’s disease. I started drug treatment with L-dopa, the most widely used treatment for Parkinson’s symptoms, and as a result, the stiffness and movement of the body were significantly improved. For that reason, I used a beta blocker used for essential tremor, and hand tremor was also reduced to some extent.”
Causes of Parkinson’s disease
Until the twentieth century, Parkinson’s was considered rather simplistic. At the top of the brainstem, in the midbrain, there is a nucleus called the substantia nigra, which looks black and is literally called the substantia nigra. In the substantia nigra, a neurotransmitter called dopamine, which regulates the motor coordination neural network, is produced and sent to a region of the basal ganglia called the globus pallidus. When the function of the nerve cells that secrete dopamine in the substantia nigra declines and is lost due to aging, the motor control function centered on the basal ganglia becomes abnormal and the body becomes stiff and slow. Twenty-five years ago, this was the mainstream theory of the cause of Parkinson’s.
However, with advances in medicine and the accumulation of various research data, the pathophysiology involved in the development of Parkinson’s disease has been completely reversed. It is said that neuronal aging in Parkinson’s disease begins with the medulla oblongata, the lowest part of the brainstem, not the midbrain. And the degenerative changes gradually spread to the pons and midbrain, which is the upper part of the medulla oblongata, and eventually invade the cerebrum. The brain ages in the reverse order to Alzheimer’s disease. Therefore, recently, constipation due to degeneration of the medulla oblongata and sleep disturbance due to degeneration of the pons are recognized as the earliest symptoms of Parkinson’s disease. These symptoms may start in your 40s or 50s. At the same time, the theory that Parkinson’s disease starts from the autonomic nervous system that controls the intestine and ascends to the brainstem is drawing attention.
If you look at the basic research papers, the causes of Parkinson’s disease are ‘sleep disturbance’ and ‘extreme stress’ and the brain is being abused. If you have any concerns regarding Parkinson’s disease, such as a family history, you must pay attention to these points in your life.
The tremor of Parkinson’s disease is considered a symptom that is somewhat separate from the other basic symptoms. The basic symptoms are all due to a lack of dopamine in the basal ganglia. However, the exact mechanism of Parkinson’s tremor is still unknown. Most recently, the cause is being investigated in two loops of important neural circuits related to motor performance. The first loop leads to the basal ganglia-thalamus-cerebrum-back to the basal ganglia, and the second loop leads back to the cerebellum-thalamus-cerebrum-cerebellum.
Each part of the brain vibrates electrically with its own frequency just like AM radio waves. However, due to degenerative changes in the brainstem, the vibrations inherent in these two loops are not filtered and affect the motor cortex of the cerebrum, resulting in tremor. Because the cause of Parkinson’s tremor is a lack of dopamine and other factors, it is difficult to see a great effect with dopamine derivatives. Rather, it is more effective to use drugs used for essential tremor.
Recently, there is a strong theory that Parkinson’s disease and Alzheimer’s disease begin gradually from the age of 40. At this time, what we can do is get enough sleep, a healthy diet, and proper exercise. It’s clichéd, but it also means that it’s just as important. In these days of rapid aging, I always wonder how great it would be if a healthy lifestyle might reduce the incidence of neurodegenerative diseases.
Help = Hidak Consulting Doctor Hanseung Lee (Neurologist at Herb Neurology Clinic)
