World Parkinson’s Day
April 11, 2022 is World Parkinson’s Day. This day is intended to create a better understanding of the living situation of those affected and their families.
The good news first: The course of Parkinson’s disease can be slowed down. Even if it hasn’t been stopped entirely yet. How and in what form the destruction of the nerve cells is promoted has already been well researched. However, the “why”, i.e. the exact cause, is still unknown. One thing is certain: This cause causes an ever-progressing braking of dopamine production.
Behavior and lifestyle have no relevant influence on when and in what form the disease becomes noticeable. So far there is no way to prevent it. Familial accumulations are known, but those genetic defects that have now been scientifically proven are not automatically passed on. Almost 20 gene locations are currently known in medical research that are considered markers for Parkinson’s.
Without dopamine, no movement
The messenger substance dopamine ensures that signals are transmitted from one nerve cell to the next. Without these signals, which are relayed in a tiny split second, we cannot move. If the signals are too weak, our movements are also slow and halting. When we’re scratching our nose, for example, the necessary instructions for the movements have just been transmitted from our brain to the relevant places in our body via dopamine.
“Dopamine is the fuel of our motor functions in the body. It’s like a car,” explains Prim. Philipp Werner, head of the neurological departments at the main hospitals in Feldkirch and Rankweil: “The most beautiful vintage car can be perfect and largely rust-free in front of us. If there is no fuel, it won’t drive.”
Malfunction in the “control center”
In medical research, it has been proven that the causal problem of Parkinson’s disease lies in the midbrain. Ultimately, there is a dopamine deficiency in the “target areas” of dopamine, the so-called basal ganglia. The nerve network that is available for this is the “control center” for our movements.
“In this network, or more precisely: in the substantia nigra, i.e. the black substance, the brains of Parkinson’s patients show protein deposits. These deposits obviously have a destructive effect, because the beleaguered cells can no longer start dopamine production. There is a serious lack of dopamine,” explains the primary the current scientific explanation. “So we know that this is the pathological process of this neurodegenerative disease. We see what’s wrong and what it does. But to this day we don’t know in detail why this protein builds itself in there.”
Parkinson’s disease becomes recognizable and noticeable for those affected when between 50 and 80 percent of the dopamine-producing nerve cells are destroyed. This process takes quite a long time, so the disease usually already exists for several years before it even becomes noticeable.
More than just halting movements
The most common type among Parkinson’s sufferers is the “equivalence type”, i.e. those who appear slow and stiff in their motor skills and who clearly tremble. In the other two forms, muscle stiffness (rigor) and trembling (tremor) are in the foreground. “First and foremost, it is motor symptoms that characterize Parkinson’s disease. They usually only appear on one side at first,” explains the specialist, referring to the typical choppy, halting and tripping movement sequences, the lack of swinging of an arm when walking, the restricted facial expressions with reduced blinking of the eyelids and the characteristic tremors.
“Parkinson’s disease can be diagnosed purely clinically by neurologists up to 90 percent. You don’t need a picture or a laboratory for this. What lies behind it, however, is far less easy to see through. The motor system is such a complex process in the brain that it is difficult for a normal mortal to grasp what our body accomplishes here.” This is also reflected in the international research into Parkinson’s: It has been going on for around 200 years (the disease was first described by the English physician James Parkinson in 1817) and are far from complete.
Olfactory disorders can result
Due to the nerve degeneration in the brain, olfactory disorders can also occur in addition to the motor symptoms in the course of the disease. “These olfactory disorders can even occur before that: we now know that some Parkinson’s patients can no longer smell well long before the diagnosis – often even years before. A connection is then often only made later, usually when the treating physicians specifically ask regarding it. Here, too, development occurs insidiously.” Disorders of the bladder function as well as sexual dysfunction, sleep disturbances, hallucinations and mood swings can also be associated with Parkinson’s disease.
Dance therapy and listening to music
The root cause of Parkinson’s disease cannot yet be eliminated, but symptomatic treatment with medication provides significant relief: “The positive effect sets in almost immediately and can slow down the progression of the disease significantly over the years. However, over time, the natural aging of patients causes symptoms to gradually appear despite treatment.”
In addition to dopamine tablets, additional, non-drug therapies such as dance units can bring relief: “There are studies that clearly show that the motor skills of people with Parkinson’s improve as a result of dance therapy, drumming and listening to music. Here, too, the disease is not cured, but the therapies make life much easier for those affected. In general, rhythmic movements have a positive effect and can even slow down the progression of the disease,” says Primary Werner.
For a good 20 years, a small group of those affected have also been using special neurostimulators, which – like a pacemaker stimulates the heart – stimulate the nerve cells: “Patients who clearly experience tremors benefit the most. The neurostimulators are used in a special, computer-controlled operation in the area of the basal ganglia in the brain.” However, scientific experiments with gene therapies or treatments with stem cells have so far not brought the desired results.
Hope for new therapies
Research continues worldwide. The scientists are primarily concerned with those protein deposits that bring dopamine production to a standstill: “A few years ago, German neurologists also found this so-called alpha-synuclein, which has been detected in the brain, in the skin of Parkinson’s patients found in the patients,” explains Primar Philipp Werner, “as protein aggregates in the small nerve fibers. The researchers were able to identify them long before the onset of symptoms. And neurologists at Innsbruck University Hospital have been looking for biomarkers in brain imaging as an early symptom.”
There are all other small pieces of the puzzle that allow an early diagnosis of Parkinson’s and thus possibly also the start of therapy before the onset of the first symptoms – and hopefully at some point also in treatments that can stop the disease.
