A few days before World Parkinson’s Day, which takes place on April 11, the cantons of Sellières, Bletterans and Chaumergy of the SDAE du Jura had invited Dominique Lefier, departmental delegate of the France Parkinson association, to discuss this neurodegenerative pathology, recognized occupational disease in agriculture.
The second degenerative disease following Alzheimer’s, Parkinson’s affects 200,000 people in France (750 in the Jura). It is often diagnosed between the ages of 55 and 65 but can occur earlier. Men are 1.5 times more affected than women.
Often, the general public imagines that it mainly results in tremors, but a third of patients do not have this symptom. “There are as many forms of Parkinson’s disease as there are patients,” explains Dominique Lefier. It attacks a fraction of the brain that produces dopamine, a neurotransmitter that allows information to flow in the form of electric current through neurons. “The brain functions normally but the muscles are out of step,” continues the Jura delegate from France Parkinson. “The mind wants, but the body refuses! Gestures, speech, writing, no longer follow. It becomes difficult even to type in a telephone number”.
Many symptoms
Automatic movements, such as the swinging of the arms when walking, are also impacted as well as the functioning of the digestive tract and the respiratory system. The patient suffers from rigidity, cramps, numbness, excessive sweating and slowness. Non-motor symptoms appear: fatigue, sleep disturbance, loss of smell and taste, cognitive disorders… “Pain can occur at any time. Impressions of electric shocks, burning sensations,” continues Mr. Lefier. “They come and go just as quickly.” These symptoms contribute to the desocialization of the patient.
The origin of this chronic progressive disease remains unknown. Hygiene of life and a hereditary part, up to 5%, are suspected. But environmental causes due to organochlorine pesticides are also a triggering factor. Parkinson’s is therefore recognized as an occupational disease in the agricultural world.
Honeymoon
It is important that those around you are aware of the disease. Caregivers play an essential role in encouraging the patient without rushing him to have physical activities, supporting him, arranging the habitat… But they too often need psychological support in this ordeal.
Parkinson’s disease progresses through four phases. The first is the appearance of one or more symptoms (tremors, difficulty speaking or writing, slowness of movement). Often, it is the entourage who notices it and encourages the patient to consult. The diagnosis is difficult because no biological marker or imaging analysis can detect it, only the effectiveness of drugs confirms this pathology. The first disorders appear when the production of dopamine is reduced by 50%. When a person is diagnosed, the disease began for 5, 10 years, or even more.
What treatments?
Once the diagnosis is made, a treatment to compensate for the lack of dopamine is prescribed. The patient then enters therapeutic remission, called a ‘honeymoon’. “This phase can last 10 years. It is important that the patient invests in his health and practices physical and intellectual activities because sport stimulates the production of dopamine”.
This honeymoon over, the production of dopamine starts to drop once more. It is then necessary to regularly adjust the dosage of treatments until their side effects become more important than their beneficial effects. This is then referred to as the invasion phase.
Rehabilitation, physical activity and psychological support are essential for care. Depending on the age of the patient, several treatments may be offered. Medicated, to provide dopamine with more or less rapid action, or more intrusive such as the implantation of a pump which allows continuous diffusion, like those with insulin for diabetics. Deep brain stimulation, with the placement of electrodes in the brain, is practiced by some hospitals in France and makes it possible to reduce the side effects of drugs.
But research continues to evolve, financially supported by France Parkinson. Currently, 147 trials are underway to slow the progression of the disease, reduce its symptoms or obtain a faster diagnosis. Something to raise hopes for new patients.
S.C.
