A Comprehensive Report on Parkinson's Disease

Introduction

The purpose of this report is to thoroughly inform the reader about the significant history of Parkinson’s disease, an explanation as to what Parkinson’s is, symptoms that can be attributed to Parkinson’s, treatments to Parkinson’s, and finally interesting facts about Parkinson’s and the mark that it’s left on our world. Through this, the reader will become more educated on Parkinson’s and will be able to highlight the key points of this article.

Parkinson's is a long-lasting and progressive disorder that affects nerve cells in the brain responsible for the body’s movement. It is a truly horrific disease that causes tremors, stiffness, and slowness as dopamine-producing nerve cells die. It is a disease known for progressively taking over the human body and robbing it of its motor functions. However, the discovery and research conducted on this unforgiving and mysterious disease have brought ease to our world.

The Discovery Of Parkinson’s

First Encounter

Parkinsons dates back to the 19th century when English surgeon James Parkinsons published his work “An Essay on the Shaking Palsy”. This groundbreaking 66-page essay highlighted what Parkinson’s thought to be a new medical species in our world. Parkinson’s is thought to have been driven to write this medical classic by his hero and colleague John Hunter who probably unbeknown to Parkinson’s had the shaking palsy in his Croonian Lecture of 1776.

Reported Cases

James Parkinson’s “An Essay on the Shaking Palsy,” writes about what he believed at the time to be a new “medical species” in which he found several different cases where Parkinson’s was prominent. In case 2 he writes about a woman who has suffered from Parkinson’s for the majority of her life at which it slowly took over her body causing horrible symptoms. “A lady, at the age of seventy-one, had universal palsy: every part of the body shook which was not fully supported. The muscles of respiration were so affected, that respiration was with difficulty effected; but in sleep, the vibratory motions of the muscles ceased, and the respiration was performed more equably: any endeavor of the will to alter these morbid actions increased them”.

Fast forward to 1872 Charcot and his students begin researching Parkinson’s. Charcot and his students described the clinical spectrum of this disease, noting two prototypes, the tremorous and therefore the rigid/akinetic form. They described in detail the changes, dysautonomia, and pain that can accompany Parkinson's disease. Charcot was the first to suggest the use of the name “Parkinson's disease” rejecting the earlier statement that it should be designated the name of paralysis agitans or shaking palsy because he recognized that Parkinson's disease patients are not markedly weak and do not necessarily have a tremor.

Explanation of Parkinson’s

What is Parkinson’s?

Parkinsons is a progressive disease that affects the nerve cells in the deep part of the brain called basal ganglia and substantia nigra. These nerve cells are responsible for creating neuro transmitting dopamine responsible for relaying messages and creating body movement. The cause of unknown reasons, nerve cells in the substantia nigra begin to die off and when 80 percent of dopamine is lost symptoms such as tremors and stiffness begin to show themselves.

How are Tremors Created?

Impulses intended for body movement are started in the motor cortex and it is the basal ganglia where the responsibility for activating and inhibiting special circuits lies. These neurons move incredibly quickly from the brain to the spinal cord and finally to the muscles. When the dopamine receptors in the striatum are not adequately stimulated parts of the basal ganglia to become either under-or over-stimulated. More importantly, the subthalamic nucleus becomes overactive and as a result, acts as a brake globus pallidus internal causing the shutdown of movement and rigidity. When the GPI becomes over-stimulated over-inhibitory effect on the thalamus, which in turn decreases thalamus output and causes tremors.

How do the symptoms begin?

The action of dopamine is opposed by another neurotransmitter called acetylcholine. The PD symptoms of tremor and stiffness occur when the nerve cells fire and there isn't enough dopamine to transmit messages. High levels of glutamate, another neurotransmitter, also appear in PD because the body tries to catch up on the shortage of dopamine

Genetic Variation Studies

With a large scale candidate for the next gene study, Chung et al began his study on PD by researching the association of common variants in PARK loci and related genes with PD susceptibility and age at onset in an outbred population Successfully they matched 1,103 cases from the upper midwest USA with unaffected siblings at 654 and or unrelated controls at 449. Using a sequencing approach in 25 cases and 25 controls, SNPs in species-conserved regions of PARK loci and related genes were detected. A total of 235 SNPs and two other variable number tandem repeats in the ATP13A2, DJ1, LRRK1, LRRK2, MAPT, Omi/HtrA2, PARK2, PINK1, SNCA, SNCB, SNCG, SPR, and UCHL1 genes were genotyped in all 2,206 subjects.

Symptom/Who Does It Affect?

What are the symptoms?

Symptoms of Parkinson’s vary from person to person especially depending on how far the disease has evolved. Symptoms may include:

• Bradykinesia - which can cause slow movement, emotionless face excessive blinking, and drooling
• Tremor at rest - Shaking without being able to control it can be decreased with purposeful movement.
• Rigidity - stiffness caused by increased muscle tone
• Postural instability - a sense of imbalance. Patients often compensate by lowering their center of gravity, which results in a stooped posture.
• Freezing or being stuck in place
• Shuffling gait or dragging of one foot
• Stooped posture
• Small, cramped handwriting
• Sleep problems, insomnia
• Apathy, depression
• Lowered voice volume or tremor when speaking
• Difficulty swallowing
• Constipation
• Cognitive impairment

Who is Mainly Affected?

Parkinson's affects over 1.5 million Americans with about 60,000 being diagnosed every year. Parkinson's occurs 50% more often with men rather than women and although the exact reason for this is unknown some suggested explanations can include a higher rate of head trauma and more exposure to toxins in men. Parkinsons is a disease known for affecting the elderly and is the second most common age-related nerve degenerating disease after Alzheimer’s disease. The reason why Parkinson’s affects the elderly is unknown but scientists say it can be attributed to a combination of genetic and external factors.

How is a Diagnosis Made?

Because a lot of conditions and medications mimic the same symptoms of Parkinson’s an initial diagnosis can be hard to make. Multiple tests are required to diagnose Parkinson’s because no one has the exact same symptoms. An extremely thorough physical and history is enough to diagnose Parkinson’s.

Treatments for Parkinson’s

Self Care

Many Parkinson’s patients enjoy a normal lifestyle full of exercise and healthy eating. Maintaining a healthy lifestyle by eating healthily and exercising can help maintain overall health and well-being. Exercise is just as important as medications in the case of Parkinson’s as it helps maintain flexibility and improves balance and range of motion.

Medications

There are several medications used to manage the symptoms of Parkinson’s each may be used separately or in combination with each other depending on how far the disease has advanced.

Conserve dopamine in the brain by blocking the breakdown action of MAO-B. These drugs are selegiline (Eldepryl, Zelapar) and rasagiline (Azilect), which are also neuroprotective and can slow disease progression.

Amantadine (Symmetrel) which allows for increase in dopamine release. Pramipexole (Mirapex), ropinirole (Requip), and apomorphine (Apokyn) which all mimic dopamine and attach to the receptors in the neuron's synapse. Replace missing dopamine in the brain. Levodopa which replaces missing dopamine in the brain which in turn helps with movement problems of tremors, stiffness, slowness, and walking. Tolcapone (Tasmar) and entacapone (Comtan) which help ensure the delivery of Levodopa to the brain by blocking COMT.

Reduce the activity of the neurotransmitter acetylcholine. These drugs reduce tremors and include trihexyphenidyl (Artane) and benztropine (Cogentin) which reduce the activity of the neurotransmitter acetylcholine which in turn reduces tremors.

Surgery

When all else fails to control the symptoms of Parkinson’s surgery may be the only option left. One of the most promising surgeries Deep Brain stimulation is a surgical procedure that works to add a pacemaker into the brain that is responsible for sending electrical signals to parts of the brain responsible for movements. During the surgery, electrodes get placed on the brain usually the subthalamic nucleus depending on the symptoms being treated. The electrodes are connected to long extension wires that are passed under the skin and down the neck to a battery-powered stimulator under the skin of the chest. When turned on the stimulator send electrical pulses that block the symptoms from being caused.

Interesting Facts About Parkinson’s/Impact on our world

The exact cause for Parkinson’s still remains largely unknown. Inheriting the disease is extremely unlikely as only 10% to 15% of cases are thought to be inherited genetically. Each patient of Parkinson’s experiences different symptoms due to the diversity of the disease. Although what myths made have led you to believe people with Parkinson’s can live a high-quality life if they choose to make the commitment.

Parkinson's places an enormous burden on the patient and those surrounding them. It has created financial ruin on the healthcare system society and patients themselves. As the overall patient count increases the call to cure this tremendous disease becomes larger.

Conclusion

Parkinson’s disease has become a prominent figure in our history becoming a disease revered by those approaching older ages. Humanity has come a long way in combating this disease with countless medications and ways to reduce symptoms. However, Parkinson’s still remains one of the largest medical mysteries to us. Scientists are working hard every day to make a world where Parkinson’s doesn’t plague the elderly. With countless scientists dedicating their lives work to Parkinson’s and new advances in technology diseases like Parkinson’s will cease to exist in the coming years ending this reluctant disease for good.

References

1. Fan, K., Hu, P., Song, C., Deng, X., Wen, J., Liu, Y., & Deng, H. (2019). Novel Compound Heterozygous PRKN Variants in a Han-Chinese Family with Early-Onset Parkinson’s Disease. Parkinsons Disease, 2019, 1–6. doi: 10.1155/2019/9024894
2. Palacios, Natalia, O’Reilly, Schwarzschild, A., M., Ascherio, & Alberto. (2020, January 20). Long-Term Use of Antibiotics and Risk of Parkinson's Disease in the Nurses' Health Study. Retrieved from https://www.hindawi.com/journals/pd/2020/4038375/
3. Parkinson's disease. (2018, June 30). Retrieved from https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055
4. Toodayan, N. (2018). James Parkinsons Essay on the shaking palsy , 1817–2017. Medical Journal of Australia, 208(9), 384–386. doi: 10.5694/mja17.01085
5. Wróblewska Agata, Gajos, A., Smyczyńska Urszula, & Bogucki, A. (2019). The Therapeutic Effect of Nordic Walking on Freezing of Gait in Parkinson’s Disease: A Pilot Study. Parkinsons Disease, 2019, 1–10. doi: 10.1155/2019/3846279