Parkinson’s disease occurs as a result of the damage and loss (degeneration) of a small part of the cells responsible for our movements in the brain. These cells secrete a chemical substance called dopamine that sends information from one nerve cell to another. If sufficient dopamine cannot be made in the brain, the movement and posture functions are affected and the symptoms of Parkinson’s disease occur. The main symptoms of dopamine deficiency are slower movements, decreased mobility, and shaking. However, tremors may not be in every patient. The disease progresses slowly. The presence and severity of symptoms and the progression rate of the disease differ from patient to patient. Today, although there is no definitive cure for the disease yet, the medications used to improve the symptoms to a great extent and enable many patients to continue their lives actively and productively. Thus, most Parkinson’s patients can live happily with regular treatment for many years.
Parkinson’s Disease Treatment
Today, the treatment of Parkinson’s disease is predominantly done with oral medications, and there are medications and surgical treatments applied with different methods in a group of patients with appropriate characteristics. It is thought that the dopamine deficiency in the brain, which causes symptoms such as slow movement and tremors, started approximately 6-7 years before the diagnosis of the disease, and some of the mechanisms that the brain successfully developed to overcome the deficiency during this period may cause undesirable consequences over time. Therefore, when the disease is diagnosed, it is thought to correct or supplement the dopamine deficiency. It is recommended to start therapeutic treatments.
Treatment of Parkinson’s disease with oral medications:
Following the diagnosis, treatment is started with oral medications. There are many drug options used for this purpose. Factors such as which drug group to choose, the age of the patient, the severity and nature of the symptoms (which one of the tremor or slowness are at the forefront), the length of time until the diagnosis, how many functional or social problems the symptoms cause, and finally the general health problems that accompany the patient. It is decided by taking into account.
All these drugs
To be known by the patient and his relatives by name and dosage,
It should be taken at the dose and hours recommended by the specialist physician,
Knowing and closely monitoring the expected effects and possible side effects,
Reviewing the doses with regular doctor visits and adjusting if necessary,
Timely introduction of effective measures against side effects
What is important in drug treatment in PH are its general rules.
As PH progresses, oral medications may become increasingly inadequate, they may need to be taken more frequently or in higher doses, which may lead to increased side effects. If, despite all the adjustments, the slow/dull periods of the patient reach more than 4-5 hours a day, surgical methods are considered if the recovery periods do not go well enough due to side effects such as involuntary movements.
Two more methods can be used before surgery or in patients who are not suitable for surgery. In one of these methods, the drug is continuously administered through a small needle placed under the skin and a pump connected to it, while in the other method, the drug is continuously administered through a small tube and a pump that is extended into the intestine through a small hole opened in the abdomen
Surgical treatment of Parkinson’s disease:
Surgical treatment in Parkinson’s disease may be beneficial in patients suitable for this method. These methods, known as burning (ablation) and brain pacing (deep brain stimulation), are not suitable for every patient. Before the decision of surgery, it should be ensured that the correct diagnosis is made by a neurologist experienced in the treatment of Parkinson’s disease and the most appropriate drug treatment is applied. No surgical method used in the treatment of Parkinson’s disease does not completely eliminate the disease.
Almost all patients continue to use medications for Parkinson’s disease after surgery. Scientific studies have shown that the symptoms of the disease can be reduced by 50% and the need for medication can be reduced by 80% after surgical treatment. These rates vary individually for each patient.
New treatment research in Parkinson’s disease:
Stem cell research
Cell transplant methods
Gene therapies and growth factor methods
It can be summarized as
Stem cell research
The main goal of researches on this subject is to overcome this deficiency by transplanting stem cells instead of dopamine cells lost in Parkinson’s disease. Stem cell research is still at a very early stage and there is no serious study/research conducted in Parkinson’s patients. After the experimental animal studies are found to be successful and safe, they will be applied/researched in humans. There are some serious problems in front of the stem cell method and time is needed to overcome these problems.
It should not be forgotten that for now, stem cell therapy is out of the question in Parkinson’s disease. Taking advantage of legal gaps, there are centers in some countries claiming to apply stem cell therapy. We recommend that our patients do not rely on these claims and learn the developments in this regard from their physicians.
This method is based on the transfer of dopamine cells obtained from the brains of human fetuses whose life has ended by abortion to the brains of patients with Parkinson’s after going through many complex processes. There were positive and negative results obtained with this method in the past. Therefore, cell transplantation therapy was re-investigated by a group of European Union member countries (TransEuro Consortium) in 2012. The results of this ongoing study will be announced in the next few years, and if the results are positive, this method may come to the fore as a treatment option.
In this method, small creatures called “viruses” are genetically modified and used as carriers to transfer some desired messages to the brain. These transporters, which are transported to the brain, are intended to increase dopamine production or suppress some overworking nerve cell circuits, but these approaches have not yet been proven to work. A promising approach with this method is the transfer of genes that provide substances called “neurotrophic factors” (substances that feed the nerve cells) that will prolong the life of nerve cells and protect them from cell death. Both animal models and human studies are continuing on this subject, which is quite laborious and takes years to investigate. If this approach is successful, it will be possible to stop the progression of Parkinson’s disease by gene transfer to the brain.
Parkinson’s disease and vaccine studies
The main problem in Parkinson’s disease is thought to be the excessive accumulation of a protein called “alpha-synuclein” in nerve cells, especially dopamine cells. It is predicted that Parkinson’s disease can be slowed or stopped by preventing the accumulation of this protein in the brain or by clearing it from the brain. The main purpose of this method called the “Parkinson vaccine” is to stimulate the immune system of the body with the vaccination using alpha-synuclein protein and to ensure the development of “antibodies” (defense agents of the body) against this protein. Thus, these antibodies are aimed to remove the alpha-synuclein accumulated in the brain from the brain. Preliminary studies are currently ongoing and results are expected in the next few years.
As Parkinson’s disease develops, its genetic causes and cellular mechanisms are understood, new treatment possibilities come to the fore. The process of introducing a new treatment method to the use of patients requires years of extensive research. If one or more of the studies summarized above result in positive results, there will be important developments in the treatment of Parkinson’s disease in the upcoming period.