Parkinson's disease occurs as a result of damage and loss (degeneration) of a small part of the cells in the brain that are responsible for our movements. These cells secrete a chemical called dopamine that sends information from one nerve cell to another. If not enough dopamine is produced in the brain, movement and posture functions are affected and symptoms of Parkinson's disease occur. The main symptoms of dopamine deficiency are slowness of movements, decreased mobility and tremors. However, tremor may not occur in every patient. The disease progresses slowly. The presence and severity of symptoms and the rate of progression of the disease vary from patient to patient. Although there is no definitive treatment yet that will completely cure the disease, the drugs used can greatly improve the symptoms and enable many patients to live an active and productive life. Thus, most Parkinson's patients live happily for many years with regular treatment.
Treatment in Parkinson's Disease
Today, the treatment of Parkinson's disease is mainly done with oral medications, which have appropriate properties. There are also medications and surgical treatments applied with different methods in a group of patients. It is thought that the dopamine deficiency in the brain, which causes symptoms such as slowness of movement and tremors, begins approximately 6-7 years before the disease is diagnosed, and some of the mechanisms that the brain has successfully developed to overcome the deficiency during this period may produce undesirable results over time. Therefore, when the disease is diagnosed, dopamine deficiency or supplements are needed. 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. Which drug group to choose will depend on the patient's age, the severity and nature of the symptoms (tremor or slowness), the length of time until diagnosis, how much of a functional or social problem the symptoms cause, and finally the patient's general accompanying symptoms. Factors such as health problems all come together The decision is made taking into account.
All these drugs,
- Recognition of all these drugs by their names and doses,
- It must be taken at the doses and times recommended by the specialist physician,
- Close monitoring by knowing the expected effects and possible side effects,
- Regularly Reviewing the doses with doctor checks and adjusting them if necessary,
- Introducing effective measures against side effects in a timely manner
In PH What is important in drug treatment are the general rules.
As PH progresses, oral medications may become increasingly inadequate, and 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 patient's periods of slowness/dullness reach more than 4-5 hours in total per day, and if the recovery periods do not go well enough due to side effects such as involuntary movements, surgical methods are considered.
Pre-surgery or in patients who are not suitable for surgery. There are two other methods that can be used. In one of these methods, the drug is administered continuously through a small needle placed under the skin and a pump connected to it, while in the other method, the medication is continuously administered through a small tube and a pump that is extended to the intestine through a small hole opened in the abdomen.
Surgical treatment of Parkinson's disease:
Surgical treatment of Parkinson's disease may be beneficial in patients suitable for this method. These methods, known as burning (ablation) and brain stimulation (deep brain stimulation), are not suitable for every patient. Before deciding on surgery, it must be ensured that the correct diagnosis is made by a neurologist experienced in the treatment of Parkinson's disease and that the most appropriate drug treatment is applied. No surgical method used in the treatment of Parkinson's disease completely eliminates the disease.
Almost all patients continue to use medications for Parkinson's disease after surgery. Scientific studies show that disease symptoms disappear by 50% after surgical treatment. has shown that medication requirements can be reduced by 80%. These rates are for each patient. It varies from person to person.
New treatment research in Parkinson's disease:
Can be summarized as
Stem cell research
The main goal of research on this subject is to eliminate this deficiency by transplanting stem cells to replace the dopamine cells lost in Parkinson's disease. Currently, stem cell research is at a very early stage and there is no serious study/research conducted on Parkinson's patients. After experimental animal studies are found to be successful and safe, it will be applied/researched in humans. There are some serious problems with the stem cell method and time is needed to overcome these problems.
It should not be forgotten that there is currently no stem cell treatment for Parkinson's disease. There are centers in some countries that claim to provide stem cell treatment by taking advantage of legal loopholes. We recommend that our patients do not trust these claims and learn about the developments on this subject from their physicians.
Cell transplantation
This method is obtained from the brains of human fetuses whose lives have ended through miscarriage. It is based on the transplantation of dopamine cells into the brains of Parkinson's patients after going through many complex processes. There are positive and negative results obtained with this method in the past. For this reason, cell transplantation treatment started to be researched again in 2012 by a group of European Union member countries (TransEuro Consortium). 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.
Gene therapy
This In this method, small creatures called "viruses" are genetically modified and used as carriers to transfer some desired messages to the brain. These carriers transplanted to the brain increase dopamine production or reduce certain overactive nerves. It is aimed at suppressing r 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 factor" (substances that nourish the nerve cell) that will prolong the life of nerve cells and protect them from cell death. Research on this subject, which is quite laborious and takes years to research, continues both in animal models and in humans. 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 in nerve cells and especially It is thought that there is excessive accumulation of a protein called "alpha-synuclein" in dopamine cells. It is predicted that Parkinson's disease can be slowed down 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 "Parkinson vaccine", is to stimulate the body's immune system by vaccination using alpha-synuclein protein and to create "antibodies" (the body's defense substances) against this protein. ) is to ensure its development. Thus, these antibodies are intended to remove alpha-synuclein accumulated in the brain from the brain. Preliminary studies on this subject are currently ongoing, and results are expected in the next few years.
CONCLUSION
As we understand how Parkinson's disease occurs, its genetic causes and cellular mechanisms, new developments will be made. Treatment possibilities come to the fore. The process of introducing a new treatment method to patients requires years of extensive research. If one or more of the studies summarized above yield positive results, there will be significant developments in the treatment of Parkinson's disease in the coming period.
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