Causes and Treatment of Parkinsons Disease - Essay Example

Parkinson Disease Parkinson disease is a common neurological disease that affects about one percent of individuals above 60 years of age (Hauser,Emedicine). The exact cause of the disease is unknown and researchers have proposed that a combination of environmental and genetic factors is responsible for the pathogenesis of the disease. The disease is insidious at the onset and the most common symptom is tremor (Wirdefeldt, 2). The incidence and prevalence of the disease varies widely all over the world and it increases with age. It is uncommon in individuals less than 40 years of age and it is 1.5 times more common in men when compared to women. The disease causes severe disability and is associated with high morbidity and mortality if untreated (Wirdefeldt, 2). Introduction of levodopa has decreased deaths and disability associated with the disease significantly. In this project, the clinical presentation, epidemiology, risk factors, treatment options and public education of Parkinson disease will be discussed with reference to recent literature. The exact etiology of the disease is yet unclear. It is likely that both genetic and environmental factors play a role in the development of the disease. In about 10 percent of the cases, genetic factors account for the disease development (Bekris, 228). Environmental risk factors include rural environment, exposure to pesticides and herbicides, well water consumption and living in proximity to quarries and industrial plants. Biochemical mechanisms of disease development include 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) accumulation in mitochondria and free radical damage due to dopamines oxidative metabolism (Wirdefeldt, 3). Genetic factors are important in early onset Parkinsons disease rather than in late onset disease type (Bekris, 229). Parkinson disease is a disease of basal ganglia. The main neuropathological findings in this condition are presence of Lewy bodies and loss of dopaminergic neurons that are pigmented in the substantia nigra (Wirdefeldt, 3). The first clinical signs in Parkinson disease are motor signs. The signs are asymmetric. The first clinical symptom in most individuals is asymmetric resting tremor in the upper extremity. Eventually, the patients develop progressive bradykinesia, rigidity and difficulty in gait. Gradually, the axial posture flexes progressively and the strides progressively become shorter. Non-motor clinical symptoms include decrease in olfactory function, rapid eye movement behavior disorder, sleep disturbances, slowness in thinking, depression, malaise, lassitude, sweating abnormalities, decreased sexual functioning, seborrheic dermatitis, decreased facial expression and constipation (Wirdefeldt, 7). In young-onset disease, dystonia is a significant finding. Parkinson disease is an incurable progressive neurological disease and goal of medical management is mainly to control the signs and symptoms of the disease with minimal adverse effects. There is evidence that if medical treatment is not initiated shortly after diagnosis, the quality of life deteriorates rapidly (Wirdefeldt, 12). The drug of choice in Parkinson disease is levodopa (Hauser, emedicine). It is coupled with carbidopa, a peripheral decarboxylase inhibitor. Carbidopa inhibits decarboxylation of levodopa in systemic circulation, thus allowing greater distribution of dopamine in the central nervous system. Levodopa increases motor signs and symptoms in patients with Parkinson disease. It is an excellent drug for short term use as it is associated with few side effects. However, long term use of the drug is associated with dyskinesias and motor fluctuations which seldom resolve and in fact worsen progressively (Wirdefeldt, 19). Other than levodopa, monoamine oxidase-B inhibitors also are considered for initial treatment of the disease. They not only provide symptomatic relief, but also improve quality of life. They have few adverse effects and useful for long term treatment. Dopamine agonists, like pramipexole and ropinirole, also offer some symptomatic relief and also delay the development of onset and progression of dyskinesia (Wirdefeldt, 14). Most of these drugs provide good symptomatic control for about 4-6 years (Wirdefeldt, 14). Mostly, they help in the control of motor symptoms. After this period, the drugs have lesser impact on control of symptoms and also lead to certain adverse events. All patients on anti-parkinsonian drugs must be screened for adverse effects, because adverse effects to treatment are very common and progressive and are a source of poor quality of life. Some of the adverse effects include edema, sudden-onset sleep, impulse control disorders, somnolence and hallucinations. Long term motor complications, like dyskinesia and fluctutations, and also other problems like postural instability and dementia contribute to poor quality of life (Wirdefeldt, 16). Besides symptomatic therapy, there is some form of neuroprotective therapy which may be administered for some long term benefits. The aim of this therapy is to block, slow or even reverse the progression of the disease. As of now, there is no perfect neuroprotection agent. MAO-B inhibitors, isradipine and creatine are some neuroprotective agents. In younger patients, long term therapeutic considerations must be given, because these patients are likely to suffer from side effects of long term treatment. In older patients and those with cognitive impairment, short term therapy must be the goal. In patients with severe motor fluctuations and dyskinetic movements, surgical options like deep brain stimulation must be done (Wirdefeldt, 19). Even non-motor symptoms of Parkinsonism merit equal importance because of their capacity to cripple quality of life. Treatments like antidepressants, anti-constipation therapies like polythylene glycol, modafinil for daytime somnolence, sildenafil for erectile dysfunction, methylphenidate for fatigue and other such treatments must be administered case-wise (Hauser, Emedicine) It is very important that patients with Parkinson disease be encouraged to participate in various aspects of decision making with regard to their disease (Hauser, Emedicine). They must be educated about the various clinical aspects of their disease and the expected challenges they may encounter. Psychologist and social worker may be involved for appropriate psychosocial counseling and help. Most important is prevention of falls. Falls can increase the mortality and morbidity in these patients and hence written information and oral guidance must be provided both to the patients and their caregivers regarding prevention of falls. Other issues which must be addressed during appropriate times include changes in personality, cognitive declination, sleepiness, easy fatigability, dysphagia, depression and impulse control disorders (Wirdefeldt, 22). It is yet unclear as to whether Parkinson disease is a preventable condition (Hauser, Emedicine). Since the condition is associated with some environmental risk factors, some researchers are of the opinion that avoiding such risk factors can decrease the chances of developing the disease. Decreased usage of herbicides, pesticides and well water and living in non-industrial urban areas helps might help in decreasing the risk of contracting the disease. Early diagnosis and early institution of treatment is very important for control of symptoms and improvised quality of living. Patients must be advised for regular follow-up and encouraged to report side effects to treatment. Progression of the disease and need for collateral references must be monitored and patients must be counseled about them (Wirdefeldt, 42). Thus, Parkinson disease is a common, incurable, progressive neurological condition that merits importance. Early diagnosis, early institution of treatment and patient education are important for improving quality of life. Works Cited Bekris, L.M., Mata, I.F., and Zabetian, C.P. "The Genetics of Parkinson disease." J Geriatr Psychiatry Neurol. Dec 2010;23(4):228-42. Print. Hauser, R.A. "Parkinson Disease." Medscape Reference. Web. http://emedicine.medscape.com/article/1831191-overview Wirdefeldt, K., Adami, H.O., Cole, P., Trichopoulos, D., and Mandel, J. "Epidemiology and etiology of Parkinsons disease: a review of the evidence." Eur J Epidemiol. Jun 2011;26 Suppl 1:S1-58. Print. Tanner, C.M., Ottman, R., Goldman, S.M., Ellenberg, J., Chan, P., Mayeux, R. et al. "Parkinson disease in twins: an etiologic study." JAMA. Jan 27 1999;281(4):341-6. Print. Read More