Parkinson's can not be cured until today, but the right treatment can extend the life expectancy of those affected and significantly increase their quality of life. The exact nature of the treatment depends, among other things, on the age of the patient, the symptoms that occur, the stage of the disease and the tolerability of the medication. The aim of Parkinson's therapy, however, is always to relieve the patient's discomfort and to maintain his independence as long as possible.
Individual care essential
In order to achieve these goals, it is important to start a treatment tailored to the patient as early as possible. Because only by an individual care can be addressed sufficiently on the various symptoms and the different rapid progress of the disease.
Parkinson's therapy is based primarily on the intake of medication. In addition, speech therapists as well as physiotherapists and occupational therapists play an important role. If a patient does not respond to drug treatment, surgery may be considered.
Parkinson's therapy with drugs
Since the cause of Parkinson's disease is in most cases not known, only the trigger of the typical Parkinson's symptoms - a dopamine deficiency in the brain - treated and thus relieve the patient's discomfort. Certain drugs can compensate for dopamine deficiency in the brain - but the dying of dopamine-producing neurons can not be prevented by medication.
To relieve patient discomfort, various types of drugs can be used: while levodopa is a precursor of dopamine, dopamine agonists mimic the action of the messenger. In addition, there are also drugs that inhibit dopamine degradation in the body (MAO B inhibitors and COMT inhibitors). Which drug is used in a particular case, the attending physician will decide together with the patient. Criteria for the choice of the drug include the age and health of the person affected.
Treat Parkinson's with levodopa
Levodopa is a precursor to dopamine, which is intended to balance dopamine deficiency in the brain. Instead of dopamine, this precursor substance must be used, since dopamine fed from outside does not cross the blood-brain barrier and thus can not penetrate into the brain.
For levodopa, however, this is possible and the substance can thus develop its effect in the brain after conversion to dopamine. However, the drug is already partially degraded on the way to the brain, which is why levodopa is often combined with other drugs that prevent premature degradation in the body.
Levodopa is the most effective treatment for Parkinson's and is well tolerated especially at the beginning of treatment. By taking the symptoms usually improve quickly, the muscle tension is lowered and improves the movement speed. Since disease-related complications can often be avoided by taking levodopa, the life expectancy of patients usually increases significantly. The disadvantage, however, is that it can sometimes come to therapy complications by the administration of levodopa.
Side effects of levodopa
The longer you take levodopa, the more the duration of action usually decreases. Often, the effect diminishes a few hours after ingestion. By contrast, the side effects often become more severe over time. Sleep disorders, involuntary movements (dyskinesia) and cardiovascular disorders are particularly common. In addition, states of confusion can occur. Therefore, levodopa is usually used only in patients over 70 years.
Therapy with dopamine agonists
Due to the increasing side effects of levodopa, younger patients under the age of 70 are often given other medicines at the beginning of treatment. These so-called dopamine agonists mimic the action of dopamine and thus take over the task of the messenger substance. Dopamine agonists have the advantage, compared to levodopa, that they do not lose their effect over time. However, they are also less effective from the beginning.
In contrast to levodopa, the body has to be slowly accustomed to the dopamine antagonists, so the dose is slowly increased over several months. As a result, it takes longer at the beginning of the therapy until the patient feels an improvement in the symptoms. If dopamine agonists are taken, unpleasant side effects such as abdominal pain, nausea and drowsiness occur more frequently. If cardiac valve disease occurs, certain dopamine agonists should not be prescribed, as otherwise connective tissue growth on the heart valves may occur.
Parkinson's treat with MAO-B and COMT inhibitors
While treatment with levodopa and dopamine agonists aims to replace the messenger substance dopamine, MAO-B and COMT inhibitors reduce the breakdown of dopamine. This happens because the function of the dopamine-degrading enzymes is inhibited. Due to the slowing down, dopamine can work longer in the brain and the concentration of the messenger substance is increased.
While MAO-B inhibitors inhibit the body's ability to inhibit the dopamine-degrading enzyme, COMT inhibitors prevent the breakdown of levodopa. Because of this, COMT inhibitors and levodopa are often taken in combination.
Outpatient video-assisted Parkinson therapy
If Parkinson's disease progresses over time, the medication must be readdressed on-site by a neurologist on site or in a specialist clinic. An alternative to this is the ambulant video-assisted Parkinson's therapy, which is currently still under construction. Its advantage is that it allows a close observation of the motor skills of the patient and can be taken into account during the medical re-adjustment and possible fluctuations in the course of the day.
In ambulatory video-assisted Parkinson's therapy, a video camera, a loudspeaker and a printer are installed in the apartment of the Parkinson's patient. The patient triggers one or more video recordings of two minutes daily. During this time, announcements from a neurologist sound through the loudspeaker, prompting the patient to perform certain movements.
Subsequently, the recording is transmitted to the responsible doctor and evaluated by the doctor. If there are a certain number of video recordings, the doctor prepares a treatment plan and gradually adjusts the medication. The patient can print out the current medication plan every morning.
As a rule, video-assisted Parkinson's therapy lasts 30 days. At the end, the patient is examined again by a neurologist on site. The entire treatment, including the video recordings, will then be handed to the clinicians and the on-site neurologist for future availability.
Parkinson's ON and OFF phases
The longer the therapy lasts, the more often it can lead to fluctuations in the effectiveness of the medication and thus also to motor complications. If the medication works well, the patient is mobile and has little discomfort - this condition is called the ON phase.
However, if the effects of the medication diminish, symptoms such as tremors, gait insecurity and muscle stiffness occur - this condition is called OFF-phase. If there is a frequent change of ON and OFF phases, the patient's quality of life can suffer greatly. In such cases, it may be necessary to readapt the medication.