Parkinson’s disease

Diagnosis

The diagnosis of Parkinson’s disease cannot yet be made using a specific test. Numerous imaging and diagnostic procedures are available to the healthcare provider when they suspect Parkinson’s disease or need to rule out other illnesses. These consist of:

• Physical examination: Parkinson’s disease can be diagnosed by a neurologist using the patient’s medical history, a review of their symptoms, and a neurological and physical examination.
• Imaging test: 
  • Single–photon emission computerized tomography (SPECT) scan: additionally known as a dopamine transporter (DAT) scan. The symptoms and findings of a neurological exam are ultimately what decide the right diagnosis, even though this can support the suspicion that the patient has Parkinson’s disease. The majority of people do not need a DAT scan.

• Blood test: To rule out any other disorders that could be the source of the symptoms, the medical team may request lab testing, such as blood tests.
• New lab testing: The possibility of testing for Parkinson’s disease symptoms has been discovered by researchers. Alpha–synuclein protein is tested for in both of these new tests, but in a different ways. Although these tests cannot directly identify the specific conditions caused by misfolded alpha–synuclein proteins, the information obtained from these tests can still be valuable in assisting your healthcare provider in making a diagnosis.

• • Spinal tap: One of these tests involves examining cerebrospinal fluid, the fluid that envelops the brain and spinal cord, to detect misfolded alpha–synuclein proteins. In order to collect cerebrospinal fluid for testing, a healthcare provider will perform a spinal tap (lumbar puncture).
  • Skin biopsy: A biopsy of the surface nerve tissue is a potential further test. A biopsy is taking a small sample of the skin, including the skin’s nerves. Two locations on the leg and one spot on the back were used to collect the samples. If the alpha–synuclein exhibits a certain type of malfunction that could raise the risk of getting Parkinson’s disease, the samples can be analyzed to find out.

Diagnosing Parkinson’s disease can sometimes be a time–consuming process. To accurately identify the condition, healthcare providers may recommend scheduling regular follow–up appointments with neurologists who specialize in movement disorders. This allows for comprehensive evaluation and expertise in diagnosing Parkinson’s disease.

Treatment

While a cure for Parkinson’s disease remains elusive, medications are generally effective in significantly reducing its symptoms. The specific treatment approach can vary from person to person, depending on individual symptoms and the effectiveness of different therapies. The mainstay of treatment for Parkinson’s disease is medication, although in severe cases, surgical interventions may be recommended as an option. 

Healthcare provider might also suggest modifying the lifestyle, particularly by engaging in regular physical activity. Stretching and balance–related physical treatment is crucial in some circumstances. A speech–language pathologist could aid in addressing speech issues.

• Medications: The patient’s medication regimen may help them to control tremor, mobility, and walking issues. These medications boost or act as dopamine substitutes. Dopamine levels in the brain are low in those with Parkinson’s disease. Dopamine cannot enter the brain, hence it cannot be administered directly.

• • Carbidopa–levodopa: The most effective treatment for Parkinson’s disease is levodopa, a natural substance that enters the brain and is changed into dopamine.
  • Carbidopa, which guards levodopa from early conversion to dopamine outside the brain, is taken with levodopa. This avoids or decreases side effects like nausea. In people with advanced Parkinson’s disease ,it is recommended to take carbidopa-levodopa on an empty stomach.
  • Levodopa’s benefits may diminish over time as the condition worsens.
  • Inhaled carbidopa–levodopa: The brand–name medication Inbrija provides carbidopa–levodopa by inhalation. When oral medications abruptly stop functioning during the day, it could be useful in treating symptoms that develop. 
  • Carbidopa–levodopa infusion: Carbidopa and levodopa are combined in the brand–name drug Duopa. But the medication is given through a feeding tube, which sends it in a gel form straight to the small intestine.
  • Duopa is prescribed to further advanced Parkinson’s disease patients whose reaction to carbidopa-levodopa is inconsistent but still responsive. Duopa is continuously pumped into the body, maintaining constant blood levels for the two medications. Putting the tube in place requires a quick surgical procedure. The tube could fall out or the patient could have an infection where they get their infusions.
  • Dopamine agonists: Dopamine agonists do not convert to dopamine like levodopa does. Instead, they imitate the brain’s response to dopamine. A dopamine molecule latching onto a cell will cause the cell to behave in a specific way because dopamine is a neurotransmitter. Cells can become receptive to dopamine agonists and act the same way. Younger people are more likely to use them to put off starting levodopa.
  • Rotigotine, which is administered as a patch, and pramipexole, both act as dopamine agonists. A short acting dopamine agonist injection called apomorphine is utilized for rapid relief.
  • Levodopa is more effective than dopamine agonists for treating symptoms. However, they have a longer half-life and can be combined with levodopa to lessen the occasionally unpredictable effects of the drug.
  • Monoamine oxidase B (MAO B) inhibitors: Selegiline, rasagiline, and safinamide are some of these medications. By preventing the brain enzyme monoamine oxidase B (MAO B) from functioning, they assist in preventing the breakdown of brain dopamine. Brain dopamine is broken down by this enzyme. The co–administration of selegiline and levodopa might aid in preventing the occurrence of wearing off.
  • Due to potentially significant reactions, these medications are not frequently used in combination with the majority of antidepressants or specific painkillers. Before taking any additional medications containing an MAO B inhibitor, consult with your medical team.
  • Catechol O–methyltransferase (COMT) inhibitors: The two most common medications in this class are entacapone and opicapone. By inhibiting an enzyme that breaks down dopamine, this medication somewhat prolongs the effects of levodopa therapy.
  • Another COMT inhibitor, tolcapone, is rarely used as it has a risk of severe liver damage and liver failure.
  • Anticholinergics: For many years, these medications were used to help manage the Parkinson’s disease–related tremor. There are many anticholinergic medications on the market, such as trihexyphenidyl and benztropine.
  • Amantadine: Amantadine alone may be prescribed by healthcare providers to temporarily relieve the symptoms of mild, early–stage Parkinson’s disease. During the later stages of Parkinson’s disease, it may also be administered along with carbidopa–levodopa therapy to manage dyskinesia, or uncontrollable movements brought on by the combination drug.
  • Adenosine receptor antagonists (A2A receptor antagonists): These medications work by focusing on brain regions that control dopamine release and regulate dopamine response. One  of the A2A antagonist medications is istradefylline. 
  • Nuplazid: This medication is employed to address the hallucinations and delusions that can arise in individuals with Parkinson’s disease. The exact mechanism of action is still uncertain, according to experts. 

Surgical procedures

• • Deep brain stimulation (DBS): When levodopa therapy is no longer as effective in the latter stages of Parkinson’s disease and in patients with tremor that does not seem to react to standard drugs, this therapeutic option is virtually always an alternative. DBS can regulate drug fluctuations, lessen or stop dyskinetic movements, lessen tremor, lessen rigidity, and improve movement.
  • A specific area of the brain is implanted with electrodes during deep brain stimulation (DBS). The electrodes are linked to a generator that is inserted just below the collarbone in the chest. The generator may lessen Parkinson’s disease symptoms by sending electrical pulses to the brain.
  • In order to treat the disease the settings could be altered. Risks associated with surgery include infections, stroke, and brain hemorrhage. Some patients encounter issues with the DBS system or difficulties as a result of stimulation. Some system components might need to be replaced or modified.
  • DBS, aside from tremor, is ineffective for issues that do not improve with levodopa medication. Even if the tremor is not highly sensitive to levodopa, it may still be managed by DBS.
  • While DBS may help with Parkinson’s symptoms over the long term, the illness still progresses as a result of it.

• Advanced treatments: The utilization of MRI–guided focused ultrasound (MRgFUS) as a minimally invasive therapy has shown promise in helping certain Parkinson’s disease patients manage their tremors. In this procedure, an MRI is used to guide ultrasound waves to the specific area of the brain where the tremors originate. The targeted application of intense ultrasound waves generates localized heat, effectively ablating the problematic regions responsible for the tremors.
• Experimental treatments: Researchers are looking for additional medicines that might be effective for Parkinson’s disease. Even though they are not generally accessible, these do provide those who have this illness hope. Several of the experimental therapy modalities are as follows:
  • Stem cell transplant: These increase the number of dopamine–using neurons in the brain, replacing the destroyed ones.
  • Neuron–repair treatments: By encouraging the formation of new neurons, these medicines aim to restore damaged ones.
  • Gene therapies and gene–targeted treatments: These therapies primarily target specific mutations that are responsible for Parkinson’s disease. They aim to enhance the effectiveness of medications like levodopa and others.