Parkinson's: new treatment options that improve the quality of life of patients

 

New medications and adjuvant therapies that help treat the various manifestations of this disease are being tested on World Parkinson's Day which is commemorated every April 11.

Since 1817, the year in which the British neurologist James Parkinson discovered what was known at that time as agitant paralysis, medical science has found various treatments that allow Parkinson's patients to improve the manifestations produced by this neurodegenerative disease and thus improve its quality of life.

What is Parkinson's and what does it produce?

After Alzheimer's, Parkinson's is the second most common neurodegenerative disease in the world: in Argentina it is estimated that it affects approximately 120,000 people and most of the patients are over 65 years of age. However, more and more men and women under the age of 50 suffer from it.

This pathology affects the brain structures responsible for the control and coordination of movement and posture. Research suggests that environmental factors such as toxins, pollutants, herbicides, pesticides could cause disease in genetically susceptible people, but its cause is still unknown.

Because in this disease some neurons gradually decompose or die, most of its symptoms have to do with a loss of nerve cells that are responsible for producing dopamine (a kind of chemical messenger in the brain). When dopamine levels drop, an abnormality in brain activity appears.

Its symptoms begin gradually and may be different for each person: tremors, which usually begin in one limb (hand or fingers); slow movement; muscle stiffness, which can be painful and also limit movement; alteration of posture and balance; reduced ability to perform unconscious movements (blink, smile); changes in speech and writing.

In addition to motor disorders, some patients may manifest other symptoms that significantly impact their quality of life, such as depression, cognitive or thinking impairment, anxiety, drop in blood pressure, constipation, incontinence, salivation, nightmares, hallucinations, drowsiness and insomnia.

How is it treated?

There is no cure for Parkinson's, but there are a variety of medications that can significantly help control symptoms. In addition, “there are several already known drugs that are repositioning themselves for the treatment of this disease. These are drugs used to treat other diseases and which today could have beneficial effects in Parkinson's patients. We are talking about beta adrenergic drugs, which are drugs used in asthmatic patients; or drugs used to treat diabetes, such as exenatide or liraglutide. The latter are drugs that could modify the evolution of the disease and appear to be quite promising, although the studies have not yet been completed ”, comments Dr. Emilia Gatto, a neurologist specializing in Parkinson's at INEBA. 

On the other hand, clinical trials are being carried out to stabilize and improve the changes in blood pressure that patients may have, which often make them more at risk of falls when sitting up or standing for a long period of time.

The use of synthetic cannabinoids is also being studied, which has shown a certain beneficial effect in the management of some non-motor manifestations of the disease, such as anxiety or sleep disorders. However, its consumption can generate some adverse effects such as confusion, disorientation, digestive intolerance and in some cases, episodes of depression.

Other drugs under study are those that act on psychosis, without aggravating motor symptoms. These are conditions that generally appear in more advanced or later stages of the disease and are accompanied by hallucinations or delusions. Its administration would improve this condition that many times not only impacts the patient's quality of life, but also affects the emotional burden and the effort of caregivers and family members.

"The therapeutic outlook is encouraging," says the neurologist. “Although progress continues with certain gene-type therapies to try to target precision medicine, what we are learning these years is that there may not be a single drug to treat the disease, but that, as in many other cases, a combination of several is required to achieve a benefit ”, concludes Dr. Gatto.

Exercise as an ally

Beyond drug therapies, the doctor may also suggest some lifestyle changes to patients, such as regular physical activity. Exercise improves balance, flexibility and gait, and it is essential to do so even in the current context of a pandemic. Water gymnastics, swimming, Pilates, cycling, tai chi, and walking are some of the most recommended activities.