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INTRODUCTION – A BRIEF HISTORY OF THE DISEASE

Parkinson’s disease (PD) is a long-term degenerative disorder of the central nervous system (CNS), primarily affecting the motor system.

The first description of the disease was made in 1817 by the English physician James Parkinson in his monograph “An Essay on the Shaking Palsy”, in which he described resting tremor, small shuffling steps, the characteristic forward-leaning posture, sleep disturbance and constipation. Later scientists further expanded the characteristic clinical picture of the disease. In 1967, Georgios Kotzias et al. discovered that Levodopa improves the symptoms of the disease. Since then, significant progress has been made both in understanding the pathophysiology of the disease and in therapeutic approaches, both pharmacological and surgical.

GENERAL INFORMATION – EPIDEMIOLOGY

PD belongs to a group of disorders known as movement disorders, which cause unexpected or uncontrolled body movements. Its main cause is unknown, although some cases are hereditary, while others are believed to result from a combination of genetic and environmental factors that trigger the disease.

The disease affects millions of patients worldwide – 1% of the population over the age of 60 in the USA suffers from it. In developed countries, the annual incidence among people over the age of 65 is 160/100,000. Before the age of 50, the disease is relatively uncommon and its frequency increases with advancing age.

In PD, brain cells in the part of the brain that produces dopamine become damaged or die. Dopamine is a substance essential for smooth and purposeful movement.

The four primary symptoms of PD are:

• Tremor with characteristic rhythmic movement

• Rigidity, muscle stiffness or resistance to movement, in which the muscles remain continuously tense and contracted

• Bradykinesia – slowness of spontaneous and automatic movements, resulting in difficulty performing simple tasks or rapid routine movements

• Impaired balance and postural instability, resulting in an increased risk of falls

Other symptoms that may coexist include difficulty swallowing, chewing or speaking, emotional disturbances, problems with urination and/or bowel movements, cognitive impairment / dementia, fatigue and sleep disorders.

PD usually affects people around the age of 70, but it may also occur much earlier. PD is more common in men.

PROGNOSIS

The disease is chronic, lasting for many years, and progressively worsening, with symptoms increasing in number and severity over time.

Its progression is not the same in all patients. Some develop severe disability relatively quickly, while others experience only mild mobility impairment. Not everyone has the same symptoms. In some patients, tremor predominates, while in others there is no tremor but rather bradykinesia – the akinetic form.

TREATMENT

There is no definitive cure for PD, but various medications can dramatically relieve the symptoms.

In PD, dopamine levels are reduced and, for this reason, dopamine replacement therapy is administered. The main treatment is Levodopa, combined with Carbidopa – Carbidopa delays the conversion of Levodopa into dopamine until it reaches the brain. Nerve cells use Levodopa to produce dopamine and compensate for the deficiency.

Nevertheless, not all patients respond equally well to Levodopa: bradykinesia and dyskinesia respond better, tremor responds less, while balance impairment does not respond at all. Anticholinergic drugs can help with tremor and rigidity.

In addition to medication, exercise is essential in the management of PD. Patients should learn to exercise daily by performing stretching exercises, yoga, chiropractic therapy and, above all, walking.

Walking should be performed consciously and rhythmically rather than automatically, while steps should not be short and shuffling but should involve lifting the foot from the ground, as in military marching.

PD AND CORONAVIRUS

Patients with PD are predominantly elderly and are therefore considered vulnerable to infection with the novel coronavirus.

Treatment for PD is not immunosuppressive; it neither affects nor is affected by inflammation.

Discontinuing antiparkinsonian treatment could be fatal for the patient.

Therefore, patients with PD should continue taking their medication without modification, remain at home in order to avoid the risk of exposure to coronavirus (the much-needed walking should by no means stop, but should take place inside the home or in a very protected outdoor area, e.g. a yard or balcony), and follow very carefully the instructions for washing the hands and face with soap and water or mild antiseptics.