Parkinson's disease is not only affecting the elderly, but about 20% of patients are younger than 50 years of age, and the severity is rising. Parkinson's disease was known in 1817 when the British doctor "James Parkinson" reported a patient he had examined in an essay.
Parkinson's disease is a disease that causes clinical symptoms due to the death of dopaminergic neurons in the midbrain of the brain. The three main symptoms of Parkinson's disease are slow motion in the body abnormally, tremors of trembling hands or feet, and stiffness in muscles and joints. When the symptoms are mild, it may be misdiagnosed as arthritis or frozen shoulders. According to a survey conducted by the Parkinson's Disease Center at Asan Medical Center in Seoul, Korea was diagnosed with Parkinson's disease only 18 months after the onset of symptoms. That's why patients' pain and medical expenses are wasted.
Parkinson's disease can show a wide variety of motor symptoms in addition to the three main symptoms. Symptoms such as walking while dragging one leg (see Suspicious Symptoms) while walking. These symptoms are not accompanied by all patients, but in many patients they appear in various combinations.
Diagnosis and treatment are more complicated because there are various non-motor symptoms as well as motor symptoms. In addition to physical fatigue, about 40% of all patients have depression, anxiety, and cognitive impairment. In addition, about 10-20% of patients may show hallucinations or delusions, which are psychotic symptoms, and sleep quality is poor. It is common to have REM sleep disorders and unpleasant dreams vividly. And there are many patients who have difficulty with frequent urination at night than during the day.
Parkinson's disease patients, as well as dopaminergic neurons in the brain, as well as the loss of neurons that move the internal organs, occur from the beginning, so most of them complain of constipation and smell wrong. Non-motor symptoms appear. Treatment for the non-motor symptoms of Parkinson's disease is different from the treatment for motor symptoms and is more difficult.
The cause of the outbreak
It is not yet clear why Parkinson's disease develops. In recent decades, knowledge on pathophysiology has been accumulating through active epidemiological studies and genetic studies. Pesticides such as herbicides and pesticides, which are one of the environmental factors, have been reported to increase the risk of Parkinson's disease.
On the other hand, as research on genetic factors progresses rapidly, many developments are being made. Mutations in these genes can explain the incidence of familial Parkinson's disease, which is within about 10% of all patients, but cannot explain the cause of the development of the remaining patients, which are more than 90%.
Diagnosis of Parkinson's Disease
Since the diagnosis of Parkinson's disease is possible when the loss of dopaminergic neurons in the brain biopsy and the presence of Lewy body, the clinic is diagnosed based on clinical symptoms through neurological tests. It is differentially diagnosed. In particular, differential diagnosis from degenerative brain diseases similar to Parkinson's disease is very important in evaluating the treatment and prognosis of patients. In recent years, the number of patients with drug-induced Parkinson's syndrome caused by a bowel movement improving agent such as levosulpyride is increasing, so the attention of doctors and patients is required.
The drug treatment effect is excellent, but late complications appear.
No treatment has been developed to prevent or slow the progression of Parkinson's disease. When Parkinson's disease is diagnosed, treatment or surgery is performed with various drugs that can replace dopamine, which is insufficient in the brain. One important fact is that among degenerative brain diseases, only Parkinson's disease is the only disease in which symptoms are significantly improved by drug treatment. In fact, if the drug is taken properly, patients who cannot get up can walk, and those who cannot walk well can run.
Levodopa is a representative drug for Parkinson's disease. It was developed in the 1960s, but it is still the most effective. It is a staple drug for Parkinson's disease because symptoms improve quickly and excellent efficacy persists. Most of them are called'honeymoon period' because they have been very effective in improving symptoms without side effects for 2 to 3 years after they started receiving this drug treatment.
However, after this honeymoon period, late complications appear. When taking levodopa, the energy of the body rises and the condition of the body is very good, and when the time to take the next levodopa is approached, the energy of the drug decreases and the symptoms become worse. In addition, dyskinesias often appear when the weak energy is too excessive, or in the process of rising or falling out, part or all of the body moves as if dancing excessively regardless of the will. This late complication occurs in more than 50% of patients 5 years after taking levodopa. A dopamine agonist that compensates for the shortcomings has been developed and used as a therapeutic agent, but the therapeutic effect is lower than that of levodopa, and there are limitations as other side effects may occur more. Amantadine, anticholinergic drugs, Maobi enzyme inhibitors, and comb enzyme inhibitors are also used, but there are also limitations.
Overcoming drug limitations with "deep brain stimulation surgery"
Another treatment is surgical treatment. Deep brain stimulation surgery, which has been covered by insurance in Korea since 2005, helps overcome the limitations of drug treatment. After surgery, the symptoms of Parkinson's disease will improve immediately, and the dose of therapeutic drugs can be reduced. It can reduce the incidence of late motor complications such as dyskinesia and motor agitation. However, as with other brain surgery, complications from the surgery itself can occur around 1-5%, so in the case of essential patients, it is better to undergo surgery by an experienced medical staff and exercise is essential.
Future medicine to conquer Parkinson's disease
The diagnosis of Parkinson's disease is made by a brain biopsy, which is difficult in reality and must be diagnosed by clinical symptoms in a doctor's office. If you feel or have any indications of suspected Parkinson's disease, it is wise to seek immediate medical attention from a neurologist specializing in Parkinson's disease. It improves to the extent that there is no major obstacle to work or daily life with proper medication and surgery.
Symptoms That May Suspect Parkinson's Disease
It's hard when you get up from bed or chair.
The size of the text is smaller than before.
People around you say that your voice is getting smaller or weaker.
There is a tendency to stagger or fall when walking or standing.
When I walk, my feet don't fall off the ground and I feel unnatural.
People around me say that the expression on my face is harder than before.
There are symptoms of shaking hands or feet.
It is difficult to lock the buttons by hand.
When you walk, you walk with your feet dragged, or you often walk as your stride is shortened.