Parkinson’s disease is a neurodegenerative movement disorder. Tremors, rigidity, slowness and imbalance characterize it. The core motor features of PD are caused by a shortfall in dopamine in the substantia nigra pars compacta of the brain.
Current treatments for PD focus on replacing the lost dopamine, which is why drugs like levodopa are so popular. But their effectiveness fades over time.
Focused Ultrasound
The loss of dopamine-producing cells in the substantia nigra is responsible for the motor symptoms of Parkinson’s disease. Medications such as levodopa and other dopamine agonists have significantly improved PD treatment in recent years. Deep brain stimulation and other surgical interventions also bring new hope to patients with the condition.
A minimally-invasive procedure called focused ultrasound may treat tremors and other disease symptoms. During the concentrated ultrasound procedure (also known as high-intensity focused ultrasound or HIFU), providers use magnetic resonance imaging to guide and monitor sound waves that heat up and destroy (ablate) tissue in the targeted area of your brain without harming the surrounding healthy tissue.
In a recent clinical trial published in The New England Journal of Medicine, UNC researchers demonstrated that unilaterally focused ultrasound ablation of the thalamus significantly reduced tremor and dyskinesia in PD patients. UNC’s Vibhor Krishna, MD, led the study. The HIFU procedure is being evaluated to treat other neurological conditions, including essential tremor and neuropathic pain. The procedure does not require incisions or full anesthesia; most patients can go home the same day.
Deep Brain Stimulation
In deep brain stimulation (DBS), doctors implant electrodes into the part of your brain that controls movement and block the signals that cause your symptoms. It may reduce tremors, stiffness and difficulty moving. It may also improve non-motor symptoms, such as sleep problems and pain. This is an option if medications no longer control your tremors and other movement symptoms or worsen your quality of life.
The exact mechanism is unknown, but experts believe DBS regulates abnormal electrical signaling patterns that cause PD symptoms. It is a surgical procedure. UMMC doctors use stereotactic navigation to pinpoint the brain area to target with the electrodes. This is done in surgery that takes about an hour.
UMMC’s team of specialists include neurosurgeons, neurologist and clinical neuropsychologists. Before you undergo DBS, the U-M interdisciplinary team reviews your medical history and discusses your expectations. This consists of the benefits and risks of the procedure. The team will make sure that DBS is the right choice for you.
Stem Cell Transplantation
Researchers are looking into a new treatment for Parkinson’s that uses stem cells to replace the brain cells destroyed by the disease. They would implant the stem cells into the affected brain areas and transform them into nerve cells to help regulate dopamine levels. However, this is still a very experimental treatment and has not proven effective in clinical trials.
Stem cells are special cells that can become any specialized cell in your body. They are found in the embryo and can transform into many different types of cells, including bone cells or brain cells. They are also found in the blood and bone marrow and can be transplanted into the patient’s body to treat diseases like Parkinson’s.
Previous studies have shown that stem cell therapy improves motor function and reduces the severity of symptoms in patients with PD. These improvements were due to the MSCs’ ability to protect and repair damaged neurons within the nigrostriatal system, increase dopamine production, and inhibit microglial activation.
Medications
Medications are a mainstay of treatment for people with Parkinson’s. They help to ease tremors, rigidity, and balance and coordination problems. The medications act in a delicate balance with neurotransmitters to coordinate the millions of nerve and muscle cells that control movement. Dopamine helps provide the signals that tell these cells to move. A loss of dopamine-producing neurons results in the symptoms of Parkinson’s disease.
Currently, the most effective medication for Parkinson’s is levodopa/carbidopa. It is a liquid that is infused continuously under the skin. This bypasses the stomach, which can empty too slowly or irregularly in Parkinson’s and interfere with medication absorption.
Other medications, such as trihexyphenidyl (Artane), benztropine, orphenadrine and procyclidine, are used to treat non-motor symptoms of the condition, such as constipation, hallucinations and nausea. These drugs work by blocking acetylcholine, which causes imbalances with dopamine.
Exercise
Symptoms of PD can include tremors (shaking in the arms, legs or jaw); rigid muscles; slow movement and poor balance and coordination. When there isn’t enough dopamine in the brain, these symptoms worsen over time.
Fortunately, there is plenty that people with Parkinson’s can do to help improve their quality of life. For starters, incorporating regular exercise into their lives can improve balance and strength, combat depression, decrease complications like falls, and boost confidence.
Studies also suggest that physical activity may have a neuroprotective effect, causing the brain to be more efficient with neurotransmitters and lessening the susceptibility of certain neurons to damage. This is especially true of high-intensity aerobic exercise.
Cycling is one such type of exercise that is effective. However, patients should check with their physician before beginning a new fitness regimen. It’s important that they find a kind of exercise that they enjoy and will stick with. This will ensure long-lasting results.
