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PARKINSON’S DISEASE: RESEARCHES AND TREATMENT
The latest research indicates that with Parkinson’s disease, cells die in that part of the brain which governs movement (the substantia nigra, literally black area) in the brain stem (base of the brain between the ears); these dying cells form small masses called Lewy bodies – named after the man who discovered them. They are very hard to see under the microscope but are always found in the brain stem in Parkinson’s disease. New techniques now mean that they can be seen more easily and they have been discovered in the main part of the brain (the cortex) in people who have Parkinson’s disease and chronic confusion. The researchers feel this is a new form of dementia and have called it Cortical Lewy Body disease.
The cause of Parkinson’s disease is not known. We do know that all the movement problems, and the tremor, etc., are secondary to the loss of a chemical in one part of the brain and this chemical is used to transmit the messages to the nerve and then the muscle cells. The chemical is called dopamine and is made and stored in a tiny part of the brain called the substantia nigra. We don’t know what causes the chemical to disappear but symptoms don’t start until, at least 90 per cent of it has gone, and this probably takes many years. A picture very similar to Parkinson’s disease can be caused by numerous small strokes, drugs and even Alzheimer’s disease; this condition is called Parkinsonism.
The treatment of Parkinson’s disease involves many different factors. Initially a lot of improvement can be gained from physiotherapy. As the disease progresses, however, it is usual for drug therapy to be used. The most commonly used drug is levodopa (contained in Sinemet and Madopar). This treatment aims to put back the missing chemical. It has revolutionized the treatment of the condition but it does not cure it; it helps control the symptoms but the disease is usually progressing underneath it all.
A comparatively new drug Selegeline (Eldepryl) appears to be valuable in treatment. It appears to enhance and protect existing levels of dopamine and is now being used early in the diagnosis of the condition. Many other drugs are used to try and control the symptoms. They all have side-effects and one of the most important is that all the drugs used to treat the condition can cause confusional states. If a person with Parkinson’s disease develops confusion, the drugs they are on must always be considered as the cause.
There is no doubt that as sufferers live longer they are becoming resistant to drug treatment and physiotherapy alone, and are becoming very handicapped. Recently we have seen the exciting use of brain implantation to treat the condition. In a few centers around the world, including the UK, either foetal cells or a person’s own adrenal tissue are being placed via a thin needle into the brain, hopefully to ‘take’ and begin producing their own dopamine. The results are eagerly awaited by doctors, sufferers and their carers, and the indications are that any benefit may take years but in some cases can be dramatic.
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