Parkinson's disease is a disease in which the extrapyramidal** motor nerves of the basal ganglia* are damaged due to a lack of dopamine production. Extrapyramidal motor nerves are responsible for balancing the body when it performs certain movements or postures. For example, when we touch our mobile phones with our fingers or stand on a shaky subway, our muscles are strained appropriately through the electrical signals of our motor nerves. However, when you have Parkinson's disease, the extrapyramidal motor neural network stops working, limiting your movement.
*Basal ganglia: A mass of gray matter outside the thalamus in the cerebral hemispheres.
**Extrapyramidal: The nerves that reflexively control muscle tone and movement of skeletal muscles.
Many patients react with surprise and fear when they are diagnosed with Parkinson's disease. However, Parkinson's disease is not life-threatening because its symptoms are mainly confined to the motor nerves. Of course, long-term Parkinson's disease can lead to diseases such as dementia and depression as sequelae, but in many cases, mental activity is not a problem, and with proper treatment, it is possible to work professionally.
The most common cause of Parkinson's disease is aging. As we age, a toxic protein called synuclein* accumulates in the nerve cells of the brain, preventing the substantia nigra from producing dopamine. For this reason, Parkinson's patients are most likely to appear in middle-aged and elderly people after the age of 50.
*Synuclein: A protein that accumulates in the human brain.
Treatment for Parkinson's disease is primarily through pharmacotherapy. There are many different types of drugs to treat Parkinson's disease, but here are two of them.
The first is levodopa, which, when in the body, turns into dopamine. It is a drug that has a very strong effect and significantly improves the symptoms of movement disorders. However, levodopa becomes less effective over time, and if taken in excess, dyskinesia such as shaking or nodding may occur. It has been reported that these side effects occur in 60% of cases with 5 years of administration and 90% of cases with 10 years of administration.
Second, dopamine agonists are similar in molecular structure and function to dopamine. Although the effect is not as strong as levodopa, it has the advantage of having fewer side effects such as dyskinesia.
Medications for Parkinson's disease are not recommended to be strong and should not be expected to have immediate effects. This is because side effects can occur in proportion to the dosage of the drug. For example, hand tremors, which are a typical symptom of Parkinson's disease, usually occur when the hands are left still, so they do not cause discomfort in daily life. You don't need to overdo it to improve your hand tremors.
If medication does not have a significant effect or if it needs to be discontinued due to side effects, deep brain stimulation treatment may be considered. Deep brain stimulation is a treatment that involves making an incision in the skull and inserting thin electrodes directly into the brain. These electrodes generate microcurrents at a rapid rate of more than 100 times per second, which can be used to stimulate the area that causes Parkinson's disease to treat symptoms. The battery of the electrodes lasts for about 5 years, and at the end of its life, you will undergo a procedure to make an incision and replace some of the skin on your chest.
Deep brain stimulation is the most effective treatment option. It has been shown to reduce almost all Parkinson's symptoms by 30 to 60 percent and reduce the daily dose of medication by an average of 50 percent. In Korea, it is covered by health insurance, and since the early 2000s, it has been widely performed in the neurosurgery department of major university hospitals in Korea.
However, in deep brain stimulation, the most important thing is to accurately diagnose Parkinson's disease before deciding on surgery. Symptoms are similar to those of Parkinson's, such as multiple system atrophy* or basal ganglia degeneration**, but if you don't have Parkinson's disease, this surgery won't help. In addition, although surgical techniques have become very stable in recent years and the number of cases has increased, it is still necessary to be cautious in the fact that a foreign object is inserted into the brain. Since cerebral hemorrhage such as arteriole rupture may occur in 1% of cases, it is recommended to consider deep brain stimulation for patients who have been on medication for more than 5 years and who have severe disruption to their daily lives and difficulty maintaining their jobs.
*Multiple system atrophy: A progressive degenerative brain disease in which atrophy occurs in various systems of the brain.
**Basal ganglia degeneration: A chronic degenerative disease caused by the destruction of nerve cells in the substantia nigra of the brain.
For Parkinson's disease, regular walking exercises are recommended. In particular, it is recommended to take a walk for about an hour during the day. Since Parkinson's disease is often accompanied by depression or insomnia, it is to induce the secretion of melatonin and serotonin through ultraviolet light.
However, people with Parkinson's disease should avoid mountain climbing because they can fall even if the ground is not even a little.
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