Parkinson's disease is a so-called neurodegenerative disease. It results in the disappearance of a certain type of neurons: those that produce dopamine almost exclusively. Dopamine is a neurotransmitter that plays an essential role in controlling movement. Parkinson's disease is manifested by motor disorders, tremors, but also cognitive problems. We do not know the origin of this pathology, but some hypotheses implicate hereditary factors, as well as others related to the environment, (or even a combination of these two types of factors).
It mainly affects people over 60, although there is a rare genetic form that can affect people under 40. The disease progresses slowly. Discreet warning signs can alert the patient or his relatives, such as increased fatigue, difficulty concentrating, as well as increasingly small handwriting (micrography).
A second opinion is very relevant in the context of Parkinson's disease. A very good knowledge of the disease will allow the patient to live better with it and especially to adhere to his treatment which can become restrictive. It must also allow a better understanding on the part of relatives, whose investment is often significant. Finally, neurostimulation is a treatment that requires special expertise and can only be offered under certain conditions. In this context, a second opinion can provide the additional information necessary for the patient to make his choices, in full knowledge of the facts.
- What are the warning signs of the disease?
- How will my Parkinson's disease evolve?
- What treatments can I benefit from?
- What are the side effects?
- Can I benefit from neurostimulation? What are the risks of this technique? What results can I expect?
- Is there a behavior to adopt to slow the progression of the disease?
- Should I change my lifestyle?
- What will be the impact of the disease on my daily life? On my relationships with those around me?
- Can I continue driving? To work? To engage in physical activity?
The neurologist is the specialist in diseases of the nervous system, and therefore that of Parkinson's. He follows the patient throughout his illness, determines and adapts the treatment according to the situation.
The three major symptoms of Parkinson's disease are slowness in the realization of movements (also called akinesia), a certain muscle rigidity and the appearance of tremors, even when the limbs are at rest. These symptoms mostly occur on one side of the body. Finally, other ancillary manifestations may accompany these first signals, such as fatigue or apathy.
The diagnosis of Parkinson's disease can be complex and requires some expertise on the part of the doctor. It is based on a clinical examination and taking into account the general condition of the patient. The first criterion is the presence of at least two of the three characteristic symptoms of the disease. The difficulty lies in distinguishing Parkinson's disease itself from a parkinsonian syndrome. This parkinsonian syndrome can be found in other diseases that require very different treatment. There is no blood test to make a diagnosis, but medical imaging tests (such as CT, brain MRI, or brain scan) are sometimes done, depending on the case. These tests can also help rule out other possible hypotheses.
- du degré d’évolution de la maladie,
- the intensity of the symptoms.
- the general state of health of the patient.
- the age.
- the patient's choices.
There is no treatment capable of stopping the progression of the disease. This varies from case to case. Nevertheless, several solutions can improve the quality of life of patients.
Drug treatments : these aim to compensate for the lack of dopamine. There are several types of drugs, which differ in their mechanism. One category of them acts by mimicking the action of dopamine (these are dopaminergic agonists), another family of drugs administers a substance that will be transformed into dopamine (L-Dopa). Finally, a third type of drug provides the body with a substance that blocks the destruction of dopamine. These treatments also differ in their mode of administration (oral route, injection pump or digestive tube). Finally, a certain number of side effects must be taken into account when prescribing (nausea, vomiting, dyskinesia, behavioral problems, etc.). This is why drug treatment must be adapted on a case-by-case basis. It will be adjusted as the disease progresses.
Surgical treatment : this consists of deep brain stimulation. The operation aims to implant, on either side of the brain and symmetrically, two small electrodes in a specific brain area called the subthalamic area. This process makes it possible to control part of the symptoms of the disease, but does not make it possible to cure it completely. Neurostimulation is performed on 5 to 10% of Parkinson's patients, as the selection criteria are drastic. The neurosurgeon in charge of the intervention positions the electrodes in the right place. The electrodes are then connected to a battery placed under the skin. The stimulation can then be adjusted on a case-by-case basis. Surgical treatment does not always mean the total cessation of medication.
Finally, physical rehabilitation and speech therapy must accompany the treatment, whatever it is. Physiotherapy makes it possible to fight against motor disorders, to prevent them and to limit their consequences. Speech therapy helps to rehabilitate speech.