Parkinson's disease

Parkinson's disease or PD (other synonyms: Idiopathic Parkinson's syndrome (IPS), Parkinson's disease, colloquially also shaking disease, older term: paralysis agitans for "shaking paralysis/shivering paralysis") is a slowly progressive loss of nerve cells. The characteristic symptoms are akinesia, rigor and (not always present) rest tremor. As an incurable neurodegenerative disease, it is one of the degenerative diseases of the extrapyramidal motor system. Approximately one percent (as of 2004) of the world's population over the age of 60 is affected by this disease. Parkinson's disease is thus the second most common neurodegenerative disease in the world (after Alzheimer's disease).

Parkinson's disease is characterized by the predominant death of dopamine-producing neurons in the substantia nigra, a structure in the midbrain. The lack of the neurotransmitter dopamine ultimately leads to a reduction in the activating effect of the basal ganglia on the cerebral cortex and thus to the movement disorders.

The leading symptoms (also called cardinal or core symptoms) are:

• early symptoms (are important in order to dampen the progression of the disease as early as possible - as many years as possible before the onset of motor symptoms - due to indications of possible Parkinson's disease through treatment)

• Years before onset Disturbance of the sense of smell
• Mood swings (mild irritability) with mild depression
• Constipation
• the disturbance of dream sleep by atypical strong movements during REM sleep (normally motionless in a healthy state) (up to screaming or flailing around)

• motor disease in the main stage (low dopamine level)

• Muscle tremor (tremor) at rest, especially as rhythmic trembling of the extremities,
• Font becomes slightly smaller,
• "out-of-round" movement when walking for long periods of time (tighten up a bit),
• (waxy) muscle rigidity (rigor) or inelastic increased resting tension,
• slowed movements (bradykinesis or hypokinesis), which can lead to immobility (akinesia), as well as
• Postural instability (postural instability).

The current definition of Parkinson's syndrome (also called Parkinsonism) requires that the cardinal symptom of bradykinesia or akinesia occurs in combination with at least one of the other symptoms (rigor, tremor or postural instability). In addition, various sensory, vegetative, psychological and cognitive disorders are possible.

To date, there is no possibility of a causal treatment for Parkinson's syndrome, which is why only a treatment of the symptoms is possible. As the disease progresses, several medications are often combined, which must be taken at increasingly shorter intervals in order to achieve sufficient efficacy and to avoid fluctuations in effect. Advanced treatment options include continuous apomorphine infusion, continuous L-dopa infusion or deep brain stimulation.

Classification

The term Parkinson's disease is a generic term for disorders with the leading symptoms listed above. The most important disease is Parkinson's disease, which is an idiopathic disease (i.e. without a known external or genetic trigger). However, if there is an identifiable external cause, it is called secondary or symptomatic Parkinson's disease. If there is a neurodegenerative clinical picture with a different pattern of damage and, in some cases, further symptoms, we speak of atypical Parkinson's syndromes.

This results in the following classification of Parkinson's syndromes:

1. idiopathic Parkinson's syndrome (IPS), the subject of this article.
• with approx. 75 % most frequent Parkinson's syndrome
2. familial Parkinson's disease
• genetic, hereditary forms, rare, named after the respective gene locus (for example PARK1)
3. symptomatic (secondary) Parkinson syndromes
• drug-induced (e.g. neuroleptics with dopamine antagonism = Parkinsonoid); there is also increasing evidence that amphetamine use significantly increases the risk of falling ill
• vascular Parkinson's syndrome, as in cerebral microangiopathy (Binswanger's disease)
• post-traumatic (for example boxer encephalopathy)
• toxin-induced (for example by carbon monoxide, manganese, MPTP)
• inflammatory (for example after encephalitis lethargica, also in diffuse pathogen-related brain diseases such as advanced HIV encephalopathy)
• metabolic (for example in Wilson's disease)
4. Parkinson syndromes in the context of other neurodegenerative diseases (atypical Parkinson syndromes)
• Multisystem atrophy
• Progressive supranuclear gaze palsy
• Corticobasal degeneration
• Lewy Body Dementia

History

The disease was first described in 1817 by the English physician James Parkinson in the monograph An Essay on the Shaking Palsy. Parkinson already pointed out the slow progression of the disease. He suspected that the cause of shaking palsy, later called Parkinson's syndrome, was a disorder of the spinal cord in the cervical vertebrae, which was disproved in 1960 by Arvid Carlsson's discovery that the lack of the endogenous neurotransmitter dopamine in certain regions of the brain stem was the cause of Parkinson's disease. However, the symptoms of Parkinson's disease have been known since ancient times. Tremor was first described in more detail by Celsus as an affliction of elderly patients to be treated. In Parkinson's disease, a distinction used to be made between postencephalitic and toxic parkinsonism.

April 11 of each year was proclaimed World Parkinson's Day in 1997 by the European Parkinson's Disease Association.

Well-known patients with Parkinson's disease were (or are) for example Wilhelm von Humboldt, Adolf Hitler, Pope John Paul II, Muhammad Ali and Michael J. Fox.