In recent years, there has been a large increase in Parkinson's disease in Greece, which is only partly due to the ageing of the population, leading to the suggestion that we will soon have a "pandemic" of the disease.
Parkinson's disease is more common in men. It is a chronic progressive disease that primarily affects mobility but also has a host of non-motor symptoms, such as sleep disturbances, orthostatic hypotension, constipation, hyposomnia, urinary urgency, anxiety, depression, hallucinations, and mild mental impairment, leading to dementia in some cases.
Motor problems are largely due to the progressive degeneration of dopaminergic neurons in the brain, while non-motor problems result from a more widespread attack of the Central and Peripheral Nervous System. Apart from the dopaminergic degeneration, the other pathological finding is the deposits of enclosed particles inside the neurons, the so-called Lewy Bodies.
Treatment in the initial phase of the disease
In the first phase of the disease, the motor symptoms are effectively treated with medication that stimulates the degenerating dopaminergic system. Patients have normal professional and social activity.
There are a number of related drugs, but the classic and most effective remains levodopa, which was actually used for the first time successfully by the Greek researcher George Kotzias in the USA in the 1960s.
Regular and intensive exercise is essential in the first phase of the disease and helps a lot in its treatment.
However, as the disease progresses, usually after five years, motor symptoms begin to significantly affect daily activities, while non-motor symptoms accumulate and negatively affect the quality of life of patients and their caregivers.
This is the advanced stage of the disease.
An important burden factor at this stage is motor complications, characterised by periods of great difficulty and slowing of movement alternating with periods of excessive mobility, with involuntary movements, the so-called hyperkinesias.
In addition, significant unsteadiness may lead to falls and difficulty in phonation and swallowing.
How the disease is treated in an advanced form
Treatment requires a multidisciplinary team that includes, in addition to the experienced Neurologist, a Specialist Nurse, a Psychiatrist, a Psychologist, a Physiotherapist, a Nutritionist and a Social Worker.
Medication management at this stage is difficult and should target both motor and non-motor symptoms. For example, the neuropsychiatric manifestations of the disease, and especially visual hallucinations and irrational, delusional ideas, may be exacerbated by dopaminergic treatment, so it needs to be adjusted accordingly, or drugs added to suppress these manifestations.
In cases of significant mental decline, drugs that are also used in Alzheimer's disease can help to some extent by stimulating another neurotransmitter system, the acetylcholine system.
In the advanced phase of the disease, the exhortation to patients to be physically and socially active, not to isolate themselves, and to exercise plays an even more important role. In this context, collective exercise programs are important.
At our Medical Centre, a study is currently being carried out on the possible beneficial effect of Greek dancing on Parkinson's Disease.
In recent years, significant progress has been made in treating motor complications in advanced disease. Oral drugs that act on dopamine metabolism have been developed, achieving a more stable state.
Medical devices have been created that can detect motor fluctuations and hyperkinesias in the daily lives of patients so that medication can be optimally adjusted. These devices are particularly helpful in those cases where it is not clear from the history of patients and their relatives what their daily situation is in their domestic and professional-social environment around the clock.
Technically assisted treatments have also been developed that can effectively treat motor complications when they significantly affect patients' quality of life.
These are continuous pumps of dopaminergic drugs that achieve a stable response throughout the day, as well as a neurosurgical procedure, Deep Brain Stimulation (DBS). In it, electrodes are placed in a specific area of the brain and connected to a pacemaker, from which the stimulation parameters of the electrodes are adjusted, achieving a smoother functioning of the brain circuits and a significant improvement in motor complications.
The decision about which method is the most suitable for each patient is completely individualised and requires very good information about the patients and their environment and close cooperation with the therapist.
These methods could be used more and earlier in patients with Parkinson's disease in Greece.
Research progress
Research into the pathogenesis of Parkinson's disease has developed greatly in recent years. Genetics has given it great impetus. Many genetic forms of the disease are now recognised.
Perhaps the most important, as it is closely related to the more common sporadic form of the disease, is the genetic form due to mutations, i.e. genetic variations, in the Alpha-synuclein gene, the same protein that is deposited in Lewy Bodies.
This genetic form is very rare internationally, but not in Greece, where there are several cases. In fact, we recently discovered a new mutation in the same gene with our team, which also seems to occur only in people of Greek origin.
Many years of research on this protein and its function and dysfunction have recently resulted in the establishment of a new biological marker for the disease, a marker based on detecting abnormal Alpha-synuclein structures in Parkinson's disease patients.
At the same time, treatments targeting these abnormal structures are being developed, and there is considerable hope that they will be implemented in the near future. These potential treatments will not treat the symptoms, like current dopaminergic treatments, but the disease at its root, thereby slowing or even stopping its progression.
By Leonidas Stefanis, MD, PhD, Professor of Neurology and Neurobiology at the Medical School of the University of Athens, Director of the First Department of Neurology, Aeginitio Hospital. Translated by Paul Antonopoulos.
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