CHEARS

Parkinson’s disease (PD) or Parkinsonism is a neurodegenerative disorder, in which the dopaminergic neurons located inside the midbrain, an area called substantia nigra (SN) diminished or die because of unidentified reasons, resulting diminished dopamine production and developing PD symptoms. Other symptoms of PD may appear as a result of the loss of noradrenaline producing nerve endings, which is an important chemical messenger of the sympathetic nervous system that also governs important physical functions such as heart rate and blood pressure. [1] As a result, lower levels of dopamine and noradrenaline play a role in the developing PD. Tremors, rigid muscles, unstable walk and balance, lack of coordination, and other PD movement impairments are caused by a reduction in dopamine production [2] and non-movement symptoms of Parkinson's disease, such as lethargy, abnormal blood pressure, depression, and so on, are produced by a decrease in noradrenaline production. [3] PD can be caused by inheritance or genetic alterations.

PD is the second most frequent neurodegenerative health problem after Alzheimer's disease, and it is partially an autoimmune disease [4] that can be caused by age. At any given time, PD affects about 1-2 people per 1000 people [5]. The prevalence of PD increases with age; only 4% of people are diagnosed with PD before the age of 50, and PD affects 1% of the population after the age of 60. Men are 1.5 times as likely than women to get PD. [6] According to the 2018 Global Burden of Disease (GBD) survey, the global burden of PD has more than doubled in the last two decades. [8] In India, the death rate from PD is 3.26 per 100,000 people, with 7.76 years lived with disease (YLD) and 58.46 disability-adjusted life years (DALYs). [7] Monaco has the highest PD death rate, at 17.65 deaths per 100,000 people. [7] (Check the first link in the supplementary material for more information on each country.) Globally, it is believed that 10 billion people suffer from PD, which is a massive amount.

The diagnosis of PD is usually done via the evaluating symptoms and neurological examination as unavailability of blood or any other laboratory reports. In the current scenario, there is no cure for PD, but medicines, therapies, and surgical therapies that can treat or relieve the symptoms, medicines that can increase the dopamine level or can control nonmotor symptoms are prescribed.[1] So, we need proper treatment dedicated to PD because there are so many people suffering from PD and the rate is increasing day by day; we need to have a proper solution for that. We can’t keep it ongoing via treating symptoms only. We need to treat disease from its root for proper relief.

Most cases of PD are caused due to lack of dopamine, so that’s why medicine named levodopa is prescribed to patients which goes into the brain and is later converted into dopamine, so the urge of dopamine can be fulfilled, but it cannot be taken alone, it has to take with its antidote carbidopa, which prevents the adverse effects of levodopa. Apart from carbidopa-levodopa combination, other medicines like dopamine agonist and monoamine oxidase B (MAO B) inhibitors, amantadine, anticholinergics, catechol O-methyltransferase (COMT) inhibitors, etc. are also prescribed to patients, dopamine agonist imitates dopamine effects in the brain, MAO B inhibitors avoid the breakdown of dopamine by suppressing the brain enzyme MAO B, amantadine medicine usually given with levodopa-carbidopa in later stages of PD to control the involuntary movements, anticholinergics medicines used to control the tremors, COMT inhibitors delays the effect of levodopa therapy by blocking an enzyme that breaks down dopamine. [9,11] Surgical therapies are also beneficial, like deep brain stimulation (DBS), lesion surgery, and neural grafting. In DBS surgery, a small electrode is placed in critical parts of the brain that might help in controlling the situation. In lesion surgery, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help in controlling the movement. The research is going on for neural grafting means, tissue replacement for the part of the brain that doesn’t work properly in PD. [10] Apart from medications and surgical, other interventions like exercise, meditation, yoga, physiotherapy, massage, healthy eating, pet therapy, etc. are also very beneficial in improving the situation. Exercises, yoga, and physiotherapy are very beneficial in improving flexibility of muscle, the strength of muscle, and balance, also help in reducing anxiety or depression. Healthy eating practices are good to maintain a healthy lifestyle; high fiber foods are recommended as patients with PD usually suffer from constipation. Meditation is the best exercise for the brain; it can reduce stress and pain and improve the sense of wellbeing. Pet therapy is also very beneficial in improving mental as well as emotional situations, it is proven that having a dog or a cat can give emotional support and reduce stress & anxiety. Massage therapy is very relaxing and also helpful in reducing muscle tension. [11] Music and dance therapy are also beneficial to patients as patients may find excellent results via dance therapy instead of physiotherapy. Alexander Technique improves posture and balance. Chinese traditional medicines, acupuncture, acupressure, tai chi, qigong can help in improving the conditions of patients, improve posture, mobility, boost mood, and improve sleep. [12] The research is going on for neural stem cell therapy that can produce the dopaminergic neurons, for the dopaminergic enzyme that can be delivered to the gene in the brain that controls movement. [2] There are so many herbs in Ayurveda that helps in improving brain power like Brahmi, Shankhpushpi, etc., these plants have been studied for their effects which confirms that these plants can improve mood, cognitive functions, and neurological functions, so we can study these plants as the intervention of PD. Environment and lifestyle play a major role in all the diseases onset, that’s why it is very important to teach the children the importance of environment; the physical and mental exercises are very important to stay healthy and fit in the long run.

Hence, PD has no cure as of now, but the situation can be reversible; if we find proper interventions, for that we need to do more research about the treatment and the pathogenesis, which is not exactly known.

References

1. Parkinson's Disease

National Institute on Aging. 2021 [cited 1 October 2021].

Available from: https://www.nia.nih.gov/health/parkinsons-disease

2. Parkinson’s disease: Causes, Symptoms, Stages, Treatment, Support

Cleveland Clinic. 2021 [cited 1 October 2021]. Available from: https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview

3. Poewe W. Non-motor symptoms in Parkinson’s disease

European Journal of Neurology 2008 [cited 1 October 2021];15(s1):14-20.

Available from: https://pubmed.ncbi.nlm.nih.gov/18353132/

4. Autoimmunity plays a role in Parkinson's disease, study suggests

2021 [cited 3 October 2021] Available from:- https://www.sciencedaily.com/releases/2020/04/200420084255.htm#:~:text=Scientists%20link%20immune%20cells%20to%20Parkinson's%20disease%20onset,-Date%3A%20April%2020&text=Summary%3A,years%20before%20their%20official%20diagnosis.

5. Tysnes O-B, Storstein A. Epidemiology of Parkinson’s disease. J Neural Transm (Vienna). 2017;124(8):901–5.

6. Statistics Parkinson's Foundation 2021 [cited 4 October 2021]. Available from:

https://www.parkinson.org/Understanding-Parkinsons/Statistics

7. GBD Compare | IHME Viz Hub

Vizhub.healthdata.org. 2021 [cited 4 October 2021]

Available from: https://vizhub.healthdata.org/gbd-compare/

8. Rajan R, Divya K, Kandadai R, Yadav R, Satagopam V, Madhusoodanan U et al. Genetic Architecture of Parkinson's Disease in the Indian Population: Harnessing Genetic Diversity to Address Critical Gaps in Parkinson's Disease Research. Frontiers in Neurology. 2020;11.

9. Parkinson's Disease Treatment Cost in India | Best Neurologist in India Medsurge India 2021 [cite 7 October 2021]. Available from: https://medsurgeindia.com/cost/parkinsons-disease-treatment-cost-in-india/

10. Parkinson's Treatment Options. 2021 [cited 7 October 2021]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/parkinsons-disease/parkinsons-treatment-options

11. Parkinson's disease - Diagnosis and treatment - Mayo Clinic 2021 [cited 8 October 2021]. Available from: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

12. Parkinson disease Information | Mount Sinai - New York [Internet]. Mount Sinai Health System.2021 [cited 14 October 2021].

Available from: https://www.mountsinai.org/health-library/condition/parkinson-disease

Supplementary data

1. GBD Compare | IHME Viz Hub

Vizhub.healthdata.org. 2021 [cited 4 October 2021]

Available from: https://vizhub.healthdata.org/gbd-compare/