Parkinson's disease in 10 questions - Doctissimo

Medical validation: April 11, 2016Dr Jesus CardenasAllergologist

Discovered in 1817 by a British doctor who gave it his name, Parkinson's disease affects 200,000 people in France. The diagnosis generally falls nearly 10 years after the onset of the disease. Too often still the sluggishness and tremors are attributed to the simple effect of aging.

1. What is Parkinson's disease?
2. Who is affected by Parkinson's disease?
3. What are the symptoms of Parkinson's disease?
4. What are the risk factors for Parkinson's disease?
5. Is Parkinson's disease hereditary?
6. How is Parkinson's diagnosed?
7. What are the stages of the disease?
8. What are the treatments for Parkinson's disease?
9. Parkinson's disease: what impact on daily life?
10. What are the challenges for research?

What is Parkinson's disease?

Discovered in 1817, Parkinson's disease is still far from revealing all its secrets. Affecting the nervous system, its cause is still not known. The disease is characterized by the disappearance of a small number of nerve cells (neurons) which secrete a neurotransmitter called dopamine involved in the proper functioning of many regions of the brain, and essential for cell survival.

Connection between two neurons

Dopamine is a neurotransmitter (chemical substance released by neurons that transmit impulses) at the junctions between nerve cells (synapses).

Synapses are areas where neurons exchange information. At this level, information is exchanged in the form of chemical messages. Chemicals called neurotransmitters are secreted and bind to specific receptors.

Normal functioning synapse

1: Nerve impulse 2: Neurotransmitter (dopamine) 3: Dopamine-specific receptor 4: Dopamine reuptake system

Who is affected by Parkinson's disease?

Each year, 25,000 new cases are diagnosed in France. Although this disease is generally diagnosed between the ages of 55 and 65 (average age of diagnosis: 58), 5 to 10% of patients are affected at much younger ages (between 30 and 55).

What are the symptoms of Parkinson's disease?

The appearance of the first symptoms is gradual. After a period of intense fatigue, Parkinson's disease is manifested by:

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These motor control disorders are most often associated with specific psychological aspects due to dopamine deficiency. These symptoms (depression, excessive anxiety) are often ignored by the general public.

What are the risk factors for Parkinson's disease?

Age remains the main risk factor. However, various avenues have also been explored¹ , including:

Apart from exposure to pesticides, where studies have been conducted by Inserm researchers, no study has succeeded in demonstrating the slightest relationship between Parkinson's disease and other risk factors.

Certain aggravating factors have however been brought to light, including taking neuroleptics or certain psychological situations (depression, etc.).

Only the protective role of smoking seems to be proven by epidemiological surveys. The latest ² involves twins and again shows that the risk of Parkinson's disease is inversely correlated with cigarette smoking. This effect would be linked to the action of nicotine which stimulates the release of dopamine and compensates for the dopaminergic deficits which characterize the disease.

Is Parkinson's disease hereditary?

Even if exceptional cases have been identified of families affected several times by the disease, no study confirms the existence of a systematic hereditary transmission. There is a genetic susceptibility, but it remains quite low. 21 genetic variants associated with the disease have been identified to date. But none of these variants is individually strong enough to cause disease. It is estimated today that there are about 5% of genetic forms linked to mutations affecting specific genes.

How is the diagnosis of Parkinson's established?

The diagnosis is not easy, the signs are progressive and too often imprecise: rheumatic pain, depression, intense fatigue... the entourage and the patient themselves find it difficult to isolate the symptoms. Alerted, the general practitioner, psychologist or rheumatologist directs the patient to a neurologist to confirm the presence of the disease. Thanks to various tests, the specialist will be able to identify Parkinson's disease by exclusion. The diagnosis can take a few weeks to a few months to confirm the installation of discreet disorders at the beginning, then more and more clear.

Advice for living better with Parkinson's disease

Parkinson's disease

Diagnostic criteria used by the French National Authority for Health³ are the four essential signs of the disease:

Other causes that may be at the origin of the same manifestations must also be excluded. Finally, a positive response to dopaminergic drugs (L-Dopa) is a diagnostic criterion.

What are the stages of the disease?

Parkinson's disease has several stages of development, indicating the severity of the disorder:

What are the treatments for Parkinson's disease?

Despite the latest medical advances, there is currently no cure for Parkinson's disease. Thus, the aim of the treatment is to correct the symptoms, in particular the motor ones, and to attenuate their consequences on the daily and social life of the patient.

Medications

The purpose of the medications used is to provide the brain with the dopamine it lacks or to slow down cholinergic activity. For nearly thirty years, L-Dopa has been the most effective treatment for this disease. It minimizes the consequences of neuronal losses by restoring the deficit of dopamine synthesis. We speak today of "dopatherapy".

However, if its action is indisputable in the short term, it could aggravate motor symptoms after a few years. Other substances, known as "dopaminergic agonists" can then take over. But these drugs (bromocriptine, lisuride, piribedil, ropinirole, apomorphine, pergolide, entacapone) are less effective. They are currently reserved for the youngest patients to avoid exposing them too early to the side effects of L-Dopa.

Surgery

Neurosurgery also offers an alternative for some patients (5% of patients). Through a surgical procedure, a specific region of the brain is stimulated with electrodes. These electrodes are connected by a subcutaneous cable to a small stimulation box placed just under the collarbone. Stimulation brings considerable relief and, in the vast majority of cases, a real transformation in the lives of patients. This technique is very effective on tremors, stiffness and difficulty in performing movements. One downside, however: deep brain stimulation can only be offered to people who have been sick for more than 5 years, and who do not have psychiatric disorders. If the patient's age is not a major selection criterion, his state of health must be satisfactory.

Non-drug approaches

Physiotherapy to maintain muscles and joints and speech therapy to improve swallowing, speaking and writing are treatment options that should not be overlooked.

Parkinson's disease: what impact on daily life?

A study conducted by the France Parkinson association, more than 2 out of 3 patients (77.2%) have to limit their outdoor activities because of their symptoms.

Family life is also weakened by the disease: 22.7% of patients say that the relationship with their spouse is affected and 22.7% note that their friends are estranged. Worse still, 37% of people with Parkinson's disease feel like they are a burden to those around them.

Concerning the external vision of this disease, much remains to be done. The symptoms of Parkinson's are still largely misunderstood: they are perceived as drunkenness or a drugged state in 77.9% of cases, simulation (74.1%) or madness (64.5%).

What are the challenges for research?

There are many research challenges: