As if the diagnosis of Parkinson’s disease is not enough, it is also accompanied by a variety of complications. Some of these problems can be overcome by changing lifestyle habits but others may require the guidance of a doctor or therapist to help cope with them. Not all of these complications can be solved with a shot or pill so expect there to be some frustration as they develop and solutions try to be garnered.

Depression

Sometimes, people develop depression before Parkinson’s disease is diagnosed. The disease affects chemical production in the brain and this includes serotonin and norepinephrine, two chemicals that are associated with depression. When these levels are low or fluctuate on a continuing basis, this can affect mood.

Chewing and Swallowing

As Parkinson’s disease progresses, so does the sluggish movements, limb rigidity and hindered progress of other muscles, including those used in conjunction with the autonomic nervous system. In other words, involuntary movements such as swallowing saliva (and thus food) can be a problem. Chewing can be particularly tough later in the disease thereby requiring softer foods that are easier to get down.

Sexual problems

Decrease in libido is a detrimental side effect to Parkinson’s disease as this can affect personal relationships with a partner or spouse. This loss of sexual desire can be attributed to both mental and physical factors. Depression and chemical imbalances can happen in the brain, causing a decrease in sex. Physically, motor coordination becomes a problem later in the disease as does limb rigidity and the ability to control certain movements.

Sleep problems

Insomnia can occur at night with Parkinson’s patients as well as fits of daytime sleeping and drowsiness. During the night, patients may not be able to fall asleep or if they do, sleep is punctuated by nightmares, uncomfortable feelings in the limbs (such as restless legs syndrome), acting out while dreaming and more.

Body elimination

Bowel and urinary elimination can also be punctuated with problems due to Parkinson’s. Just like with chewing and swallowing, body elimination is a function of the autonomic nervous system, not something consciously thought about but the body performs on its own such as digestion and the creation of fecal and urine matter. The only control a person has is over the different sphincter muscles that are employed to hold in body elimination until a person can get to the bathroom.

It is these sphincter muscles that can be affected. Sometimes, they relax too much causing bladder or bowel incontinence while other times, they are hard to relax so a person has trouble eliminating at all. Constipation is a problem because Parkinson’s can slow digestion and cause the stomach not to empty properly into the intestines. Disease medications can contribute to both urinary and bowel incontinence.

Certain Parkinson’s medications can cause problems with a number of other issues as well. Blood pressure may fluctuate as well as overall drowsiness. Twitching and jerking may occur as well as hallucinations, dry mouth and more. Because each person’s body chemistry is different, there is no way to predict how someone will react to medication, so it is important to be prepared to experiment until the right combination of drugs works positively on symptoms.

Grant award for therapy research

By Mark Dowie

Published: 04/02/2009

NEW ways of treating Parkinson’s disease are to be investigated by a researcher at St Andrews University.

Professor Philip Winn, of the school of psychology, has been awarded a grant by the Medical Research Council to study new ways of using an existing therapy.

Deep brain stimulation is a surgical method already used to treat the disease’s symptoms.

These include tremors, difficulty with movements, poor balance and gait disturbance.

With deep brain stimulation, patients can turn on or off electrodes surgically implanted in their brains which send pulses of electricity directly to specific areas of the brain.

The first aim of the research is to understand exactly what happens to brain physiology when the electrodes are switched on, to help develop better methods of stimulation.

The team also hopes to identify other targets in the brain where this stimulation might offer different benefits.

Stimulation at some sites might relieve tremor, while others may have more effect on postural and gait problems.

Prof Winn said: “It is a unique opportunity to integrate basic and clinical science.

“The method is especially useful in cases of Parkinson's where drug treatments are having less effect than normal."

The three-year £1.2million grant brings together teams of researchers in Germany, Italy, France and Scotland, co-ordinated by Christian- Albrechts University in Kiel, Germany, one of the leading centres for the surgical treatment of Parkinson’s.

To date, there is no known cure for Parkinson’s, despite the ongoing research efforts of scientists across the world. Having said that, there are a number of treatments available which can substantially relieve the pain many patients feel as a result of the symptoms of the disease. It is not the case that every patient will require medication and drugs to treat their condition, and these will only be administered where the severity of the symptoms has a strong adverse affect on the patient’s lifestyle. The course of Parkinsons Medicine offered to a patient will vary with the amount of disruption the symptoms cause, the state of the patient’s condition and the severity of the condition within the patient. Even in these cases, it is not always a guarantee that the symptoms will be helped, although these treatments will go someway to making life more comfortable.

The most effective treatment for the symptoms of Parkinson’s Disease by a long shot is the drug levodopa. This is derived from a naturally produced chemical in plant matter and animals, and works with the nerve cells to produce the dopamine which has been eroded by the patient’s condition, and is thought to be an underlying cause of the disease. The drug allows the majority of patients to extend the period of time in which they can lead their normal lives, effectively stalling the development of their Parkinson’s. Unfortunately, this treatment is only really effective in helping rigidity and bradykinesia, and may be of no help to the tremor or balance problems the patient may be experiencing. The drug is so effective, many patients forgot they are suffering from the disease as they continue to lead their lives as normal. However, levodopa is only a short term solution, as it can never replace the nerve cells which have been irretrievably damaged within the brain.

As with most medications, there are a number of side effects with levodopa, including restlessness, low blood pressure and vomiting. In some cases patients may also occasionally feel confused as to their surroundings , although this is a rare occurrence. It is important for physicians and patients to work together to come up with a happy medium between the benefits and side effects when using levodopa.

When combined with the drug tolcapone, Parkinsons medicine significantly reduces the effects of the disease, and helps block the destruction of dopamine which worsens the condition. Having said that, this tends to increase involuntary movement and twitching over a long course of treatment, and is sometimes withdrawn for several days at a time to ensure its continued effectiveness. However, patients should never completely cease treatment with levodopa without their physician’s guidance, due to the extreme and serious side effects that can emerge as a result.

Although there is no cure for the disease, Parkinsons medicine can go a long way to suppressing the debilitating and disabling symptoms of the condition, and making life more bearable for the many thousands of sufferers around the world.