Parkinson's disease is a chronic progressive disorder caused by the reduction of dopamine in the brain, typically occurring in older ages. The disease almost always begins with symptoms on one side of the body and progresses slowly. Slowness of movement, hand tremors typically seen at rest resembling coin-counting, joint stiffness and rigidity, walking with small steps, and gait disturbances are the most important symptoms that impair patients' quality of life. In addition to these complaints, speech disorders, mask-like face due to loss of facial expressions, constipation due to reduced bowel movements, decreased sense of smell, joint and muscle tension and pain, sleep problems, depression, and some psychological issues can also be counted among the significant symptoms of the disease.

What is Parkinson's Disease? A Comprehensive Guide

Parkinson's disease is a progressive and chronic neurological disorder caused by the reduction of dopamine production in the brain. Although it is usually seen in older ages, it can also appear in younger individuals. In this comprehensive guide, we will address the most frequently asked questions about Parkinson's disease in detail.

What Are the Symptoms of Parkinson's Disease?

Parkinson's disease manifests itself with various symptoms. These symptoms may vary depending on the stage of the disease and the individual characteristics of the person. The most common symptoms are:

• Slowness of Movement (Bradykinesia): A marked slowness that makes performing daily activities more difficult.
• Tremor: Trembling that typically appears at rest and is described as resembling 'coin counting'.
• Muscle Stiffness and Rigidity: Stiffness that causes restricted joint movement and pain.
• Gait Disturbances: Symptoms such as loss of balance, forward-leaning posture, and walking with small steps.
• Speech Disorders: Symptoms such as hoarseness, monotone and slow speech.
• Mask-Like Face: A blank facial expression resulting from reduced or lost facial expressiveness.
• Constipation: A frequent complaint due to slowing of the digestive system.
• Reduced Sense of Smell (Anosmia): Reduced or lost sense of smell in some patients.
• Sleep Problems: Difficulty falling asleep, frequent waking, and movement disorders during sleep.
• Depression and Psychological Issues: Emotional and psychological problems arising from the difficulties brought by the disease.

Stage-by-Stage Symptoms of Parkinson's Disease

What Causes Parkinson's Disease?

Although the exact cause of Parkinson's disease is not fully known, it is thought that a combination of genetic and environmental factors plays a role. The death of dopamine-producing cells in the brain is the primary cause of the disease.

Treatment Methods for Parkinson's Disease

Treatment for Parkinson's disease is determined according to the individual needs of the person and the stage of the disease. Treatment methods may include:

• Medication: Drugs used to increase or mimic dopamine levels.
• Physical Therapy and Exercise: Exercises aimed at improving mobility and muscle strength.
• Speech Therapy: Therapy that helps correct speech disorders.
• Deep Brain Stimulation (DBS): Methods applied to alleviate symptoms in advanced-stage Parkinson's patients.

When is Deep Brain Stimulation Needed in Parkinson's Patients?

Drug therapy is initiated as soon as the disease is diagnosed. In the first few years, patients may return to their pre-disease lives as if they had never been ill. This period is called the honeymoon period. However, as the years progress, if tremors, freezing, rigidity, and slowness of movement cannot be controlled despite drug therapy, if off periods increase during the day, and if involuntary dance-like movements emerge when drug doses are raised, it can be said that the time to consider brain pacemaker surgery has come. Brain pacemaker surgery is not recommended for the first 5 years from diagnosis. The most important reason for this is that Parkinson's disease can be confused with other diseases. In such diseases, called Parkinson-plus syndromes, brain pacemaker surgery unfortunately does not yield results as successful as in Parkinson's disease.

Which Parkinson's Patients May Not Be Suitable for Deep Brain Stimulation?

Brain pacemaker surgery requires that the disease onset dates back at least 5 years. This is because Parkinson's disease can be clinically confused with certain other neurological diseases. Brain pacemaker surgery is not recommended in patients who have frequent falls or whose medications provide almost no benefit even for a short time interval. Moreover, a slight increase in complaints may even be observed after surgery in patients with particularly advanced fall and balance problems. Brain pacemaker surgery should also not be performed in patients with severe psychiatric depression or serious mental disorders called psychosis. Since patients with Parkinson's disease may experience sadness and anxiety due to reduced quality of life and a restricted lifestyle, these mild clinical psychiatric conditions do not constitute an obstacle to surgery. However, in the more severe psychiatric issues mentioned above, drug therapy should be initiated first, and this surgery should be performed after the patients' psychiatric treatment is completed. Patients who had such complaints in the past and recovered with psychiatric medication should be closely monitored after brain pacemaker surgery. These details should be shared with the patient and their relatives in detail before surgery.

Another surgical obstacle is patients whose cognitive status is below what is expected for their age. Brain pacemaker surgery should not be performed in patients with signs of dementia either. In addition, brain pacemaker surgery is not suitable for patients with severe and uncontrolled other chronic diseases. However, controlled conditions such as hypertension, heart disease, or diabetes are not obstacles to surgery.

Living with Parkinson's Disease

Although Parkinson's disease is a condition that affects quality of life, with proper treatment and support, the progression of the disease can be slowed and quality of life can be improved. Regular doctor check-ups, healthy nutrition, exercise, and social support are important for Parkinson's patients.