DISEASE OF THE NERVOUS SYSTEM (PARKINSON’S DISEASE)

Parkinson’s disease is a progressive disorder of the central nervous system that

typically affects victims around the age of 60 years onwards. It is due to reduced
levels of dopamine in the brain (Gan Wan Yeat. 2014).

Parkinson's disease occurs when nerve cells, or neurons, in the brain die or
become impaired. Although many brain areas are affected, the most common
symptoms result from the loss of neurons in an area near the base of the brain called
the substantia nigra. Normally, the neurons in this area produce an important brain
chemical known as dopamine. Dopamine acts as a chemical messenger responsible
transmitting signals between the substantia nigra and the next "relay station" of the
brain, the corpus striatum in order to produce smooth and purposeful movement.
Loss of dopamine results in abnormal nerve firing patterns within the brain that cause
movements to become slow and abnormal. Most people with Parkinson's disease
have lost 60 to 80 percent or more of the dopamine producing cells in the substantia
nigra by the time symptoms appear, and people with Parkinson’s disease also will
loss of the nerve endings that produce the neurotransmitter norepinephrine.
Norepinephrine closely related to dopamine. It is the main chemical messenger of the
sympathetic nervous system which the part of the nervous system that controls many
automatic functions of the body, such as pulse and blood pressure. The loss of
norepinephrine might explain several of the non-motor features seen in Parkinson’s
disease, including fatigue and abnormalities of blood pressure regulation.
The precise cause of Parkinson’s disease is unknown, although some cases of
Parkinson’s disease are hereditary and can be traced to specific genetic mutations.
Most cases are sporadic which the disease does not typically run in families. It is
thought that Parkinson’s disease likely results from a combination of genetic
susceptibility. Next, the causes is come from the environmental triggers. Exposure to
certain toxins or environmental factors may increase the risk of later Parkinson's
disease, but the risk is relatively small (Anthony H.V.Schapira. 2010).
 There are four primary symptoms of Parkinson’s disease. Firstly, the tremor
associated with Parkinson’s disease has a characteristic appearance. Typically, the
tremor takes the form of a rhythmic back-and-forth motion at a rate of 4-6 beats per
second. It may involve the thumb and forefinger and appear as a "pill rolling" tremor.
Tremor often begins in a hand, although sometimes a foot or the jaw is affected first.
It is most obvious when the hand is at rest or when a person is under stress. Tremor
usually disappears during sleep or improves with intentional movement. It is usually
the first symptom that causes people to seek medical attention. Secondly, rigidity is a
resistance to movement, affects most people with Parkinson’s disease. The muscles
remain constantly tense and contracted so that the person aches or feels stiff. The
rigidity becomes obvious when another person tries to move the individual's arm,
which will move only in ratchet-like or short, jerky movements known as "cogwheel"
rigidity. Thirdly, is a bradykinesia. This slowing down of spontaneous and automatic
movement is particularly frustrating because it may make simple tasks difficult. The
person cannot rapidly perform routine movements. Activities once performed quickly
and easily such as washing or dressing that may take much longer.  There is often a
decrease in facial expressions. Lastly, the symptom of Parkinson’s disease is
postural instability or impaired balance, causes affected individuals to fall easily
(Stewart A. Factor, William J. Weiner. 2008).

At the moment, there is no cure for Parkinson's disease. However, numerous

treatments are available to help control your symptoms and maintain your quality of
life. These may be supportive therapies that help you cope with everyday life or
medication to control your symptoms. For some people with a particular pattern of
symptoms, surgery may be an option. When medications fail to control symptoms
because of severe "on-off" fluctuations, lack of effectiveness, or intolerable side
effects, surgery should be considered. You may not need any treatment during the
early stages of Parkinson's disease as symptoms are usually mild. However, you
may need regular appointments with your specialist so that your condition can be
monitored. These are some practical tips patients can use. Firstly, exercise regularly
to maintain strength and flexibility. Secondly, maintain a healthy diet by consulting
your physician before initiating a new diet or exercise plan. Thirdly, do not overdo
physical activities and know your limits and stay within them. Fourthly, remove throw
rugs and low-lying obstacles from pathways inside and outside your home. Fifthly,
replace clothes that have complicated fasteners with those you can slip on easily,
such as sweatpants, sweatshirts, or pants with elastic waistbands. Sixthly,
exaggerate lifting your feet and swinging your arms. With each step, pretend you are
stepping over a log. Lastly, take extra-small bites of food, chew thoroughly, and
swallow carefully and take a breath before you start to speak, and pause between
every few words or even between each word.

There are several types of medications used to manage Parkinson's disease.

These medications may be used alone or in combination with each other, depending
if your symptoms are mild or advanced. Firstly, conserve dopamine in the brain by
blocking the breakdown action of MAO-B. These drugs are selegiline (Eldepryl,
Zelapar) and rasagiline (Azilect), which are also neuroprotective and can slow
disease progression. Block the action of the neurotransmitter glutamate, which allows
for an increase in dopamine release. This drug is amantadine (Symmetrel). Introduce
agents that mimic dopamine and bind to the receptors in the neuron's synapse.
These drugs include pramipexole (Mirapex), and ropinirole (Requip), and
apomorphine (Apokyn). Replace missing dopamine in the brain. The drug levodopa
helps with movement problems of tremor, stiffness, slowness, and walking. Levodopa
is combined with carbidopa (Sinemet) to reduce nausea side effects and to ensure
that levodopa is converted to dopamine in the brain and not in the intestine or blood.
Optimize delivery of Levodopa to the brain by blocking COMT, which breaks down
dopamine in the digestive system, allowing a steady supply of Levadopa to reach the
bloodstream. These drugs include tolcapone (Tasmar) and entacapone (Comtan).
Reduce activity of the neurotransmitter acetylcholine. These drugs reduce tremor and
include trihexyphenidyl (Artane) and benztropine (Cogentin).

Lastly, deep brain stimulation (DBS) was use for some cases in order to cure
the pakinson’s disease. This surgery is a surgical procedure to implant a pacemaker-
like device that sends electrical signals to brain areas responsible for body
movement (Wendy Henderson. 2018). Electrodes are placed in a specific area of the
brain usually the subthalamic nucleus depending on the symptoms being treated.
The electrodes are placed on both the left and right sides of the brain through small
holes made at the top of the skull. The electrodes are connected by long extension
wires that are passed under the skin and down the neck to a battery-powered
stimulator under the skin of the chest. When turned on, the stimulator sends electrical
pulses to block the faulty nerve signals causing tremors, rigidity, and other
symptoms. (Wendy Henderson. 2018).
 REFERENCES

i. Stewart A. Factor, William J. Weiner. (2008). Parkinson’s Disease Diagnosis and

Clinical Management Second Edition. Demos Medical Publishing. Emory
University, Atlanta, Georgia. Univerity of Maryland, Baltimore, Maryland. United
States of America. ( 21-30). Charcoat and Parkinson’s Disease.
ii. Anthony H.V.Schapira. (2010). Parkinson’s Disease. Oxford University Press.
United States, New York. (5-7) Causes of Parkinson’s Disease:genetics,
environment, and phatogenesis
iii. Gan Wan Yeat. (2014). Sucess Biology SPM. Oxford Fanjar Sdn. Bhd. Selangor
Darul Ehsan. (411)
iv. Wendy Henderson. (2018). 8 Common Treatments for Parkinson’s Disease.
Retrieved by : https://parkinsonsnewstoday.com/2018/02/28/8-common-
treatments-parkinsons-disease-2/