New treatment options in Parkinson disease

We talked about syndromes and treatments of Parkinson disease, which is one of the most common diseases of the recent times, with Assoc. Prof. Başar Bilgiç from Istanbul University Faculty of Medicine Neurology Department Behavioural Neurology and Movement Disorder Unit.

Assoc. Prof. Başar Bilgiç, who gave information about Parkinson disease syndromes, said: “Parkinson is a disease that appears by shaking and slowness of movements in most of the patients, but symptoms may not be same in all the patients. The most common symptom is shaking in one side as right or left. Slowness of movements is added to this one side shaking. There are some cases in which patients with Parkinson experience any shaking. For instance; their walking can get slow, they can start to walk with body bent forward. The most problematic symptom of Parkinson is the slowness in movements and this slowness and this slowness increases as the disease progresses, walking gets distorted, there may be falling. Apart from these complaints, there are other symptoms called ‘motor symptoms’ and they can show themselves years ago. For instance; before the motor symptoms of the disease, these patients dream deeply, they yell, talk and make hand gestures. Even they can sometimes hurt themselves by falling from the bed and the people that they sleep together. Again, before the motor symptoms, there can be symptoms such as constipation, smelling problems. These are the symptoms that Parkinson disease shows itself years ago.

Clinical diagnosis of Parkinson Disease

Assoc. Prof. Bilgiç, who implied there are many methods for Parkinson disease diagnosis, said: “The diagnosis of Parkinson is a clinical diagnosis. We use laboratory techniques in some cases. If the clinical diagnosis upon the patient and their story are suitable with the determined criteria, Parkinson disease is diagnosed. Parkinson is not diagnosed with medical imaging methods like MRI but in order to eliminate other diseases that can imitate this illness we use MRI most of the time. Sometimes, when in complex cases, we use nuclear medical methods that are new in our country and are used for scanning of a substance in the brain called dopamine. However, this last one is a method that we use in the cases we really cannot be so sure and it is a troublesome and expensive technique.”

The earlier diagnosis, the easier course of disease

Assoc. Prof Bilgiç drew attention to early diagnosis and said: “Parkinson disease does not appear in just one way. Its average age of onset is 55 but it can be observed in both 30s and 70s. For instance; some types of Parkinson which are innate and observed in young people are benign disorders, they progress much slowly, reaction of medicine is much better. On the other hand, Parkinson disease which progresses without any shaking may not be a benign disorder. There is no classical progress for Parkinson disease. A lot of factors changing according to the patient’s status, the age of onset, again the patient’s social support and the treatments used for the patient effect the course of the disease. Early diagnosis is the most important. Thus, a Parkinson disease appearing at 30s can progress in a better way with the current treatments.”

Parkinson as a genetic disease

Assoc. Prof. Bilgiç implied that the disease can be genetic. He said: “Parkinson disease has genetic and familial forms. When there are genetic forms, Parkinson disease is found in the family. In the case of skipping of generations, the disease can be seen in the children without being seen in the parents, especially who have consanguineous marriage. There is a mutation called Parkin that it is the most common mutation we see in these cases. This kind of innate forms appears in the early ages and they can progress in a positive or negative way in comparison with the classic Parkinson disease.”

Current treatment upon Parkinson disease

Assoc. Prof. Bilgiç, about the treatment of Parkinson disease, said: “The treatment of Parkinson disease has improved in the recent years and so there are lots of different treatment ways. Most of the oral treatments aim to replace dopamine decreasing in the brain during the disease. On the other hand, among the oral treatments there are other treatments that do not effect upon dopamine. This disease has surgical treatment apart from pharmacotherapy. Surgical treatment means that electrodes are placed on the brain and here they act on the silencing and regulating of the brain cells that makes over firing there. In addition, there are different treatments that have been improving nowadays. One of them is a method of medicating directly to the small intestine, which is new in usage in our country. The advantage of that method is medicating of a drug called L-Dopa, which is still the most effective drug, directly to the small intestine with a pump. We first use oral drugs as a treatment then we use other methods according to the course of the patient.”

Assoc. Prof. Bilgiç indicated treatment options that have increased in the recent years and expressed: “In Parkinson disease a lot of treatments have been developed and new drugs, methods are presented. However, the most effective treatment is still the drugs that deal with dopamine in the brain. Some of these drugs are old drugs, so their new forms are being developed. Longer- acting ones and subcutaneous forms depending on the situation are tried to be improved.”

Families have important duties in Parkinson

Assoc. Prof. Bilgiç implied the most important duty belongs to the families and said: “Parkinson’s disease may not be very serious at the beginning, but as the disease progresses, activities of daily living are severely affected. In such a case, the role of the family is primarily to accept the individual as a patient and treat him or her according to it. Again, families should be careful about that there may be some changes in the behaviours of patients with medications. For example, a person who has never played gambling before may show some behavioural problems like being addicted to gambling. In such cases, the parents should be careful and inform the doctors about it. Because the patients usually do not say that. If such a condition is reported to the doctor, it is possible to select an appropriate medicine to remove these behaviours.”

Parkinson disease awareness should raise

Assoc. Prof. Bilgiç put an end to his words: “Parkinson is a disease becoming increasingly recognized. Because the frequency of having this disease increased and it became more known in society. The activities of the Parkinson Association have raised awareness on this issue. One of the reasons for the recent rise in this awareness is that some of the famous names have Parkinson disease. For example, with the death of Muhammad Ali, it became more recognizable in Turkey. However, it is still not a very well-known disease. Especially in rural areas, this disease is diagnosed later. Since rural areas are a risk factor for Parkinson’s disease, people living there need to be trained to raise their awareness.”

Photo: PD Warrior

Translated by: İrem YAŞAR

IU Press and Public Relations Department

24/04/2017
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İstanbul Üniversitesi Merkez Kampüsü
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Tel: +90 (212) 440 00 00
E-Mail: iubilgi@istanbul.edu.tr