3 ways to know if your Parkinson’s disease is progressing

An experienced neurologist explains what symptoms mean that your Parkinson’s disease is progressing and how an accurate diagnosis and proper treatment will improve your quality of life and allow you to function as much as possible with this disease.

A woman, C, has been treated at my clinic for several years with a diagnosis of Parkinson’s disease. He still works as a manager in a large company, suffering from tremors when he rests his right hand, along with stiffness and slowness, which gradually spread over about 10 years to his left side. In the last year it has started to suffer falls. She notices increasing difficulty running the business, manifesting itself in ADHD-like symptoms and problems with her short-term memory. The time between doses of medication you take to relieve symptoms is getting shorter and you now need five doses a day (every 3.5 to 4 hours). Also, the side effects of involuntary movements occur for several hours every day.

Does C meet the criteria for advanced Parkinson’s disease? How can you decide where to put the fine line that crosses between a patient who has developed Parkinson’s and one who is an advanced patient?

The answer to this is complex.

Due to disputes among international movement disorder experts over the definition of advanced Parkinson’s disease, and due to the lack of a biological marker such as a blood test or imaging test that “marks” the transition to stage advanced disease, a limited number of experts from around the world met to discuss how to define advanced disease. At the end of the process, it was determined that a person with advanced disease is defined according to the following criteria, although it is not necessary to meet all these criteria to be considered in an advanced stage.

1 – Symptoms of engine volatility

Motor volatility during the day (frequent switching between states of the pill that alleviate symptoms or when the pill has no effect on symptoms); Involuntary movements (dyskinesia) that interfere with more than one hour a day if there are two hours of symptoms a day and need five doses of budopa-based medications (which convert the brain to dopamine, a neurotransmitter associated with movement) per day , all mean that Parkinson’s disease has progressed.

2 – Non-motor symptoms

Mild cognitive impairment or hallucinations are another sign that the disease has progressed.

3 – Functional disorder

Recurring falls or difficulty performing routine daily tasks is a final sign of progress.

The diagnosis of advanced-stage Parkinson’s disease is crucial, due to the options available to patients in these stages and the need for intervention as soon as possible to prevent further secondary complications and improve quality of life.

What treatment options are available for those facing advanced disease?

1 – Drugs

First, an attempt should be made to find an effective drug treatment, including combining several drugs, dividing the doses over an increasing number of times a day, and increasing the amount of drug in each dose.

2 – Surgery

There are three treatments approved to treat advanced-stage Parkinson’s that are provided by Israeli health funds.

One treatment option is surgery to implant brain stimulation electrodes into movement control areas in the brain, called deep brain stimulation. This procedure is performed in a growing number of centers in the country. After the surgical procedure, the patient arrives at an institute that treats Parkinson’s and undergoes a procedure to calibrate the electrodes, until reaching an optimal therapeutic efficacy. It will be monitored periodically over the years, and doctors will decide to make changes based on the progress of the disease and side effects.

3 – Levodopa gel

Another treatment is the administration of levodopa in gel form by means of an external pump directly to the intestine through a tube that is inserted through the skin and runs through the stomach. It replaces the need to take pills, aids in optimal drug absorption and, in combination with regular infusions, produces levels of dopamine in the blood in the brain that are stable throughout the day. This significantly improves the side effects of the treatment and also increases the effectiveness of the treatment to achieve a better quality of life and better daily function.

4 – Apomorphine

The third is a subcutaneous pump, which continuously infuses apomorphine (a molecule that binds to and activates a dopamine receptor in the brain), helping to improve symptoms of advanced disease, in parallel with ongoing drug treatment.

All treatments are effective, safe, and have been used with thousands of patients.

The decision about the appropriate treatment is individual and should be made as part of a joint decision by the patient and the doctor. Knesset member Miki Eitan, thanks to DBS surgery, has significantly improved his life, even after developing advanced Parkinson’s. Therefore, advanced treatments provide hope for a continued good quality of life among people with the disease.

Beyond advanced treatments, it is crucial to diagnose an advanced patient in order to provide the necessary support from the immediate family. Outside sources should also be tapped, including the patient’s community and the health fund that provides medical services, including complementary medicine and rehabilitation treatment, social workers, and the Israeli Parkinson’s Association.

Dr. Saar Anis is a senior neurologist and movement disorder specialist at the Institute for Movement Disorders at Sheba Medical Center in Tel Hashomer. This article was written in cooperation with the Israeli Parkinson’s Association. It first appeared on the Jerusalem Post’s sister site, Walla!



Reference-www.jpost.com

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