If you are diagnosed with Parkinson disease, it's fair to assume your life will change. Parkinson disease is associated with the death or dysfunction of dopamine-producing cells in the brain — the cells that send signals to help coordinate your movements. The loss of these cells results in tremors, or shaking, among other symptoms.
"It's a highly evolving disease," says Christopher Goetz, MD, director of the movement disorders program at Rush University Medical Center. "The patients' needs change because the disease changes, and doctors continually adjust their perspectives to address those needs."
Holding your ground: The first stage of Parkinson disease
Fighting back: The second stage of Parkinson disease
Changing the outlook: The way forward
Holding your ground
In the first stage of Parkinson disease, symptoms may be limited to minor shaking or slowed movements. Although medical treatment is often unnecessary at this point, Rush offers counseling and emotional support for patients and families.
Individualized exercise programs can improve muscle strength and agility, helping patients with Parkinson disease maintain motor function longer. Physical therapists at Rush can help with this.
Newly diagnosed Parkinson disease patients can also take part in important research. Rush and other research centers are studying treatments, which, if successful, could one day halt the progression of the disease and control symptoms at this early, mild stage.
Since these studies are for early stage treatment, only patients who aren't yet on a medication for the disease may be eligible to participate. One such study involves increasing the body's uric acid levels. Parkinson disease patients with a naturally high level have very mild symptoms, while those with low natural ranges tend to have more significant disabilities.
Researchers hope to find out whether raising uric acid in patients with low levels can protect their brain cells. This therapy is not given to patients with high normal levels because raising levels too high can cause other health problems.
Another study is examining whether isradipine CR, a drug normally used to treat high blood pressure, might slow the progression of Parkinson disease. Isradipine CR slows the influx of calcium ions into certain muscle cells. The health of dopamine-producing cells depends on the flow of calcium, and researchers hope isradipine CR may help Parkinson disease symptoms by balancing the calcium flow in these cells.
For some people with Parkinson disease, symptoms remain mild. However, for reasons still unknown, most people progress to the second stage. Their dopamine-producing cells continue to degenerate, causing more tremors and problems with fine motor control.
These changes mean a different direction for treatment, and together, doctor and patient develop an individualized plan that may involve a variety of existing medications.
Researchers are also studying new medications that increase the activity of dopamine, the main neurotransmitter involved in Parkinson disease.
Because symptoms cannot always be adequately managed with medication in the third stage of Parkinson disease, patients at Rush who reach this stage may be eligible to receive innovative treatments such as deep brain stimulation.
This involves implanting microelectrodes to stimulate a specific region of the brain in order to block the abnormal nerve signals that cause Parkinson disease symptoms. The microelectrodes are attached to an external, battery-operated pacemaker.
People in the third stage may also be eligible for gene therapy. "This process uses implanted genes to better nourish the nerve cells affected by dopamine," Goetz says. It works by making injured brain cells produce more growth factor — a complex molecule that helps with healthy cell function, healing and growth.
If this study is successful, gene therapy may be tried in other stages of Parkinson disease.
Changing the outlook
Although Parkinson disease brings significant changes to those affected by it, medicine is changing right along with it. In fact, many Parkinson disease patients who come to Rush qualify to be part of research into new, exciting treatments.
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