Parkinson's disease

The symptoms of Parkinson's disease progress slowly and are varied. They generally fall into two categories: motor and non-motor symptoms.

Motor symptoms

The most characteristic motor signs of Parkinson's disease are :

• Tremor : This symptom affects around 70% of patients. They generally occur at rest and often affect the hands, but can also affect the legs and jaw.
• Akinesia and bradykinesia: This is a slowness in the initiation and execution of voluntary movements. Everyday tasks such as dressing or writing become difficult.
• Muscle rigidity: Muscles become stiff and sometimes painful, making movement difficult.
• Postural instability: A loss of automatic postural reflexes can lead to frequent falls, especially in the advanced stages.

Non-motor symptoms

Patients may also suffer from

• Depression and anxiety
• Cognitive problems (e.g. memory problems, dementia)
• Sleep disorders (insomnia, excessive daytime sleepiness)
• Digestive problems (constipation)
• Impaired sense of smell and loss of smell perception
• Lability of blood pressure
• Urinary urgency, urinary incontinence.

The exact causes of Parkinson's disease remain uncertain, but several factors are involved

The main risk factors for Parkinson's disease include :

• Age: The disease mainly affects people over 60, although it can occur earlier in rare cases.
• Gender: Men are more often affected than women.
• Family history: Having an affected relative increases the risk, especially in familial forms of the disease.
• Exposure to pesticides

The diagnosis of Parkinson's disease is based primarily on clinical examination and assessment of motor symptoms. No blood test or brain scan can confirm the disease with certainty.

1. Clinical examination

The neurologist assesses the presence of the main motor symptoms, such as bradykinesia, rigidity and resting tremor. A positive response to dopaminergic treatments is an additional criterion that may support the diagnosis.

2. Complementary brain imaging tests

Imaging tests, such as MRI or DaT-scan, may be used to rule out other pathologies. However, these tests are not directly diagnostic of Parkinson's disease.

3. Demonstrating the presence of α-synuclein

The abnormal accumulation of α-synuclein deposits is characteristic of the disease. These accumulate in the form of intra-neuronal inclusions, known as Lewy bodies, which are probably responsible for cell death. Aggregates of this protein are present in several organs in Parkinson's patients. They can be identified by a biopsy of the skin or salivary glands and by a lumbar puncture in the cerebrospinal fluid. These tests are not yet part of current clinical practice.

Symptoms progress and at a more advanced stage, fluctuations in the patient's condition set in. It is therefore advisable to keep a detailed diary of symptoms over time. These tools, known as the ‘ Symptom Perception Card “ or ” Parkinson Surveillance ’, make it possible to document symptoms and better adapt therapy.

Although there is no cure for Parkinson's disease, there are a number of treatment options that can effectively manage the symptoms.

Drug treatments

The first-line treatment is generally L-dopa (or levodopa), a precursor of dopamine, which helps to compensate for the lack of dopamine in the brain. L-dopa is always combined with molecules such as carbidopa and benserazid, which reduce the side effects and improve the efficacy of L-dopa.

Dopamine agonists mimic the action of dopamine in the brain, while MAO-B and COMT inhibitors prolong the effects of levodopa.

Drug therapy can be optimised by monitoring drug intake.

Treatment with continuous dopaminergic infusion

In the advanced stages of the disease, when symptoms fluctuate widely and disably, continuous dopaminergic infusion therapy can significantly improve patients' quality of life. Pump infusions can be used in patients of any age.

Deep brain stimulation

For patients whose symptoms are no longer well controlled by medication, Deep Brain Stimulation(DBS) is an option. This involves a neurosurgical procedure to implant electrodes in the brain to modulate neuronal activity and improve movement regulation. There are eligibility criteria for deep brain stimulation, and the age limit is 70.

Non-drug treatments

Non-pharmacological interventions such as physiotherapy, speech therapy and regular physical activity are essential to maintain patients' mobility and quality of life. Physical exercise, in particular, helps maintain muscle strength, flexibility and balance.

Parkinson's disease is a progressive illness, the course of which varies from person to person. Motor symptoms become increasingly disabling over time, reducing the patient's independence. At an advanced stage, other complications such as dementia, problems with balance and walking, and swallowing disorders may become more severe and require specialist treatment.

To date, there is no proven prevention strategy for Parkinson's disease. Some therapeutic approaches are exploring the idea of slowing the progression of the disease through neuroprotective treatments. Finally, some studies suggest that regular exercise and caffeine consumption could reduce the risk of developing the disease.

It is essential to consult a doctor as soon as any unexplained motor symptoms appear, such as tremors at rest or difficulty walking. Early diagnosis allows the disease to be managed more effectively and improves quality of life through appropriate treatment.

At Hôpital de La Tour, care for patients with Parkinson's disease is multidisciplinary. This includes neurology, physiotherapy, speech therapy and urology. The Neurology Centre has neurologists specialising in Parkinson's disease. Specific rehabilitation programmes are available to help patients maintain their independence for as long as possible. Speech therapy and treatment for urological problems are also available.

1. What are the first symptoms of Parkinson's disease?
The first symptoms of Parkinson's disease often include tremors at rest, slowness of movement (bradykinesia) and muscular rigidity. Non-motor symptoms, such as loss of smell and constipation, may also appear.

2. How is Parkinson's disease diagnosed?
Diagnosis is based primarily on a clinical examination by a neurologist, who assesses the presence of motor symptoms such as bradykinesia, tremors and muscular rigidity. Imaging tests, such as brain MRI and DaTSCAN, can help confirm the diagnosis.

3. Is there a cure for Parkinson's disease?
No, there is currently no cure for Parkinson's disease. However, drug treatments and surgical procedures, such as deep brain stimulation, can help manage symptoms and improve quality of life.

4. What are the surgical options for treating Parkinson's disease?
Deep brain stimulation is a common surgical option for patients whose symptoms are no longer well controlled by medication. This technique involves implanting electrodes in the brain to modulate neuronal activity.

5. Can Parkinson's patients continue to work?
In the early stages of the disease, many patients are able to continue working with adjustments to their schedule and tasks. However, as the disease progresses, physical and cognitive limitations can make it more difficult to continue working.

6. Are there any preventive measures against Parkinson's disease?
Although the exact causes of Parkinson's disease remain unknown, some studies suggest that regular exercise and caffeine consumption may reduce the risk of developing the disease. However, no formal preventive method has yet been recognised.

7. Does Parkinson's disease affect cognitive function?
Yes, as the disease progresses, some patients may develop cognitive problems, such as difficulties with concentration and memory, and in more serious cases, dementia.