Parkinson’s Disease Treatment

The Department of Neurology at Herzliya Medical Center provides thorough diagnoses and personalized treatment of Parkinson’s disease. The neuropathology clinic uses unique techniques to detect early clinical signs of the disease, as well as the most effective medications and invasive treatments that allowing interrupting disease progression and restoring disturbed functions previously.

What is Parkinson’s Disease?

Parkinson’s disease, PD (also known as paralysis agitans – “shaking palsy”) – a heavy and progressive disease of the central nervous system (a neurodegenerative disease) that affects the motor, and at later stages cognitive function. The disease acts on an area in the midbrain called the substantia nigra that controls movement, affecting neurons that produce a chemical messenger (dopamine). Progression of the disease results in decreased levels of dopamine as these neurons are destroyed, resulting in abnormal brain activity – predominantly uncontrolled movement. Scientists have not been able to ascertain the cause of Parkinson’s disease, but have found a clear genetic link, as well as the pathogenic role of some neurotoxins, such as Lewy bodies. Symptoms resembling PD may occur with prolonged use of certain medications that block the action of dopamine. PD is less common in young adults; it usually develops in people around the age of 60 and older, affecting more men than women. PD is a form of parkinsonism which is used to describe symptoms associated with PD but due to other causes, treatment may be of benefit to these such causes, and so it’s important to distinguish between the two disorders.

Parkinson’s Disease Symptoms

Symptoms vary and range from subtle early changes to a steady worsening of symptoms over the years. Tremors, stiff muscle and slow movements are the most common symptoms of Parkinson’s disease. These and other symptoms of Parkinson’s disease are further detailed:

• Tremor (involuntary shaking) – often the first sign of the disease, forcing patients to see a doctor (and the main reason for the name “shaking palsy”). Tremors appear on one side of the body (hand tremors, for example), in most cases spread to both sides of the body
• Slowing of voluntary movements (bradykinesia) – is one of the important signs to watch out for, especially when a person expresses difficulty trying to move from a resting position
• Rigidity (increased tone), skeletal muscle – arms do not swing when walking, freezing – the inability to walk suddenly
• Loss of automatic movements, such as facial expressions, blinking and more. People with telltale signs appear to have a mask-like face (serious or expressionless)
• Impaired balance – stooped posture and awkward body positioning, which can lead to frequent falls
• Poor fine motor skills – writing and to exercise manipulate small objects
• Impaired speech (monotonous, fast or slurred speech)
• Psychiatric disorders, such as impaired consciousness, cognitive decline

Other symptoms include difficulty swallowing or chewing, sleep disorders, urinary problems or constipation and more.

Staging of Parkinson’s Disease

Staging facilitates treatment, ensuring a more effective approach is taken. There are five clinical stages of Parkinson’s disease based on the Hoehn and Yahr scale:

Stage 1 – minimal clinical manifestations

Stage. Patients rarely ask the experts at this stage, as there is no significant functional changes. However, early intervention at this stage might slow down the progression of Parkinson’s disease. Patients may experience symptoms on one side of their body.

Stage 2 – moderate clinical manifestations

Symptoms apparent on both sides of the body, while the balance is maintained. Functional disorders offset, however, a number of tasks require a significant effort on the part of the patient.

Stage 3 – functional disorders

Loss of balance and changes in tendon reflexes. Progression of the disease prevents many tasks and loss of balance results in frequent falls and injuries.

Stage 4 – loss of the ability of independent movement

Patients require assistance when walking outside or the use of special devices to ensure stability.

Stage 5 – final stage PD

Characterized by a complete dependence on others, the inability of independent movement, even with the help of devices and/ or support. Moving requires a wheelchair. Complications of PD may arise such as secondary disorders of the musculoskeletal system and mental disorders.

Diagnosis of Parkinson’s Disease

The basis of the diagnosis of Parkinson’s disease at Herzliya Medical Center requires a thorough examination by a highly qualified neurologist and a series of clinical tests to confirm the diagnosis. Diagnostics include:

• Positron emission tomography (PET) – brain function and activity particularly areas controlling movement
• Single-photon emission computed tomography (SPECT)
• Magnetic Resonance Imaging (MRI) and functional magnetic resonance imaging (fMRI) of the brain
• A clinical study with dopamine agonists (the reaction of the patient to the introduction of analogues of dopamine)

Conservative Treatment of Parkinson’s Disease

Drug treatment in Israel at Herzliya Medical Center is conducted with the help of modern drugs, this includes the following pharmacological groups:

• Dopamine derivatives having the ability to penetrate the central nervous system (Dopicar, Rytary, Sinemet). Therapeutic effects also noted in the dosage of Duopa via drip directly into the small intestine
• Stimulants dopamine receptors – pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro), apomorphine (Apokyn)
• Inhibitors (antagonists) of enzymes that destroy dopamine – Selegiline (Eldepryl, Zelapar), rasagiline (Azilect), entacapone (Comtan), tolcapone (Tasmar)
• Anticholinergics – benztropine (Cogentin)
• Amantadine – effective in the early stages of the disease as monotherapy and is able to compensate for the side effects of drugs in the treatment of dopamine

Invasive Treatment of Parkinson’s Disease

Deep brain stimulation (DBS) is an innovative treatment for Parkinson’s disease, alleviates the symptoms of PD and helps in cases where traditional conservative treatment has not expressed or prolonged an effect. During the procedure, electrodes (the lead) are positioned at a specific region of the brain and thin wire (extension) is inserted into the underlying skin (of the head, neck, and shoulders) that connects to a generator. Electronic pulses of a certain frequency help to stabilize involuntary movements, reduce tremors and rigidity of the skeletal muscles.

After a complete diagnosis by neurologists at Herzliya Medical Center, the most effective treatment for Parkinson’s disease is determined, aimed to assist patients in everyday tasks and with minimal risk of side effects.