Diagnosing and Treating Parkinson’s Disease
Parkinson’s disease (PD) is increasingly common in America and around the world. According to Parkinson’s Foundation, as many as 10 million adults worldwide may have Parkinson’s disease.
Yet research into what causes and triggers PD to arise and how to effectively diagnose and treat the condition is still in its early stages.
Part of the challenge is that Parkinson’s itself is not one specific condition but rather a group of related neuro-degenerative disorders that share many symptoms in common.
What Causes Parkinson’s Disease?
Parkinson’s can occur at any age and stage of life. Early onset PD typically occurs on or before the age of 50 but it can even occur in children. Early onset Parkinson’s is more closely associated with heritable PD.
While most cases of Parkinson’s are considered idiopathic, or arising from non-specific or unknown causes, a smaller percentage are known to be heritable.
When Parkinson’s is diagnosed later in life, it is more likely to arise from environmental causes, including traumatic brain injury, exposure to toxins, prolonged use of certain medications, stroke and the presence of co-occurring conditions.
Parkinson’s arises when cells in an area of the brain called the substantia nigra start to become damaged or die off. These cells have a very important job – making dopamine.
Dopamine is a vital neurotransmitter that controls movement, motor function, cognition, sleep and emotion. The less dopamine the brain has, the more disruption there will be in these areas.
Diagnosing Parkinson’s Disease
Parkinson’s is usually diagnosed by a neurology physician, but sometimes it is first detected by the patient’s primary care doctor.
There is one test that is now being used to diagnose Parkinson’s. It is called the DaTscan and it was FDA-approved in 2011 specifically to for use as a Parkinson’s diagnosis.
In addition to the DaTscan, a physician will look for four major categories of symptoms to make a definitive diagnosis of Parkinson’s disease:
– Tremor or shaking.
– Bradykinesia (slowness of movement).
– Rigidity or stiffness, especially in arms, legs, trunk.
– Postural instability, including falls or trouble balancing.
At least two of these four major criteria must be present consistently for some prior period of time before a doctor will consider Parkinson’s as a possible diagnosis.
There is also genetic testing that is now available to help with family planning and future planning.
Treatment for Parkinson’s Disease
As with understanding the underlying causes and triggers for Parkinson’s disease, treatment for PD is still in its early stages. At this point, all medications available are designed to address the symptoms of PD. There is no medication as of yet to prevent or cure Parkinson’s.
PD patients today can choose from two treatment tracks: traditional medication and non-traditional medication. Some patients may combine elements of each, although patients who take this approach should always talk with their physician to avoid side effects.
Traditional Medications for Parkinson’s Disease
Traditional medication offers limited options at the moment. The primary medication is a synthetic form of levodopa. Levodopa is an amino acid the body makes naturally. It is a precursor or building block to dopamine.
Levodopa-carpidopa works to add back dopamine to the brain and lessen PD symptoms.
Additional traditional medication options include these:
– MAO-B inhibitors. These medications act to prevent the brain from breaking down dopamine.
– COMT inhibitors. These medicines can increase the impact of levodopa.
– Anticholinergics. These medications are sometimes used to treat tremors.
– Amantadine. This medicine only treats early-stage PD symptoms.
– Deep brain stimulation. This is not a medication but a procedure that is used to decrease dyskinesia (involuntary muscle movements), tremor and other PD symptoms.
Non-Traditional Medications for Parkinson’s Disease
Non-traditional medication is also available to help alleviate the symptoms of Parkinson’s disease.
Cannabis or medical marijuana is one non-traditional medication that is receiving increased attention from both patients and researchers.
The reason is because the cannabis plant contains natural cannabinoids like THC and CBD that can cross the blood-brain barrier (BBB) in ways that many other medications cannot.
The reason medical marijuana can cross the BBB is because THC and CBD are quite similar to the cannabinoids the body makes naturally. So when the brain sees medical marijuana cannabinoids coming, it doesn’t prevent them from crossing over.
This makes medical marijuana an exciting option for patients who want an alternative to traditional medications and for patients who haven’t responded well to a traditional course of treatment.
To date, a number of limited scope research studies have highlighted potential cannabis benefits for Parkinson’s patients, including improvements in dyskinesia and tremors, motor symptoms, psychosis, sleep disturbance, movement slowness and overall quality of life.
While there is much more research to be done, the same can be said for every aspect of understanding, diagnosing and treating Parkinson’s.