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Doença de Parkinson
Dra. Vitorina Passão (Neurologist) . 11/04/2017
Parkinson‘s Disease (P.D.) was described in 1817 by Dr. James Parkinson as a “Shaking Palsy”. In the original description, P.D. appears as “Shaking Palsy”, summarising the disease’s most conspicuous aspects: on the one hand limitation or lack of movement, or “palsy”, and on the other the “shaking” tremor. The condition would later be named after the man who made this first description.
P.D. affects approximately 2 out of every 1000 people worldwide. In Portugal, it is estimated that there are more than 13 thousand people with this disease. It generally appears after the age of 60, but can rarely afflict people at a younger age.
It is described as a degenerative disorder of the Central Nervous System, and its clinical manifestations are caused above all by the loss of neurons that produce a neurotransmitter (dopamine). In the overwhelming majority of cases, the reason for this loss of neurons in unknown. Rarely, a genetic change occurs that is at the origin of this process of premature neuronal death.
Difficulty with movement is one of the principal symptoms of the disease, namely an overall slowness of movements, decreased facial expression, decreased eye blinking, a lower voice, slow walking and difficult balance.
The tremor is typically slow, first afflicting one side of the body most markedly and unevenly, appearing when the body is at rest, disappearing or lessening when movements are carried out. This symptom may not occur in about 1/4 of those with the disease.
In addition to the motor symptoms and tremors, P.D. is also manifested by sleep disorders, depression, constipation and reduced olfaction. As the disease evolves, cognitive and behavioural changes may also take place, among others.
Diagnosis is not always easy. Frequently, this pathology can initially be mistaken for spinal problems, age-related alterations or even depression. Diagnosis is then carried out based on clinical manifestations, as well as physical and neurological observation. There is a defined set of criteria, including the symptoms and alterations found through observation, which enable a precise diagnosis.
Although there is no treatment to cure or prevent the progression of P.D., there are numerous medicinal alternatives that help improve many of the symptoms and maintain the patient’s quality of life, over a variable time period.
In some cases, surgery is advisable.This therapeutic alternative is not curative either, but rather symptomatic. It is reserved for situations where the patient’s response to medication is no longer sufficient and only following a thorough evaluation. In these cases, a device is placed in a precise part of the brain. Its activation stimulates the area and consequently improves motor function, enabling quality of life and autonomy to be recovered.
Despite its degenerative, progressive and incurable nature, P.D. is not necessarily fatal. With the therapeutic options currently available, most people suffering from this condition can maintain relative quality of life and autonomy for many years.