Parkinson’s, what are the new treatments for tremor (also used to control “essential” tremors) – Corriere.it

from Cesar Beccarizzi

Deep brain stimulation can be a complement to medications in controlling disease. and refine early diagnosis techniques

In recent years, great progress has been made in the treatment of Parkinson’s disease (here is the Corriere Salute forum). The leap forward, for example, is the potential you have shown deep brain stimulation
Known by the acronym DBS from English deep brain stimulation – explain Alfredo BerardelliProfessor of Neurology at the University of La Sapienza, Rome -. In the year 1997 The US Food and Drug Administration has approved this for the control of tremors in Parkinson’s disease and essential tremors.

Idiopathic tremor and DBS

What is the difference between Parkinson’s disease and idiopathic tremor? The tremor – explains Berardelli, who is also president of the Italian Society of Neurology – Causes shakiness during movement that is not accompanied by other Parkinson’s symptoms, such as slowing, muscle stiffness, and balance disorders. It happens that those with idiopathic tremor cannot drink coffee without pouring it, while Parkinson’s can do so because his hands tremble at rest, and when he grabs a cup he calms down.

Is DBS an alternative to medication? In 2002, it was discovered that by stimulating certain areas of the brain with DBS, it was possible to control symptoms of Parkinson’s disease that the drugs could no longer affect, and the following year it was possible. Also approved for the treatment of dystonia
, a condition in which the muscles contract in a disorganized manner and the patient appears to be twisting, the expert points out. Many considered it a last resort. 2016 was a turning point year with his team Approval in combination with drugs in those with chronic movement complications Even for only four years. Over time, Dbs has become more accurate, and because it is able to treat younger and younger people without age-related complications, it has become a safe, up-to-date solution.

telemedicine

Thanks to telehealth, it can now also be started remotely, and there is also an Italian version by Professor Alberto Priori from the University of Milan that is adapted to the needs of the engine at the moment. With a good group of patients and in newer centers if combined with drugs that are more effective than drugs alone. Treatment has evolved, however, toward multidisciplinary centers You can be seen on the same day by a neurologist, neurosurgeon, psychiatrist or internist. Relatives of patients often ask whether Parkinson’s disease is hereditary.

Causes and prevention

Can you predict in advance whether you will get sick? the disease It has genetic, environmental, and above all subjective causes– Determines Berardelli. It is necessary to focus more and more on the characteristics of each individual because in theory this allows us to predict disease progression and response to drugs. We have identified the possible final cause of the disease, i.e. The structural alteration of a protein we all have in the brain for memory. It’s called synuclein and it can mutate: it alters the structure, accumulating and suffocating dopaminergic neurons (those that “suffer” in Parkinson’s disease, ed), giving rise to the disease. Why change is not yet understood, but to find it Alpha-synuclein (other than usual) Indicates whether someone will get sick We already know how to detect it, for example in saliva.

Meanwhile, trials are underway on what we might call a “vaccine” for Parkinson’s disease. A monoclonal antibody directed against this mutant protein, similar to what was created for the Corona virus. This may be the best treatment, and with the pandemic-driven acceleration in pharmaceutical production, it could come within a year.

drug news

Is there news about drugs? Deficiency of the neurotransmitter dopamine is the cause of the disease
Produced by neurons in certain areas of the brain. It has been finely tuned Rescue treatments by injection, sublingual or nasal spray For patients who suddenly freeze due to the so-called freezing, but The reference drug remains levodopa
From a substitute for dopamine created in the laboratory. The first time the patient takes it he is fine, so much so that we are talking about a “therapeutic honeymoon”.

After a few years the effect wears off. Twenty years ago, we had an unfounded fear that it would damage neurons and it was believed that Dyskinesia, strange involuntary movements which appear at a certain point above all else on the tongue, mouth, and face were the result of this. Today we know that levodopa is non-neurotoxic Its use early and in appropriate doses does not aggravate the course of the disease.

Levodopa and its effects

Does the duration of the effect of levodopa depend on the dose in which it is used? To delay the use of levodopa, even drugs that depress dopamine-producing nerve cells, dopamine agonists, have been created to the last drop. Gianni Pezzolithe former director of the Parkinson’s Center for the Institutes of Perfection in Milan, who was one of the first in the field to verify the incorrectness of false biases on levodopa by going to Treating patients in sub-Saharan Africa who have long disappeared in the West -. There was no levodopa, but there were so-called de novo or nevus patients with many years of illness and never cured from opening our eyes. We understood that here we are trying to delay the use of levodopa because we have been giving too much, while proper doses are the best medicine.

We also made mistakes with dopamine agonists Professor Berardelli adds. If suspended suddenly, it causes uncontrollable impulses, turning patients into innocent players Or in chain shoppers from compulsive shopping for an irrepressible drive to seek psychological compensation from excessive dopamine. Winning gambling or filling up the tanks increases dopamine and thus Parkinson’s found a way to quench the dopamine thirst we gave him.

May 4, 2022 (change 4 May 2022 | 21:24)

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