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Dealing with Parkinson's?

3 signs that the disease is progressing - and what to do with them

A senior neurologist explains what the signs are that Parkinson's disease is advanced and how accurate diagnosis and appropriate treatment enable quality of life and function alongside the disease

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• Parkinson's

Dr. Saar Anis, in collaboration with the Parkinson's Israel Association

Wednesday, October 20, 2021, 16:38

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C. has been treated at my clinic for several years with a diagnosis of Parkinson's disease. She is still working, as a manager in a large company, suffering from tremors at rest in her right hand, stiffness and slowness, which gradually spread over about 10 years also to the left side. In the last year she has started to suffer from falls. She notes increasing difficulty in managing the company, which manifests itself in ADHD and short-term memory. The time of taking the pills for the disease is getting shorter and now she needs 5 doses a day (every 3.5-4 hours). In addition, side effects of involuntary movements developed for several hours during the day.

Does C meet the criteria for advanced Parkinson's disease? How can one decide where the thin line crossing that defines the contestant as an "advanced patient" passes?

The answer to that is complex. Due to international disagreement among movement disorders experts in the definition of advanced Parkinson's disease, and due to a lack of a biological marker such as a blood test or imaging test that "marks" the transition to the advanced stage, a limited number of experts from around the world were convened to define advanced disease. . At the end of the process, it was defined that a person with advanced disease is defined according to the following criteria: (It is not necessary to meet all of these criteria in determining advanced disease).

1. Motor volatility during the day (frequent switching between states of on = positive effect of the pill on the symptoms, and off = when there is no or no effect of the pill on the symptoms), involuntary movements (dyskinesia) interfere over one hour a day, over two hours Of Off symptoms during the day and at least 5 servings of budopa-based drugs (which turn the brain into dopamine - a neurotransmitter associated with movement) per day.

2. Non-motor symptoms, such as mild cognitive decline, hallucinations.

3. Functional disorder, which includes recurrent falls and difficulties in daily functioning.

There are 3 approved treatments in the health basket for the treatment of advanced disease.

By a woman (Photo: ShutterStock)

Diagnosis of an advanced stage disease is crucial, due to the options open to patients at these stages, and the need for intervention as early as possible to prevent further secondary complications and improve quality of life.

What are the treatment options available to people with advanced disease?

First, one should strive for the improvement of drug treatment, including combining several drugs, dividing the doses into an increasing number of times a day and increasing the dose of each dose. Second, there are 3 approved treatments in the health basket for the treatment of advanced disease:

1. Surgery to implant electrodes for brain stimulation to the areas of movement control in the brain (called deep brain stimulation DBS - deep brain stimulation). The surgical procedure is performed in an increasing number of centers in the country. After the surgical procedure, the patient arrives at a dedicated institute for the treatment of Parkinson's and undergoes a process of calibrating the electrodes, until he reaches optimal therapeutic efficiency. In the future, it will be monitored regularly over the years and it will be possible to make changes depending on the progress of the disease and the side effects.

Administration of levodopa in gel form by means of an external pump directly to the intestine (through a dedicated tube inserted through the skin and across the stomach). This way, replaces the need for pills, helps in excellent absorption of the drug, and in combination with regular infusion produces blood dopamine levels in the brain that are stable throughout the day and thus significantly improves the side effects of treatment and also the effectiveness of treatment in achieving better quality of life and function.

3. A subcutaneous pump, which continuously infuses apomorphine (a molecule that binds to a dopamine receptor in the brain and activates it), thus helping to improve the symptoms of advanced disease, in parallel with the continuation of drug treatment with pills.

All treatments are effective and safe and have extensive experience. The decision on the appropriate treatment is individual and is made by a joint decision of the patient and the attending physician. We recently learned about the case of MK Miki Eitan, who, thanks to DBS-type surgery, has significantly improved his life, even after reaching the advanced Parkinson's stage. Hence the advanced treatments give hope for continued good quality of life among those dealing with the disease.

Beyond the advanced treatments, there is a high importance in diagnosing an advanced patient to provide the necessary support, for example from the immediate family, and the envelope that can be provided from external sources such as the community, the HMO (providing medical services, complementary, rehabilitative, etc.), social services, Parkinson's Israel and more.

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