Shakes your head a sign of Parkinson's

Parkinson's disease - when movements change

The illness

In the brain, the nerve cells communicate with each other with the help of certain messenger substances. The messenger substance Dopamine helps, for example, that the nerve cells coordinate the movements of the muscles with one another. In Parkinson's disease, the brain cells that make dopamine gradually die. Without dopamine, the nerve cells can no longer properly "coordinate" the movement sequences. That makes the movement of the muscles more and more difficult.

Why the nerve cells die is so far unclear in three quarters of the sick. The experts then speak of one idiopathic Parkinson's syndrome. This is what this information is about.

Signs and complaints

It is characteristic that those affected move increasingly slowly. They find it difficult to start a movement. Muscle movements also become smaller: Sick people often walk with triple steps, their arms swing less and they write increasingly smaller. Your face becomes more expressionless, you swallow less often, and your voice becomes quieter. At the onset of the disease, only one side of the body is usually affected.

Other important abnormalities are excessively tense muscles and muscle tremors at rest. The following signs may also appear:

  • Sensory disturbances such as pain, lack of sense of smell, tingling, numbness

  • Changes in body functions such as blood pressure, temperature, bladder and bowel function, impaired sexual functions

  • Sleep disorders and mental illnesses such as depression

  • Forgetfulness, gaps in memory and falling attention

The disease proceeds very differently. Usually the symptoms increase slowly over the years.

Investigations

If you are suspected of having Parkinson's disease, you should consult a specialist who is familiar with it. Describe your complaints in detail. It is helpful to take someone with you who can also describe the changes.

The doctor will check your reflexes and other nerve functions. In this way it can be determined whether it is Parkinson's disease or whether there are other reasons for your symptoms. To rule this out, computed tomography (CT) or magnetic resonance imaging (MRI) of the head should also be performed.

Treatments

Parkinson's disease is progressing steadily. It is not curable. However, there are several ways to alleviate the discomfort.

Physiotherapy should be offered to you right from the start. It improves mobility, gait security and maintains muscle strength.

Medicines can make up for the lack of dopamine. They have different effects and can also be used together. They help well against movement disorders. However, they do not prevent the nerve cells from dying further.

After several years, the drugs no longer work as well. Then they should be readjusted. This means, for example, increasing the dose or combining drugs with one another. This can also increase the risk of side effects. Known include low blood pressure, dizziness, nausea, diarrhea and drowsiness. In the long term, excessive, uncontrolled movements can occur. It is possible that the drugs increase sexual desire. Gambling or shopping addiction and compulsive acts are also possible when taking certain drugs. Therefore, discuss with your treatment team whether more drugs bring you more advantages than disadvantages.

If medication does not work well enough, surgery on the brain may be an option. The technical term for this is Deep brain stimulation. It can reduce discomfort, but it involves more risks.

Occupational therapy helps that you can take care of yourself in everyday life for as long as possible and should be offered to you. If you have speech disorders, your doctor should offer you speech therapy. This improves volume and intelligibility. Difficulty swallowing should also be treated with speech therapy.

What you can do yourself

  • Specialists recommend regular check-ups. This allows you to check the course and adjust the treatment if necessary.

  • The drugs do not work the same for everyone. Be prepared for the fact that it may take some time before your treatment is properly set.

  • The effect of the medication can change over the course of the day. Therefore, half an hour before and an hour and a half after eating, you should not take any means with the active ingredient L-Dopa.

  • Physiotherapy can maintain your mobility and independence in everyday life. Try to use this treatment option at any point in your illness.

  • You can take part in a patient training course.

  • You can get help with personal or professional difficulties as well as with legal questions from social services, advice centers or self-help organizations.

  • You can receive psychotherapeutic support for mental health problems.

  • You are allowed to drive Group 1 vehicles such as cars and motorcycles if your fitness to drive has been checked. You are not allowed to drive group 2 vehicles (trucks, buses, taxis).

  • It can be helpful to exchange ideas with other people affected, for example in self-help groups.

  • At first, the disease hardly affects you. Over time, you will need more support. You may find it helpful if you think about how you would like to be looked after at an early stage. Discuss this with your relatives and ask your treatment team about the options.
November 2016, published by the German Medical Association and the National Association of Statutory Health Insurance Physicians