Apomorphine is a dopamine agonist used to treat occasional episodes of immobility associated with symptoms of Parkinson's disease. This is the first drug that can be injected when the muscles become rigid and stiff and that person can no longer pick up a seat or not and can perform daily activities. Apomorphine treatment given at need may make possible the reduction of dopamine agonist’s doses. This leads to lower adverse effects such as involuntary movements and seizures. There may be some cases where treatment is going for the steady dose of levodopa and dopamine agonists and some doses of apomorphine, when needed, rather than undergo a treatment where the oral drug doses are adjusted according to the emergencies occurred.

Apomorphine must be administered with anti-emetic drugs to prevent nausea and vomiting appearance. Recent studies show that treatment with high doses of antioxidant coenzyme Q10 may slow progression of Parkinson's disease, but should be taken in the early stages of disease. Further studies are needed to determine how safe is the treatment and its effectiveness.

Ongoing treatment may be a number of drugs used to treat Parkinson's disease in its various stages.
*Generally, the initial treatment of Parkinson's disease begins with:
-Dopamine agonists (bromocriptine, pergolide, pramipexole, ropinirole);
-Levodopa and carbidopa;
-Peripheral inhibitor of catechol-0-methyltransferase (COMT) inhibitors, entacapone, tolcapone;
-Anticholinergic agents (benztropina, trihexifenidil)
-Selegiline - inhibitor of monoamine oxidase type B;
-Amantadine.



*Note!
All drugs used to treat Parkinson's can have unpleasant side effects. Medical treatment is ideal to control symptoms and side effects are well tolerated by patients. Doctors generally will try one drug at a time and will recommend a low dose to minimize adverse effects.
It is good to know that:
- Levodopa and other medicines may be more effective if taken before meals;
- Sudden stopping medication can worsen symptoms and can be dangerous.
A number of complications can occur after a long treatment for Parkinson's disease, which may include:
- Unexpected changes in patient response to medication;
- Twitching or convulsions.



Problems can occur as a result of the disease itself, such as:
- Unable to move
- Decreased muscle tone.
Changing the dosage or using a different combination of drugs can be helpful in such situations. Necessary medicines treating this disorder are prescribed by the practitioner and the patient must be well informed about how they have to take them. It is very important to strictly observe the patient for a doctor's recommendations as a result of better therapy.

*Surgery
Surgery may be considered when medication can no longer control symptoms of Parkinson's disease or when side effects are quite severe and affect daily activities of the patient.

*Deep brain electric stimulation is a new treatment in Parkinson's therapy. This therapy uses electrical impulses to stimulate a certain area of the brain. Electrical impulses generated by a series of electrodes placed through brain surgery. This technique can be used in combination with drug therapy with levodopa or other drugs, when it no longer controls the symptoms in an appropriate manner. This surgical technique is about to become the preferred surgical therapy, especially in cases that are in an advanced stage of disease. It doesn’t destroy the nerve substance in the brain and has much lower risks than older methods, most destructive, such as palidotomia and talamotomia.

Neuro-transplant is an experimental process that is under study for Parkinson's therapy. Implant consists of cells that produce dopamine in the brain. These cells may originate from a fetal brain, although the use of fetal tissue is controversial. In the future, neuro-transplants may include transplanting nerves from healthy areas in the affected areas or use genetically modified cells. The neuro-transplant was made to a small number of people and can be done in just a few medical centers in the world. Information about the effectiveness of this method is limited and until now, there is a real option for the vast majority of people.
*Surgical options
- Electro deep brain;
- Paliotomia (is rare);
- Talamotomia (is rare);
- Nerve cell transplantation (experimental phase).



1. Deep brain electro stimulation
Deep brain electric stimulation doesn’t cure Parkinson's disease nor eliminates the need for medication. Deep electro thalamus stimulation is made to treat the tremor given by the disease. Procedures that stimulate the subthalamic nucleus and globus pallidus controls a wide range of Parkinson disease symptoms besides tremor and are used more often than stimulation of the thalamus.
2. Palidotomia and talamotomia
Some neurosurgeons can do surgery, but none of them is not usually done.
3. Neuro-transplant
This procedure is still experimental and has not been carried out only on few people. Its effects are visible after several months or more until now, has not documented any benefit of these interventions.
Persons who wish to consider surgery in the treatment of Parkinson's disease must turn to the best neurosurgeon available. You can receive information about this disease from a number of organizations that support people affected by Parkinson's disease.



Note!
Surgery becomes an option for those affected by Parkinson's disease when the disease is advanced and medication cannot control the disease in an appropriate manner. In the case of a disease that can evolve, of some symptoms that are getting worse, some people may have a series of events that cannot be controlled. However, when a person has a severe tremor on one side, we must take into account deep brain electro stimulation because it has better results than medication. Those with advanced Parkinson's disease or who have other illnesses (such as heart disease or lung cancer or kidney disease) are not in one of the best candidates for surgery. Also, surgery is not an option for those with dementia or psychiatric problems.

Surgery is not a solution for those with Parkinson's disease. Usually, after that, the medication is still necessary, but surgery may reduce the number and doses of drugs necessary to control symptoms. All this leads to reducing adverse effects caused by drugs and also to collect and control the Parkinson disease symptoms.

*Issues that may be helpful in outpatient treatment of a patient with Parkinson disease symptoms are:
- Modification of certain activities and rearranging the house so that daily activities to be as much simplified and reposition furniture to be made so that the patient always something there to support the move;
- To follow a healthy diet, which includes fruits, vegetables, grains, vegetables, fish, poultry, lean meat, low dairy;
- Exercise and physiotherapy, which are very effective in all phases of the disease;
- Tremor appeared to handle and it can be good for reducing weight in making a trembling hand;
- To work with a speech therapist for speech improvement;
- Reduction in terms of eating problems and excessive salivation by changing the foods they eat and how;
- Face the engine freeze, through various methods such as walking to a target on the floor;
- To cope with sexual dysfunction. Talk to your doctor about this problem. This may suggest some changes in therapy such as drugs or exercise change.

*Drug therapy for patients who suffer manifest Parkinson disease symptoms:

Drug treatment is usually in the treatment of Parkinson's disease. The aim of medication is to compensate for the lack neurotransmitter - dopamine, which causes symptoms of the disease. Treatment is started, usually when symptoms lead to handicap person. Treatment may vary depending on symptoms, patient age, and depending on its response to drugs. Medicines can relieve symptoms, but a number of adverse effects. It takes time for the doctor to establish an effective combination of drugs, which take effect on each person. Today, levodopa is considered the most effective in controlling symptoms of Parkinson's disease for many years was the preferred drug for the treatment of newly diagnosed Parkinson persons. However, due to its use for a long time and higher doses appeared a number of motor complications, which were difficult to treat.



Therefore, some doctors prefer to use dopamine agonists, newer devices (such as pramipexole and ropinirole), especially in the early stages of disease. Using these drugs in early stages of disease leading to delay the introduction of levodopa treatment and thus delay the occurrence of motor complications. But use of these drugs may lead to motor complications.



The question regarding these two drugs, levodopa or dopamine agonists is beneficial in early stages of disease, is not fully clarified. Levodopa controls symptoms better than dopamine agonists. However, considering the studies, doctors concern regarding long-term effects of levodopa administration in the early stages and in high doses, has led them to recommend the initial treatment with dopamine agonists, especially those under 60 years. As the disease progresses, your doctor may prescribe concomitant levodopa and dopamine agonists.

*Parkinson's disease stages signs symptoms and treatment:

A person in an advanced stage of disease is limited in terms of freedom of movement and conducting daily activities. Symptoms of Parkinson's disease may change from day to day and adverse effects of drugs used in the treatment may limit its effectiveness. Your doctor will need to alter treatment based on changes that occur in disease symptoms. A speech therapist may recommend speech and breathing exercises that can help patients who have monotonous speech, imprecise, whispered, specify those affected by Parkinson's, especially in the final stages.

There must be a modification in terms of nutrition, about what and how they eat. For example, they can eat standing up and eating little, and food has to be as easy to chew as possible. However the patient may exempt any food problems. Keeping your chin high, swallowing often and avoiding sweets may be reduced salivation. Muscular blocking can be solved by making deliberate movements. Moving to a fixed point on earth, making a first step in long march style can help overcome episodes of muscle stiffness.



*Treatment for symptoms of Parkinson's disease if the condition gets worse:

As the disease progresses, symptoms become increasingly annoying. Most patients develop a tremor from easy to moderate. Movements are slow and limited due to muscle stiffness and slowing or loss of automatic reflexes (bradykinesia).

Treatment at this stage is weighed according to the severity of symptoms and adverse effects of drugs. The symptoms will change as the disease  passes through various developmental stages. The doctor will monitor the evolution of individual patient treatment and will change depending on the appearance of new symptoms. Levodopa is the most popular drug used to treat Parkinson's disease. Still, it may have some adverse effects at high doses or after a long treatment. Your doctor may prescribe dopamine agonists, pramipexole or ropinirole such as to prepare the start of levodopa treatment. Recent studies have shown that these drugs can delay the occurrence of adverse effects of levodopa. Also, the doctor may prescribe dopamine agonists with levodopa in the same time.



*Outpatient treatment:
Everyday life of a patient with Parkinson. Initially, the disease doesn’t affects a person's life too greatly, but with the passage of time it becomes increasingly annoying. Home treatment helps those affected to adapt and as the disease progresses, to remain independent as long as possible. Its quality of life depends largely on the continuation of service, maintaining a close contact with family and maintaining independence. Using a cane or a walker may be useful as the disease progresses.

*Treatment overview for symptoms  Parkinson disease

At first, patients with Parkinson's disease may not need treatment if symptoms are mild. Prescribing doctor may postpone treatment until the time symptoms are distressing and interfere with daily activities. Additional treatment methods such as exercise, physiotherapy and occupational therapy can help in all stages of Parkinson's disease, especially in maintaining the tone, mobility and independence. If medication is needed, there are several options. Although levodopa is still considered the best medicine for Parkinson's, its side effects (which include involuntary movements and other motor complications) may cause problems in the late stages of disease. Recent studies suggest that initial treatment with dopamine agonists pramipexole and ropinirole such as the need may delay starting treatment with levodopa and may thus delay the occurrence of side effects of it. Other nondopaminergice drugs that can be used in the early evolution of the disease are amantadine, mono-amine oxidize inhibitors (such as selegin) and anticholinergics (such as trihexifenidil).

The doctor together with the entire team that oversees the patient suffering from Parkinson's can advise you on this in terms of emotional support and medical education specific to the disease. They are important at all stages of disease evolution. There is no treatment to stop the destruction of nerve cells that causes the disease. However, some medications can improve symptoms. Surgery may be also useful in treating the symptoms, but for a small number of people. Treatment is different for each person and may change as the disease evolves. Age, occupation, family and living conditions may influence decisions on starting treatment, its type and when to change medications. If health status changes and treatment should be adjusted to achieve a balance between quality of life, side effects of disease and treatment cost.



*Ongoing treatment for symptoms Parkinson disease

There are a number of measures to be taken by the person affected by Parkinson's at home to make it easier to cope with symptoms. Patient should be advised to use their energy for activities strictly necessary and to design the house so that it is very easy to move any things you need to be at hand. All this will help you be an independent. Regular exercise, a balanced diet is important in the treatment. Exercise can help maintain tone, coordination and strength, but also in maintaining weight and reducing the potential for constipation. In terms of people with Parkinson's diet is very important that they ask all the information on physician diet because protein intake may interfere with drug absorption and can change their effectiveness.



It is advisable for the patients to keep a health status as best as possible. A balanced diet, rest, and emotional support from family may be helpful. Recognizing and treating depression is an important part of therapy at home. Depression is common in people with Parkinson's and may appear before the disease is diagnosed.

In this article, I'd like to devolve a subject about symptoms of Parkinson's disease, but also I'd like to convince anyone about the importance of a specialized consult. More over, I'd like to convince you about the importance of a prompt consult when you see or you feel some strange changes in your body which you consider as being symptoms of Parkinson's disease.

*Professional health consult:
It is best to consult your family doctor when symptoms of Parkinson's disease appear. No need for emergency treatment when tremor lasts longer. However, it should be discussed with your doctor about the appearance of the tremor at the next consultation. If the tremor affects the daily activities of a person or if other symptoms occur, you must go to the doctor soon.



A person who was diagnosed with Parkinson's disease should consult a doctor immediately if:
- There are noticeable changes in symptoms such as severe episodes of rigidity - the sudden loss of mobility - that can affect walking;
- Symptoms are not relieved by medication;
- Other complications arise;
- Is depression.
People suffering from Parkinson's should go to your doctor regularly (every 3-6 months or depending on how it decides) to modify the treatment as the disease evolves.

Patient description should answer the following questions:
- Tremor occurred suddenly or gradually?
- Led to his improvement or worsening?
- As part of the body was affected?
It is advisable to call emergency services if symptoms such as sudden weakness, paralysis, loss of balance, impaired speech or vision problems. These may be signs of a heart attack. Symptoms of Parkinson's disease usually develop slowly during several months.

Medical specialists recommend

The following health professionals can diagnose and treat Parkinson's disease:
- GP;
- Doctor of internal medicine;
- Neurologist.
Other specialists that may be involved in tracking patient suffering from Parkinson's are:
- Speech doctor;
- Physiotherapist;
- Occupational therapy specialist.



*Diagnosis and investigations

1. Early diagnosis
At the moment there is no screening test for Parkinson's disease. Diagnosis of Parkinson's disease is based on medical history and a thorough neurological exam.
2. Investigations
There are no laboratory tests to diagnose Parkinson's disease. If the patient's symptoms and results of a doctor during the consultation are not entirely typical of Parkinson's disease you can do some tests to diagnose other conditions with similar symptoms. For example, blood tests can be done to see if somehow it is not a thyroid or liver disease. An MRI examination can be done to exclude a myocardial infarction or a tumor of the central nervous system.

Another imaging test called PET (positron emission tomography) can detect low levels of dopamine in the brain and can also be diagnosed as Parkinson's disease. However, this investigation is not a usual because it is very expensive and not available in many hospitals, is still in experimental phase..

*Other conditions that can cause symptoms similar to those of Parkinson's disease are:
- Essential tremor (name by which types of tremor are grouped without apparent pathological significance and especially hereditary), which has no symptoms other than tremor fine and fast. Can occur before the age of 25 years;
- Parkinson's syndrome met super nuclear progressive paralysis (a heterogeneous degenerative disorder involving damage to nerve cells in the brain, the cerebellum or basal ganglia) and multiple system atrophy (proposed term variable combination of the following disorders: dysfunction of the autonomic nervous system , extra-pyramidal signs, ataxia that occurs, especially in adulthood);

- Alzheimer's disease. Confusion and memory loss similar to those in early stages of Alzheimer's disease does not appear until late stages of Parkinson's disease;
- Central nervous system lesions;
- Various thyroid disorders;
- Liver disease;
- Central nervous system infections (ex encephalitis);
- Brain tumors;
- Myocardial infarction;
- Carbon monoxide poisoning;
- Intoxication by heavy metals (such as manganese);
- Psychiatric disorder.



Certain medications (such as antipsychotics and certain medications used to treat high blood pressure) may also give similar Parkinson disease symptoms. Other symptoms that may appear in this condition can include depression and sexual dysfunction. These issues should be discussed with your doctor.

*Risk factors
Risk factors in this disease are difficult to identify because the disease is not known. Advanced age is the only known risk factor for Parkinson's disease (not included early-onset Parkinson's disease). Most debut after 50 years, although disease can occur in people between 30 and 50 years and even, in rare cases, the youth.
A very small number of people who have been diagnosed with this disease have a close relative suffering from Parkinson's disease symptoms. It seems that a family history of Parkinson's disease significantly increases the risk of disease from a family member. With family cases early onset Parkinson's disease can be an important risk factor in illness and other family members, but it is a rare form.
Some studies have shown that prolonged exposure to certain environmental factors, such as pesticides, chemicals, using water from wells can increase the risk of disease, but until now this has not been demonstrated. There are many conditions that can develop Parkinsonism (a group of symptoms that include tremor, muscle rigidity, slower movements and balance disorders).



And evolution of the disease symptoms may vary greatly from person to person. There is no known cure for this disease. However, medicines, surgery, exercise and lifestyle changes can reduce some symptoms.
Emotional state can affect disease symptoms. Anxiety, nervous tension and sadness can the evolution of the disease and symptoms. Relaxation usually reduces symptoms. In a stressful time a person with Parkinson's disease can have a "paradoxical outburst." This has as result a time when people affected by Parkinson's symptoms and no longer can move and move normally.

This article contains some essential things you should know about the early symptoms of Alzheimer's disease, but also it contains useful piece of advice about how to treat a patient who suffer of this grave disease from the comfort of his house. In the first stage of dementia, these tips are useful and applying them, you can perfectly treat the early symptoms of Alzheimer's disease in the house of the patient if he refuse to be treated in a specialized institution:

- Tasks according to abilities. Performing certain activities may take longer than in the past but if the person is determined to make that work is indicated to continue. Some changes are recommended. For example, if the cooking becomes a problem, we recommend other activities that are achievable, that means shopping, meal planning or construction or location of the easiest recipes.
- Amendment fireplace so that it is a safe place. Ex carpets stabilization using nails, putting surfaces to prevent slipping in the bath, ensuring cooker with automatic flame extinguisher, in case no memory problems. Assessment of risk of injury if you continue cooking.
- Ensuring a healthy diet. It is important that the person with Alzheimer's diet consist of fruits, vegetables and grains. If the weight is small and doesn’t indicate its successful, growth supplements are indicated. Some people with dementia have sleep disturbances.

It is advisable to avoid sleeping during the day and make the exercise day and before bed to drink a glass of warm milk or tea without caffeine.



- Scheduling the time of day in which intellectual capacities are maximized. May be indicated to create a routine that does not vary greatly from day to day. The person may be less frustrated if the activities are made after a certain time or day program.
- Memory problems creatively. Using lists, labels and other ways that help the memory of certain things. Noting the daily activities on a timetable or an agenda and positioning it in a conspicuous.
- Before going to a place it’s indicated that the address and how to return home to be written on a note where we intend to go, even if these have been made several times in past activities. It is advisable that the exits should be made with assistance if possible.
- Preservation activity, maintaining an active life and involvement in several things slow deterioration of mental abilities.Information for people who care for patients with Alzheimer's Most patients with Alzheimer's are cared for at home by family members or friends.



Care of people with Alzheimer's disease can be an exhausting work, both physically and emotionally, but there are ways to make care easier this time. One of the keys to success is represented by caregiver education. Can be taken to maximize the patient's remaining skills to master the problems along the way and improve patient quality of life and the caregiver. Care should be noted that a person can be a positive experience for both career and patient.

*Other symptoms of Parkinson's disease

Parkinson's disease can cause a variety of other symptoms.

These may include:
- Reduced dexterity and coordination. Handwriting changes and writing are becoming less common (micro-graphic). Reduced athletic abilities and daily activities such as dressing or meal becomes more difficult;
- Muscle cramps and joint damage;
- An oily skin and the appearance or increase dandruff;
- Digestive and urinary problems. Constipation is common. Is difficult to control urination and frequent urination may occur and compelling. Drugs used to treat the disease may help or worsen symptoms;

- Problems in the control of involuntary or automatic body functions such as: increased sweating, decreased blood pressure when people stand in orthostatic position (orthostatic hypotension) and sexual dysfunction. But these symptoms can be given and the treatment used in Parkinson's disease;
- Sudden onset and brief inability to move. Often affect the person walking;
- Sleep problems can occur, mood and thinking at those affected by this disease.

Sleepiness or insomnia can occur at these patients due to anxiety, depression, or physical fatigue. People affected by the disease may not have a normal sleep since and can not easily change position in bed.



One person affected by symptoms of Parkinson's disease can easily become a person dependent on others, a person fearful, indecisive and passive. It is possible that they talk much less than before speaking, to withdraw even from family and friends and remain inactive and removed some, if not encouraged to overcome. Depression is very common at these people and can be caused both by chemical changes occurring in the brain and as a reaction upon learning the news that he suffers from a disease leading to disability. But with proper treatment, the patient's condition can be improved.

Up to one in three people suffering from Parkinson's disease may develop dementia and confusion, similar to those of Alzheimer's disease (all primary degenerative dementia, characterized by the appearance of a slowly evolving dementia), the final phase of the disease. Depression can contribute to memory loss and causing confusion.



Memory loss, hallucinations (hearing or seeing things that do not exist in reality) and imaginative dreams can sometimes be caused by drugs used to treat Parkinson's disease. There are a variety of diseases with symptoms similar to those of Parkinson's disease. Some of these may be reversible.

*Diseases with similar symptoms

Parkinson's disease can be difficult to diagnose because many diseases have symptoms that are common in Parkinson's disease (tremor, muscle rigidity, slower movements, and balance disorders).

-General

Parkinson's disease can affect a person's ability to control body movements. Certain nerve cells in the brain occur normally, a chemical called dopamine. Dopamine is a neurotransmitter or chemical mediator, through which nerve cells control body movements. In Parkinson's disease, these nerve cells that produce dopamine, are destroyed leading to low levels of it. When this happens, problems may arise in body movement.

Parkinson's disease gives a range of symptoms and complications. This article only covers the general treatment of disease rather than individual symptoms.
Treatment can control Parkinson disease symptoms in the early evolution of the disease and is started as soon as symptoms affecting daily activity and ability to work sick person. For example, a right-handed person that installs tremor on the left side may not feel embarrassed by the appearance of this symptom and cannot feel the need for treatment until symptoms are worse. A person that cannot fulfill their assignments because of the sign may want to start treatment much faster than a person who works or not or if the daily activities are not affected by of any of the symptoms.



Symptoms of the disease usually occur at people aged between 50 and 60 years. The condition develops slowly and can sometimes go unnoticed by family, friends and even the person concerned. A small number of people develop symptoms only on one side, these not progressing on the other side. Drugs can control symptoms to some extent, but along with the disease, they become increasingly ineffective. Parkinson's disease can cause a variety of complications as they evolve. The link between Parkinson's disease risk factors is still under research. These risk factors include: genetic factors, age, environmental toxins or free radicals (antioxidants). Although this research is about to reveal some answers, experts do not know for sure the cause of this disease.

-Causes

Ongoing studies are seeking to determine if there is a genetic cause of Parkinson's disease. Only a small percentage of those with Parkinson's disease have a parent, brother or sister with the disease. However, the transmission of genes (the basic unit of heredity composed of deoxyribonucleic acid) appears to be abnormal because of early-onset Parkinson's disease within families where the disease is found at much younger ages.Low levels of dopamine (mediators) involved in movement control give the symptoms of this disease. The lack of this neurotransmitter occurs when nerve cells in a certain part of the brain (black substance), which produce dopamine deteriorate or are destroyed. The exact cause of the damage to nerve cells is unknown.



-Parkinson disease symptoms

The type and severity of symptoms varies from one patient to another and according to disease stage. Symptoms that may occur in a patient in the early stages may not develop until in late stages of the disease to other patients or may not appear at all.