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.

*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.

Nowadays, Parkinson’s disease is an illness that many people face with. The diagnosis of Parkinson depends upon the presence of one or more of the four common motor symptoms of disease, which are: resting tremor, rigidity, bradykinesia, postural instability.

In adding, there are other secondary and nonmotor symptoms that affect a lot of people and are increasingly recognized by doctors as essential to treating Parkinson’s.



Each person that suffers from Parkinson’s will feel the symptoms differently. For many of the people that suffer from Parskinson’s have problem with tremor while others have problems with the balance. For example, for some people the disease advance very fast while for others not.

Here are some Parskinson’s disease symptoms:

Primary Motor symptoms:

-Resting tremor- about 70 percent of people who suffer from Parkinson’s disease experience a slight tremor in the early phase of the disease. Some people feel this tremor on hands or foot, on one side of the body or less commonly in the jaw or face. The Parkinson’s tremor usually appear when a person’s muscles are relaxed, that’s the reason why it’s called “resting tremor”. This means that the affected body part shake when it’s not doing effort.

-Bradykinesia (Slow Movement)- this phenomenon appears when a person have trouble with the movement. In addition to slow movements a person that suffer from Bradykinesia will probably have incomplete movement. People that have this disease should walk with sort, shuffling steps.

-Rigidity- this disease cause inflexibility in the muscles. Muscles normally stretch while you are move, and then relax while they are at rest. In rigidity, the muscle tone of an affected limb is constantly inflexible and does not relax, sometimes resulting in a decreased range of motion.

- Postural Instability (Impaired Balance and Coordination)- People that suffer from Parkinson’s experience instability when standing impaired coordination and balance. These symptoms combined with other symptoms such as Bradykinesia amplify the chance of falling. You can’t do abrupt movements or making turn if you suffer from this illness.

I have read here the secondary motor symptoms. Here are a list with the Parkinson’s Disease symptoms, but not all the people that have this disease will experience one of the below.

- Dystonia

- Fatigue

- Impaired gross motor coordination

- Akathisia

- Loss of facial expression
- Difficulty swallowing and many more. You can read all of these symptoms on this website and you can also read a lot more of this disease.

Here are the nonmotor symptoms:

- pain

- sleep disturbances

- constipation

- fear or anxiety

- memory difficult and slowed thinking<

- fatigue and aching

I have read here that nowadays there is no cure for Parkinson’s disease. There are a lot of medications provide dramatic relief from the symptoms.

All in all, if you feel on of the Parkinson’s disease symptoms go and see a doctor and ask him to give you some advices and medications to make you feel better.

Recurrence of Parkinson's disease symptoms is a reduction in medication effect. As this phenomenon (called "wearing-off") is becoming more obvious, it is increasingly difficult to determine the period in which the patient responds to treatment with levodopa (active period) and the period when treatment is inadequate (passive range).

The symptoms usual decrease medication effect (the phenomenon of "wearing off") are motor (tremors, muscles are stiff, movements are slow and painful, slow and inaccurate) and non-motor (anxiety, depression, slowness in thinking or memory problems , tingling, anxiety, fatigue, sweating, excessive salivation, constipation, body temperature variations).

Recognition of symptoms associated with the phenomenon of "wearing off" is important because when therapy should be modified to better control the disease. Obtaining durable responses without fluctuations of concentration of levodopa is possible only through the combination of other drugs that reduce the metabolism of levodopa, and optimizing the therapeutic effect.

A new treatment for Parkinson's disease symptoms
With few time ago, the company Novartis announced that a new product in the form of tablets is available in the market and offset by 100% for patients with Parkinson's disease. That's a very good news and I'd like to continue my article relating you some interesting things about this new treatment. The triple combination reduces symptoms and improves the ability of patients with Parkinson's disease to perform daily activities.

"Triple Combination" ensure the patient actively extend the range in which Parkinson's symptoms are well controlled and daily activities can be carried out effectively ended, and the easiest and most convenient method of administration. Novartis is actively involved in educating patients and their family and launched an extensive information campaign that includes brochures and a website to inform patients.
*How to live with Parkinson's disease. Maintaining a positive attitude and daily routine is essential for long-term control of disease.



The lifestyle of the Parkinson's patient should include:
-a balanced diet based on vegetables, fruits and protein foods (milk, cereals);
-consumption of enough water and avoiding alcohol and caffeinated drinks;
multivitamin and mineral intake;
-exercise program - sedentary worse overall health. Movement joints and maintains flexibility in postural tone, tones muscles, improves blood circulation and reduce stress;
-outdoor activities (walking, gardening);
-the more ways of entertainment that make the patient happy.
A good mental state is essential for successful treatment.



It is important that patients accept their illness and limitations do not be discouraged, to accept the help of those close to him when he needs to continue to do what he likes, do not quit when depression overwhelms him when routine tasks become difficult, to not get isolated, still have social life. With treatment, optimism and support of those close to him, the patient can enjoy a relatively normal life for many years.

In the early phase of disease, symptoms occur only on one half of the body and then extending the other half. Among, the typical Parkinson's disease symptoms include:

-Tremor of hands, arms, legs, chin and face, the trembling occurs when the affected limb is at rest, may affect one or more states and is less visible during sleep and exercise;

-Muscle-stiffness and micro-graphic (handwriting is small and cramped, illegible);

-Slowness and difficulty moving - also called akinezie bradkinezie or, as the disease progresses, muscle coordination is becoming more difficult;

-Postural instability - disorders of balance and coordination because it alters or disappear reflexes that adjust the position of various segments of the body to balance, these disorders occur usually in advanced stages of disease and are extremely dangerous, making it necessary to support and moving patients using crutches or support staff.

There are, however, and Parkinson's disease symptoms not related to movement:

-Sleep disturbances (insomnia or excessive daytime sleepiness);

-Depression - due to chemical changes occurring in the brain;

-Difficulty speaking: reducing the volume of voice, difficulty in articulating words, hoarseness, variations of tone - events caused by small muscle rigidity, and impaired movement control disappearance breath control;

-Sensation of "lump in the throat" and difficulty swallowing;

-Blocking engine - difficulty in initiating and executing simple movements such as stepping over the threshold, in which case it will move gently or it will show foot barrier with a flashlight or a laser device;
-Bent position, with head bent and shoulders down. Several of these symptoms are relieved by medication.


Treatment

Because the symptoms of Parkinson's disease is due to a deficiency of dopamine in the brain, most drugs were called "dopaminergic" and are produced to replace the dopamine deficiency, copy or "mimic" the action, or to stop metabolism.

From all the possible treatment  schemes for this disease, there is an essential component of levodopa (L-dopa), which, after reaching the brain, is converted into dopamine. In the body, levodopa is metabolized by enzymes, a process that reduce the amount of drug that reaches where necessary, namely the brain. Therefore, an inhibition of these enzymes and thus inhibits the metabolism of levodopa is available to a greater extent in the brain, improving symptom control default.


Long term treatment

Levodopa treatment is very effective, especially if it’s given in the first stage of disease. Initially, symptoms are constant and sustained control throughout the day. After several years, fluctuations occur on some patients whose own medication controls symptoms - usually are motor fluctuations, but also involuntary grimacing, abnormal movements similar to those of dance (dyskinesia) or sustained involuntary muscle contractions that abnormal position or positions cause various body parts (dystonia).  In addition, disease symptoms reappear or worsen considerably before the time fixed for taking a new dose of medication.

Parkinson's disease is a common neurological disorder, which is estimated to affect over four million people worldwide. Despite all the scientific and medical efforts that were made, it is not yet found a cure to heal patients that suffer of Parkinson's disease symptoms, but the new regimens significantly improve their life’s quality. Contrary to widespread opinions, Parkinson's disease symptoms affect not just the elderly. Although the average age at which diagnosis is 60 years, one of 20 people begin to have Parkinson symptoms even before reaching the age of 40 years. Patients diagnosed at young ages, between 21 and 40 years, suffer from so-called early-onset Parkinson's disease.

-Causes:

Parkinson's disease is caused by destruction or degeneration of neurons that produce dopamine, neurotransmitter substance, responsible for the body's ability to control normal movements. The main area affected is located deep in the brain substance, is called "substantia nigra” (black substance).

-Symptoms Parkinson disease:
Symptoms appear when dopamine levels in the brain decreases by about 20% from normal values. Not all patients have the same symptoms at the same stage of disease. The disease manifests itself very differently from one individual to another; sometimes pass many years to observe a significant limitation of daily activities.

Symptoms become increasingly evident as the disease evolves. An early sign that may indicate (without binding) Parkinson's disease is the invisible hand’s tremor- an inner tremor, without any visible manifestation. Many patients suffering from Parkinson's disease feel well for years until symptoms become bothersome. Parkinson syndrome, the most common being extra pyramidal syndrome, it’s the result of basal ganglia’s damage. In few words, Parkinson's consists of a progressive degeneration of neurons in the brain region that controls muscle movement. Therefore, there are also other several possible causes of Parkinson syndrome which is manifested by symptoms consisting in tremor, rigidity, impaired postural reflexes, the mimic, voice, etc.

Parkinson's disease it’s defined by physical posture "stuck". Patient goes in small steps, like running after his own center of gravity that he do not reach ever. Also, there is impaired natural automatism - no balancing arms in walking, lack of normal leg extension in sudden rocking chair that was placed, with the lack of lift eyebrows with the eyelids to look up. Also, it’s manifested the delayed onset, slow and incomplete reactions mimic, facial posture petrified, passive motility disorders (extra pyramidal contractile), autonomic disturbances (hot flushes, hyper salivation, sweating), speech disturbances (speech is slow, monotonous, with a tendency fighting to silence), psychiatric disorders (depression, anxiety, etc.).

Finally, another sign is essential tremor, consisting of rhythmic oscillations, regular, hands, head, legs, occurring at rest (static) or to attempt to maintain a job, but disappeared during active voluntary movements in sleep.

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


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 symptoms in the early evolution of the disease and is started as soon as symptoms affecting daily activity and the ability of the sick person to work. For example, a right-handed person that tremor can be installed on the left side not to feel embarrassed by the appearance of this symptom and can not feel the need of treatment until symptoms are worse. A person who can not fulfill his assignments because symptoms will want to start treatment much faster than a person who does not work or is not affected in the daily activity of any of the symptoms.

Symptoms of the Parkinson disease usually occur on people aged between 50 and 60 years.Parkinson's disease is one of the most common neurological disorders, affecting approximately 1% of people aged over 60 years.

The disease occurs 1.5 times more often in men than in women. The disease occurs because during time, there appears a lost of dopamine neurons located in the black substance in the brain (nigrostriat) and appear Lewy bodies (protein aggregates that occur inside nerve cells).

It seems to become a clinical case lost over 80% of dopamine neurons. Lewy bodies in this black substance are characteristic of the disease, but their presence is not path gnomic and may occur as in other neurological disorders. The disease occurs because the brain responsible for movement control does not work properly with loss of neurons. As the neurons in this area are getting deteriorate and finally die, the producing of an essential neurotransmitters, dopamine, it is also reduced.

The effect of diminishing dopamine doses is the impaired motility. The patient has trouble to maintain posture, balance, does not have adequate control of movement. Although it is known that the illness involving loss of dopamine neurons and consequently decrease the concentration of dopamine (a neurotransmitter) in the brain, experts still have much to clarify regarding the exact cause of developing the disease. There are theories that say that are involved and some exogenous toxins and genetic mutations in the development of Parkinson's disease. There is currently no curative treatment of Parkinson's disease, but many drugs are available which can relieve Parkinson's disease symptoms and improve the patient's general condition.

The goal of treatment is just that - to allow control of symptoms and increase patient quality of life in general as much as possible. Drugs currently used to allow control of symptoms for a period of 5-6 years. After this period, disease progression can not be controllable by the treatment and many patients develop significant motor problems, which come to interfere with the ability to achieve even the personal care.

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, the disease getting stocked and on the other side.
Drugs can control symptoms to some extent, but along with the disease, they become increasingly ineffective. Parkinson disease can cause lots of complications as it evolves.

Parkinson's disease is the fourth most common degenerative neurological disease of the elderly. It affects about 1% of the population ³ 65 years and 0.4% of the population> 40 years. The average age of onset is about 57 years. It may begin in childhood or adolescence (juvenile Parkinsonism).

In Parkinson's disease signs and symptoms, you find a depopulation of the pigmented neurons of the balck substance, locus ceruleus and other brainstem dopaminergic cells, the cause is unknown. The loss of neurons in the black substance that project to the caudate nucleus and putamen results in a depletion of the neurotransmitter dopamine in these areas. The disease usually begins after age 40, increasing in population groups older.


The secondary parkinsonism is the result of impairment or interference with the action of dopamine in the basal ganglia due to idiopathic degenerative diseases, drugs, exogenous toxins. The most common cause of parkinsonism is represented by the recruitment of anti-psychotic or reserpine, which cause parkinsonism by blocking dopamine receptors. The concomitant administration of an anticholinergic drug (eg. benzatropina at a dose of 0.2 to 2 mg po tid) or amantadine (100 mg bid) may improve the condition.


Less frequently, the cause is represented by carbon monoxide poisoning or manganese from hydrocephalus by structural lesions (tumors, stroke of the midbrain or basal ganglia) from subdural hematoma, degenerative diseases, such as the nigrostriatal degeneration and olivopontocerebellare or multisystem atrophy.


Parkinson’s disease signs and symptoms


In 50-80% of patients, the disease starts in an insidious manner with a hand tremor at rest, at 4-8 Hz (movement of the packer of pills). This tremor is maximal at rest, during movement decreases and disappears with sleep also increases with the emotions and fatigue. Are generally most affected hands, arms and legs.


May also be interested in the jaw, tongue, forehead and eyelids, while the voice is not involved, many patients have only stiffness, tremor is absent. Rigidity is evolutionary and slow movements (bradykinesia), decreased (hypokinesia) and are difficult to initiate (akinesia).


The patient begins to walk with difficulty, moving first with small and hesitant steps, arms bent, and not given swaying and torso slightly bent forward, the steps may suddenly become faster and the patient suddenly begins to run to avoid fall forward (feast).


The hypokinesia and decreased muscle control in distal hesitate micrograph and a growing difficulty in daily activities. Dementia may occur in approximately 50% of patients and depression is common.


On examination, the passive motion of the limbs showed a resistance level, with a lead pipe rigidity, especially at the elbow and wrist. The tremor was superimposed on a field defined phenomenon of gear. An examination of the sensitivity is usually normal. One can see signs of dysfunction of the autonomic nervous system (e.g. seborrhea, constipation, urinary retention and orthostatic hypotension). Muscle strength is usually preserved, although it may have decreased the ability to perform rapid movements. Reflexes are normal but hard to highlight the presence of rigidity or tremor.