Neurology

Sinusitis

What is Sinusitis?

Sinusitis, commonly referred to as a sinus infection, occur as a result of the growth of a pathogenic micro-organism, be it virus, bacteria or fungus,  within the sinuses. This will result in the blockage of the sinus ostium. When the blockage is mitigated, drainage of mucus and pus will occur. This drainage will happen along the nasal passages all the way to the throat or the nostrils. This type of infection can lead to inflammation where there will be an invasion of immune cells resulting in the swelling of the sinus tissue. Therefore, inflammation of the air passages or cavities within the nasal passage is referred to as sinusitis which can be caused by infection, allergy or other irritants. 

sinus

  • What is a Sinus?
  • Types of Sinusitis
  • Statistics
  • Causes
  • Signs and Symptoms
  • Diagnosis
  • Treatment
  • Complications
  • Prevention
  • Conclusion

What is a Sinus?

Sinuses are void, air filled cavities located in the skulls and are connected to the nasal airway passages by a narrow opening in the ostium (bone). Human beings have four of these hollow or void cavities called sinuses:-

  1. Frontal Sinus (located in the forehead)
  2. Maxillary Sinus (located behind the cheeks)
  3. Ethmoid Sinus (located between the eyes)
  4. Sphenoid Sinus (located deep behind the ethmoids)

These four pairs are generally mentioned as the paranasal sinuses and are often reported as a unit. Cells that are found in the inner lining of the sinuses are the epithelial cells, mucus secreting cells and cells that play a role in the immune system like lymphocytes, macrophages and eosinophils.

Sinuses play a role in humidifying and warming the air we breathe in. In addition, it insulates neighbouring structures like the eyes, nerves, etc and increase voice resonance and act as cushion against facial trauma. It also decreases skull weight.

Types of Sinusitis

Sinusitis is categorised in many different ways based on the time period of the condition and the type of inflammation.

Time Period

  • Acute Sinusitis- Less than 30 days
  • Subacute Sinusitis- Over 1 month but less than 3 months.
  • Chronic Sinusitis- Over 3 months.

Type of Inflammation

  • Infectious Sinusitis- generally arise due to uncomplicated virus infection. However, bacteria and fungi  can cause sinus infection although it is quite rare. Subacute and chronic sinusitis generally develop from incomplete treatment of acute forms. 
  • Non-infectious sinusitis- arise due to irritants and other allergy conditions and have the same time span as acute, subacute and chronic as infectious sinusitis.

Statistics

Sinusitis is a common affliction which can affect people at any point of their lives. It usually occurs when irritants in the environment like pollen affects the nasal passages. This is usually the case with hay fever. Other irritants that can cause sinusitis include certain chemicals, use or abuse of nasal sprays (obtained over the counter) and other illegal substances that are taken in via the nose. It is said that approximately 30 million adults are afflicted with this condition.

Causes

Sinusitis may arise when something obstructs or interferes with the air passage into the sinuses and the mucus drainage  out of it. The openings of the sinus called the ostea can be blocked as a result of the swelling of tissue lining and nasal passage tissue. This is seen in common cold, allergy and other conditions brought out by certain irritants. The sinus can be blocked by a tumor or other forms of growth.

Drainage of mucus from the four cavities can be disturbed due to thick mucus secretion as a result of a reduction in hydration (content of water present) which can take place due to a disease like cystic fibrosis. The epithelial cells that are present in this region have hair like structures called cilia which move backwards and forwards in order to propel mucus out of the sinuses. Cilia have the tendency to be easily damaged by many irritants like smoke. When cilia are damaged, mucus drainage from the sinus will be less efficient.

Stagnated or trapped mucus becomes a breeding ground for bacteria, virus and in some patients suffering from AIDS or other immumnodepressive disorders fungus may grow. Additionally, these micro-organisms can bring about blockage of the sinuses. Maxillary and ethmoid sinuses are the most commonly affected sinuses.

Scarcely,  immumnodepressive patients or survivors of disasters like hurricanes, earthquakes, tsunamis, etc, may inspire fungi from the soil or water. In due course, be it a couple of days or weeks, the fungi will grow and will affect the blood supply to almost all the types of tissue present, mainly the tissues of the nose and the eyes. Although, this type of infections are scarce, it can be very fatal and will be in need of instant medical as well as surgical care.

Signs and Symptoms

Common symptoms associated with sinusitis include headache, facial soreness or tenderness, fever, pressure or pain. Nonetheless, only 25% of the patients afflicted with this condition have reported fever with acute sinusitis. Other symptoms that commonly occur include:-

  • Nasal discharge that is discoloured or cloudy
  • Sore throat
  • Cough
  • Nasal congestion
  • Headache when leaning forward due to additional pressure on sinuses.
  • Tooth pain or ear pain
  • Fatigue
  • Bad breath
  • Itchy eyes and sneezing (non infectious sinusitis)

Diagnosis

Sinusitis is generally diagnosed with the help of an examination and past medical records. This is due to the fact that X-rays of sinuses are usually unreliable and other imaging tests such as CT and MRI scans are expensive although they are very sensitive and specific. Thus, sinusitis is diagnosed at its early stages based on clinical findings which may include

  • Nasal passage redness and swelling
  • Purulent drainage from the nasal passages
  • Tenderness to tapping
  • Swelling of eyes and cheeks 

 From time to time, nasal secretions are inspected for cells that will help the doctor assess the condition and help him or her understand if it is an allergic or infectious sinusitis. Allergic sinusitis may show cells like eosinophils whereas infectious sinusitis may show cells like polymorphonuclear cells. If bacterial infection is suspected then the doctor will prescribe antibiotics. It is important to note that antibiotics are prescribed for bacterial infection and are not effective against viral infections.

In some cases, sinusitis does not respond to the preliminary treatment prescribed. That being so, the doctor may require in depth studies which will include CT or MRI scans. In pregnant women, ultrasound has been utilised to diagnose such infections. However, it is not as specific or sensitive as CTs or MRIs. Another technique that can be used is rhinoscopy. This will employ a small flexible fibre optic tube that can be used to look at the back of the nasal passages and ostea to check for blockages and obstructions by swelling or growth.

Occasionally,  a needle aspiration, also known as needle puncture, of the sinus may be required. This procedure is performed to acquire infected material to culture. As a result, one can discover the causative organism or pathogen that is causing sinusitis. However, this type of culture is rarely deemed to be helpful in determining whether a bacterial or fungal infection is causing the condition as the nasal passages are packed with non-infecting bacteria. A needle aspiration is generally undertaken when treatment fail to make one feel better. An otolaryngologist is required to carry out this procedure. Additionally, needle aspiration of the sinuses are said to be fairly uncomfortable where the patient will require local anaesthesia. Some patients may be in need of general anaesthesia. After needle aspiration is carried out, the contents will be sent for culture as well as staining after which the sinus may be rinsed with a solution of saline. This is the most accurate method that is available to diagnose sinusitis.

Furthermore, endoscopy techniques can be utilised to diagnose sinusitis. Rigid and flexible endoscopy can be both used to acquire diagnostic contents from the infected sinuses. Regrettably, even these procedures are said to be uncomfortable and may require the patient to be sedated. In addition, the procedure will be carried out by an otolaryngologist.

Moreover, fungal infections of the sinus is generally diagnosed by biopsy and tissue which will be removed by a surgeon. Other methods include fungal culture and microscopic examination by a trained pathologist or microbiologist.

Treatment

Antibiotics are not required for sinusitis that result from a viral infection. Recurrently prescribed treatment include pain and fever medications, decongestants and mucolytics.

Persisting bacterial infection of the sinus is exhibited by facial pain, nasal discharge (pus like), symptoms that last for more than a week  and patient not responding to over the counter nasal sprays or medications. Acute sinus infection resulting from bacterial invasion is often treated with a course of antibiotics which is aimed at treating common bacteria that can give rise to sinusitis. The five common bacteria that cause sinusitis are as follows:-

  1. Streptococcus pneumoniae
  2.  Haemophilus influenzae
  3. Moraxella catarrhalis
  4. Staphylococcus aureus
  5. Streptococcus pyogenes.

Thus, antibiotics that are known to be effective are able to kill these types of bacteria.

Chronic sinusitis infection generally requires longer courses of prescribed treatments and medications. In addition, the patient may need a sinus drainage technique. This drainage procedure requires a surgeon to operate to unblock the sinuses where patient will be under general anaesthesia. Moreover, antihistamines should not be consumed and avoided. However  if the patient has sinusitis as a result of allergy due to pollen, dander or other environmental allergens, then antihistamines may be prescribed. This patient may use a topical nasal steroid spray which will help in reducing the swelling without drying effects. This is a main advantage over antihistamines; nonetheless, both are used sometimes.

Many individuals develop allergic sinusitis initially and later on develop sinusitis caused by bacterial infections. In these patients, appropriate and early treatment of the allergic sinusitis will put a stop to bacterial sinusitis from developing.

In rare occasions or natural disasters, individuals may acquire fungal infections such as  zygomycosis or mucormycosis which will weaken the patient. Death rates of about 50%-85% have been stated in patients suffering from fungal infections that result in sinusitis. Treatment solely depends on early findings, appropriate surgical procedures, antifungal medications and alleviating other health problems like diabetes.

Complications

Severe life threatening complications due to sinusitis do not occur very frequently. However, there is a slight possibility that the sinus infections can extend into the brain via a wall of a sinus resulting in a life threatening situation  For instance, meningitis or brain abscess are such complications.  Furthermore, other structures in the vicinity of the sinus can become infected too. This can lead to other problems such as osteomyelitis of the skull bones and infection near or around the eye area called orbital cellulitis. Infections leading to death due to bacterial or fungal organisms hardly ever occurs. The patients who are prone to these types of complications are those who have a suppressed immune system and those who have undergone multiple trauma injuries due to natural disasters (relatively rare).

Prevention

Presently, vaccines that are designed against infectious sinusitis are not available. Having mentioned that, there are other types of vaccines available that act against viruses like influenza and bacteria like pneumococci. These organisms can lead to infectious sinusitis. These vaccines that are designed to act against certain pathogens may be effective in reducing or preventing acquiring infectious sinusitis indirectly. However, there are no studies that can prove this theory. No fungal vaccines against infectious sinusitis are available.

Conclusion

Sinusitis, commonly referred to as a sinus infection, occur as a result of the growth of a pathogenic micro-organism, be it virus, bacteria or fungus,  within the sinuses. This will result in the blockage of the sinus ostium. When the blockage is mitigated, drainage of mucus and pus will occur. This drainage will happen along the nasal passages all the way to the throat or the nostrils. This type of infection can lead to inflammation where there will be an invasion of immune cells resulting in the swelling of the sinus tissue. Therefore, inflammation of the air passages or cavities within the nasal passage is referred to as sinusitis which can be caused by infection, allergy or other irritants.

Sinusitis is a common affliction which can affect people at any point of their lives. It is categorised in many different ways based on the time period of the condition and the type of inflammation. Symptoms associated with sinusitis include headache, facial soreness or tenderness, fever, pressure or pain. Severe life threatening complications due to sinusitis do not occur very frequently.
We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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Be the first to comment - What do you think?  Posted by Masna M - June 25, 2013 at 04:12

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Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic state which results in stiffness and soreness of muscles, tendons and joints. Fibromyalgia causes pain and is portrayed by sleep disturbances, tiredness, fatigue, bowel disturbances, depression and anxiety. It is also known as fibromyalgia syndrome and may be abbreviated as FMS. Fibromyalgia was referred to as fibrositis formerly.

Fibromyalgia is one of the common conditions that affect muscles resulting in chronic pain and disability. The causes of fibromyalgia are still not known. An important characteristic of fibromyalgia are the tissues involved in generating pain have nothing to do with inflammation. Thus, patients do not develop any deformity or severe damage to the body. The condition does not cause any damage to internal organs which makes it quite different from other rheumatic disorders. In these diseases and disorders, pain , stiffness and tenderness which results from inflammation which can lead to deformity and damage to joints, muscles and  internal organs.

fibro

Statistics

Women have a higher incidence rate of fibromyalgia when compared to men. More than 80% of fibromyalgia cases presented are women aged between 35 and 55. Although less common, fibromyalgia can affect children, men and the aged.  Fibromyalgia can occur by itself or maybe related to other diseases like rheumatoid arthritis or systemic lupus. The incidence rate also differs from one country to another. In countries like Sweden and Britain, 1% of the total population are estimated to be afflicted with fibromyalgia. In the United States, around 4% of the total population are affected by fibromyalgia.

Causes of Fibromyalgia

As previously mentioned, the exact cause of fibromyalgia is still not known. Patients afflicted with this condition experience pain as a result of a stimuli, which in normal situations would not be regarded as painful. Researchers have discovered that there are high levels of substance P, a nerve chemical signal, and nerve growth factor. These are found in the spinal fluid of affected patients. In addition, serotonin, a brain chemical or neurotransmitter, is comparatively low in fibromyalgia patients. Research and studies conducted on pain of fibromyalgia patients have concluded that the brain (central nervous system) is by some means ‘supersensitive’. This phenomenon lead to a disturbance in the perception of pain. Additionally, fibromyalgia patients have impaired non-REM or non rapid eye movement, sleep phase. The commencement of this condition is often linked to psychological trauma, infection and stress.

Signs and Symptoms of Fibromyalgia

The major symptom associated with fibromyalgia is pain which is not caused by inflammation of tissue. Fibromyalgia patients have an increased  sensitivity to the many different sensory stimulants they might encounter. In addition, they have an uncommon low threshold to pain. Therefore, certain pain stimuli, considered as minor sensory stimuli, which would not cause excruciating pain in a normal person can become a very severe condition in fibromyalgia patients. Moreover, the body pain can worsen by noise, changes of weather and mental stress and trauma. The pain felt by fibromyalgia patients are often prevalent and widespread which generally affects both sides of the body. Pain can be felt in the neck, arms, shoulder areas, rear end, back (upper) and the chest areas. Tender points are areas in the body that are tender to touch, even if it is just light touch. Tender points or pressure points  of fibromyalgia patients can arise and are often found near and around elbows, knees, back of head, hips, shoulders, sides of sternum,etc. These are the common signs of fibromyalgia. Another common sign, felt almost by 90% of the fibromyalgia patients, is fatigue. Fatigue can be linked to the abnormal and irregular sleep patterns seen in patients who have this condition. Several degrees of the depth of sleep has been observed. In order to be refreshed, a person should have enough deep sleep. This is considered more important than the number of hours a person may sleep for. Alas, patients with this condition do not have deep sleeps which can be restorative and therapeutic. This is called ‘non-rapid eye movement’ or non-REM sleep. As a result, patients who wake up in the morning do not feel completely relaxed or rested although they would have slept for a number of hours which would seem adequate. Some patients wake up with muscle ache and muscle fatigue, like they have working all night long rather than being asleep. Emotion and/or mental stress and disturbance have been reported in more than half of the patients who suffer from fibromyalgia. These mental symptoms may include, lack of concentration and the ability to remember and recall, absentmindedness, mood swings, touchiness, apprehension and depression. Doctors are unable to confirm fibromyalgia as it is rather difficult and no appropriate laboratory tests are available, thus fibromyalgia patients are frequently misdiagnosed. Doctors may misdiagnose them as having depression and not fibromyalgia. Patients afflicted with this condition may also have other symptoms like tension headaches and migraines, numbness or tingling sensation in certain areas of the body, pain in the abdominal region which may be linked to irritable bowel syndrome, bladder problems causing polyuria and painful urination.

Diagnosis of Fibromyalgia

There are no available blood tests or any other laboratory test that can accurately diagnose fibromyalgia. These tests, if performed  will let the medical doctors rule out the possibilities of the patient being afflicted with other medical conditions. Consequently, the diagnosis of fibromyalgia is dependent on clinical grounds. Therefore, a doctor will make his diagnosis based on medical history and a thorough physical examination. Some patients have a widespread body pain. In this case, doctors will diagnose fibromyalgia by identifying tender points. Typically, but not always the case, fibromyalgia patients may present at least 11 out of the 18 tender points of the condition. In addition, doctors will diagnose the condition based on finding pain which is not a result of any inflammation of tissues. He/she may also rule out all other possible medical conditions that have similar features to this illness.Some of these conditions include:-

  • Hypothyroidism- condition where there is low thyroid hormone levels in the body.
  • Vitamin D deficiency
  • Muscle and Bone diseases
  • Parathyroid disease which cause high calcium levels
  • Hypercalcemia- high levels of calcium in blood
  • Infectious diseases
  • Cancer

As mentioned before, there are no specific blood tests or any other tests that can confirm fibromyalgia in a patient. However, doctors may require a few tests to rule other medical conditions in order to diagnose the illness. Hence, thyroid and calcium levels in the blood may be needed to exclude conditions like hypothyroidism, hyperparathyroidism and hypercalcemia. In muscle diseases, like polymyositis, a muscle enzyme known as CPK is elevated. Similarly, in a bone disease, for example Paget’s disease, a bone enzyme called alkaline phosphatase is elevated. Consequently, a doctor may require the levels of these components in the blood in order for him/her to eliminate such medical conditions. In addition, doctors may ask for a complete blood count, CBC, or other liver tests to exclude hepatitis and other infectious diseases. Vitamin D deficiency is easily diagnosed by obtaining the levels of vitamin D.

 

Video of Fibromyalgia

Treatment for Fibromyalgia

Fibromyalgia treatment plans are said to be successful when they combine four components namely patient education, stress management, exercise and medications. The symptoms of fibromyalgia are quite extensive and is different from one patient to another. Therefore, treatment plans are generally personalised taking into account each individual’s needs. Studies have also shown that the most successful treatment for fibromyalgia include the combining the different approaches mentioned above.

Patient Education

Patient education is very important as it allows them to understand the illness and its symptoms in depth which will help them cope up with the condition. However, not all physicians and medical doctors out there are well acquainted with the details and particulars of the illness. Hence, one should enrol in community hospital support groups which could be of tremendous help. Branches of The Arthritis Foundation are also there to help patients. These have become very important sources of education for patients as well as doctors. The Arthritis Foundation is a nationwide health organisation which provides voluntary services in many sectors including public education. On the other hand, community hospital support groups allow patients to share their personal experiences with the illness as well as information about treatments that were successful and others which have failed. This type of information can be very advantageous to a patient.

Stress Management

It is not at all possible or extremely difficult to evaluate and measure the different levels of stress in patients. In some cases, patients may find spilling coffee a very stressful event whereas in some other cases a lorry bombarding into their living room might be just another day in their stressful lives. As a result, to manage or reduce stress in fibromyalgia patients, treatment should be personalised. Several methods may be employed in order to reduce stress. These include stress modification at workplace/home, counselling, support groups, support from family, friends, doctors, as well as relaxation tapes. Additionally, changes to certain environmental factors like noise, weather exposure, temperature,etc can be beneficial. Also, optimal number of hours of sleep is encouraged to reduce stress.

Exercise

Aerobic exercises like swimming, walking, cycling, etc can be very effective treatments for patients who are afflicted with this illness. Exercise routines is very beneficial to the patient if performed every other day. Exercises should be performed regularly and preferably in the morning hours. Although, exercise is widely accepted as a fine treatment for fibromyalgia, how exercise benefits a patient is still not known. It is believed that it may promote a more deep level of sleeping. Physical therapy when combined with regular exercises can be even more beneficial.

Diet

Avoiding caffeine and alcohol before retiring to bed can contribute to a better more peaceful sleep. Fibromyalgia diet generally consists of foods that promote restful sleep and such patients should prefer these types of food. On an important note, these changes in diet may not be helpful to everyone, only some find it useful. Additionally, there is no such thing as a fibromyalgia diet or supplements that are endorsed to all patients. For example, when patients experience irritable bowel syndrome, one should adjust his or her diet in such a way that would not worsen the condition. Similarly, when patients experience interstitial cytitis, one should adjust their diet in a way that food that would further irritate the bladder should be steered clear of.

Prognosis

The prognosis for fibromyalgia is generally good. This illness does not damage or threaten to damage any organs of the human body. Therefore, the outlook for patients with this condition is usually quite good without any serious damage. Patients who have a good understanding of the illness, combine different approaches to improve sleep, take time to follow some stress reduction techniques and those who follow regular exercise always tend to a lot better than other patients.

Prevention

It is important to understand that there is no method to prevent fibromyalgia. Symptoms of fibromyalgia can be managed and controlled with exercise, having a good night’s sleep, stress management and a good medical approach to the illness.

Future of Fibromyalgia Therapy

The causes of fibromyalgia are yet to be found. Researchers have been studying many different viruses. They suspect that viruses could be a potential cause of fibromyalgia. If an infectious organism or toxin is found to be the cause of the illness, then specific laboratory tests can be employed that will accurately diagnose the condition.

Conclusion

Fibromyalgia is a chronic state which results in stiffness and soreness of muscles, tendons and joints. Fibromyalgia causes pain and is portrayed by sleep disturbances, tiredness, fatigue, bowel disturbances, depression and anxiety without any inflammation. It does not cause any deformity or damage to the body. 90% of the patients report feeling fatigued. Additionally, irritable bowel syndrome can occur along with fibromyalgia. Sleep disturbances is very common among the patients. No tests are available that can diagnose the illness. Fibromyalgia treatment plans are said to be successful when they combine four components namely patient education, stress management, exercise and medications.     We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

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We welcome your comments at the end of the article.

 

The Team Manager Web Diseases

 

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Be the first to comment - What do you think?  Posted by Masna M - June 7, 2013 at 11:49

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Parkinson’s Disease

What is Parkinson’s Disease?

Parkinson’s disease is named after James Parkinson, a British doctor who published his works on Parkinson’s disease in 1817. In his essay he described the disease in great detail which was referred to as the “shaking palsy”. Parkinson’s disease is the most common movement disorder and the second most common neurodegenerative disorder which is portrayed by the progressive loss of control of muscles. Thus, Parkinson’s disease concurrently leads to resting tremors, rigidity or stiffness,  slowness and diminished muscle strength and balance. As the disease progresses one may find it difficult to perform simple activities like walking, talking and completing simple day to day tasks.

The degree of progression and impairment of Parkinson’s disease differ from one person to another. Some have the tendency to live a long fruitful life whereas some others are prone to disability at its early stages. Premature death in Parkinson’s disease generally occur as a result of injuries related to falling or due to manifestations of  pneumonia.  

  • Statistics
  • Causes of Parkinson’s Disease
  • Genetics and Parkinson’s Disease
  • Risk Factors
  • Symptoms of Parkinson’s Disease
  • Conditions that Resemble Parkinson’s Disease
  • Diagnosis of Parkinson’s Disease
  • Treatment for Parkinson’s Disease
  • Coping up with Parkinson’s Disease
  • Prevention and Prognosis of Parkinson’s Disease
  • Conclusion

Statistics

Parkinson’s disease is said to affect 5 million people worldwide and 1 million people in the United States. Patients who have been diagnosed with Parkinson’s disease are generally 60 years of age or more. As the life expectancy is on the rise, the number of individuals who will suffer from Parkinson’s disease are said to increase in the future. The most common form of the disease is the ‘adult-onset’ Parkinson’s disease. Other forms of Parkinson’s disease like early-onset Parkinson’s disease (between 21-40 years) and juvenile onset Parkinson’s disease (before 21 years) are also said to exist.

Causes of Parkinson’s Disease

Dopamine plays an important role in Parkinson’s disease. Dopamine is a neurotransmitter that acts as a messenger which carries messages between two areas of the brain: the substantia nigra and the corpus striatum. These messages help to smoothen out and control movement in the body. Thus, the movement disorders are brought about by the lack of the messenger, dopamine, in the brain. The lack of dopamine is brought about by the loss of the cells producing it which is located in the substantia nigra. As there is an insufficient amount of dopamine, the message- carrying capabilities from the substantia nigra and corpus striatum is poor resulting in impaired movement. Thus, the loss of dopamine brings about movement related symptoms of Parkinson’s disease.The non-movement related symptoms of Parkinson’s disease is brought by the degeneration of other cells in the brain.

The theory that the lack of dopamine is the factor which causes movement impairment in Parkinson’s disease, is widely accepted and well known. Unfortunately, the reason as to why the brain cells that produce the dopamine deteriorate is not clear. Dysfunctional cellular activities, stress and inflammation contributing to cell injury and death were revealed in genetic and pathological studies. Also, abnormal Lewy bodies containing the alpha-synuclein protein were found in the brain cells of Parkinson’s disease sufferers. The role these clumps of Lewy bodies play in Parkinson’s disease is also not clear. Thus, scientists reckon that genetic and environment factors might lead to the loss of dopamine.

Parkinson-3

Genetics and Parkinson’s Disease

Parkinson’s disease is said to be ‘idiopathic’ in many patients which loosely means that the disease emerge sporadically without any known cause for it. Nevertheless, around 15% of people with Parkinson’s disease report having a relative with the disease. Thus, by studying family history records of Parkinson’s disease, scientist have now come across several genes that are linked to the disease which can help understand the disease and aid in finding new therapies. Five genes are associated with Parkinson’s disease that have a definite role to play:

  1. SNCA (synuclein, alpha non A4 component of amyloid precursor)-  this makes the alpha-synuclein protein which aggregate in clumps called Lewy bodies. Mutations of this gene are found in early onset Parkinson’s disease.
  2. PARK2 (Parkinson’s disease autosomal recessive, juvenile 2)- This gene codes or makes the parkin protein. Mutation of this particular gene is almost always found in patients who suffer from juvenile Parkinson’s disease.
  3. PARK7( (Parkinson’s disease autosomal recessive, early onset 7)- This gene codes for the DJ-1 protein, which guard cells from oxidative stress. Mutation of this gene is found in patients who suffer from early onset Parkinson’s disease.
  4. PINK1 (PTEN-induced putative kinase 1)- Once again, mutations of this gene is found in early onset Parkinson’s disease. The precise function that the protein that is produced by this gene is still not known; but it is said that the protein may play a role in helping mitochondria (structure inside cell, produces energy) from stress.
  5. LRRK2 (leucine-rich repeat kinase 2)- This gene codes for the dardarin protein. Mutation of this gene is found in patients suffering from late-onset Parkinson’s disease.

Several other genes are also associated with Parkinson’s disease namely: GBA (glucosidase beta acid), SNCAIP (synuclein alpha interacting protein), and UCHL1 (ubiquitin carboxyl-terminal esterase L1).

Risk Factors

  • Age is the biggest risk factor associated with the development as well as progression of Parkinson’s disease. Many are above 60 years of age when they develop Parkinson’s disease.
  • Statistics have shown that men are affected more (1.5-2 times) often than women.
  • Some, a small number of individuals, are at risk due their family medical background.
  • Other risk factors include: head trauma, illness and exposure to certain pesticides and herbicides (environmental toxins).

Symptoms of Parkinson’s Disease

Primary Symptoms

The main symptoms of Parkinson’s disease are all linked to motor function capabilities involving both voluntary and involuntary movements. These primary symptoms usually begin on one side of the patient’s body. Symptoms are generally mild at the beginning and will progress as the disease progresses over time. Some sufferers of Parkinson’s disease are more affected than some others. Statistics have also shown that patients will have lost about 605-80% of cells producing dopamine in the brain by the time the primary symptoms emerge. The following are some motor symptoms which can be seen in a Parkinson’s disease sufferer:-

  • Tremors- in hands, fingers, arms, legs, feet, jaw or head. These can be seen when the patient is resting but not seen when they are performing a task. Tremors are said to worsen when the patient is tired, excited or under stress. 
  • Rigidity- is the stiffness of limbs and the trunk which during movement may increase. Rigidity also can bring about muscle aches and pains. Cramped handwriting (microphagia) may arise due to loss of fine hand movements. In addition, the patient may experience eating difficulties.
  • Bradykinesia- is defined as the slowness in voluntary movement. As the disease progresses, one may find it hard to initiate movement and complete movement. Bradykinesia along with rigidity can affect facial muscles that can result in “mask-like” or expressionless appearance.
  • Postural instability- Impairment of reflexes can make it difficult to maintain balance by adjusting one’s posture; this results in falls.
  • Parkinsonian gait- Individuals who have developed a more advanced Parkinson’s disease state will have a characteristic shuffling walk along with a crouched or stooped position. Arm swing while walking may be diminished or entirely absent. Patients may also find it hard to start walking and making turns. Thus, sufferers may become motionless in mid stride and appear to be falling forward while walking.

Secondary Symptoms

The primary symptoms related to Parkinson’s disease are diminished motor functions while secondary symptoms are in relation to progressive loss of muscle strength and brain damage. The severity it manifests itself vary from one patient to another and not every other patient will experience all of them. Some of these secondary symptoms are as follows:-

  • Stress
  • Anxiety
  • Confusion, loss of memory and dementia (common in older patients)
  • Depression
  • Constipation
  • Swallowing difficulties
  • Excessive salivation
  • Decreased sense of smell
  • Sweating increased
  • Erectile dysfunction in males
  • Problems of the skin
  • Frequent Urination
  • Slowed and soft speech with a monotone voice.

Conditions that Resemble Parkinson’s Disease

Parkinson’s disease can resemble a number of other medical conditions in its early stages. Parkinsonism is a term used to describe Parkinson-like symptoms. These medical conditions include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, encephalitis (brain inflammation), stroke and certain head traumas. Primary lateral sclerosis and Alzheimer’s disease are other medical conditions which can be misinterpreted as Parkinson’s disease. Other medical conditions include dystonic tremor, essential tremor, vascular Parkinsonism and drug induced Parkinsonism.

Diagnosis of Parkinson’s Disease

A good treatment plan can be administered when an  accurate diagnosis of Parkinson’s disease is made at its early stages. This will result in high quality of life for a relatively long period of time. There are no tests that are available that can diagnose Parkinson’s disease with certainty. Diagnosing Parkinson’s disease is quite a challenge due to the similarities of its symptoms with other movement disorders and medical conditions. There is a chance that some individuals suffering from Parkinson’s disease may be diagnosed as having another disorder and some other individuals who are having Parkinson-like symptoms may be misdiagnosed as having Parkinson’s disease. On that basis, it is very important to evaluate and re-evaluate the patients in the early stages on a regular basis to eliminate and rule out other possible medical conditions that may have similar symptoms.

An accurate diagnosis can be made by a neurologist who has specialised in movement disorders. An initial assessment will be made by referring to one’s medical history, a neurological exam and by the symptoms one shows. When evaluating one’s medical history it is important to know the medical history of their family, if they have had Parkinson’s disease, what medications they were under and whether they have had head traumas in the past and whether they were exposed to certain toxins. A neurological exam, on the other hand, will evaluate ones movement, coordination, walking and certain hand movement related tasks.

A number of guidelines are available which can assist one to diagnose Parkinson’s disease correctly. Hoehn and Yahr scale and the Unified Parkinson’s disease rating scale are few of the many.Tests can be used to measure the patient’s mental capacity, mood, behaviour, day to day tasks and motor function. They can help with initial diagnosis and in monitoring the progression of the disease so that necessary therapeutic adjustments can be made. Sometimes, brain scans and laboratory tests are also performed in order to rule other medical conditions which may resemble Parkinson’s disease.

One can diagnose Parkinson’s disease if:-

  • At least two out of three major symptoms are shown in the patient. These three major symptoms are the resting tremor, rigidity and slowness. 
  • Onset of symptoms on one side of the body.
  • Symptoms not present due to secondary causes (medications, strokes).
  • Symptoms are significantly improved by certain medications.

Treatment for Parkinson’s Disease

Currently, no treatment is available to cure Parkinson’s disease. Many therapies and treatment plans are available to postpone the emergence of motor symptoms of the disease and to improve the motor symptoms as well. These therapies target to increase the availability of dopamine in the brain . This can be achieved by replacing dopamine, imitating the action of dopamine, or prolonging the effect of the available dopamine by blocking its break down in the brain. Studies have proved that the quality of life of a Parkinson’s disease sufferer can be prolonged by administering therapy in its early stages in the non motor phase.

There are effective drugs used in the treatment for Parkinson’s disease which converts itself to dopamine in the brain.  As usage of this drug for a long period of time can lead to side effects, such as painful cramps and involuntary movement, it is given at a later stage where motor impairment is quite severe.

In early stages of the disease, dopamine agonists and MAO-B inhibitors are given to the patient. Dopamine agonists imitate the action of dopamine and MAO-B inhibitors act to reduce dopamine break down. These are said to be very effective in relieving motor symptoms. Side effects may take the form of swelling caused by accumulation of fluid in body tissue, sleepiness, dizziness, constipation, hallucinations and nausea.

For severe motor symptoms that cannot be managed, surgery may be performed. Deep brain stimulation or DBS is a surgical procedure which stimulate specific areas of the brain which seems to block signals causing motor symptoms. It involves placing a small electrode in the brain and attaching the electrode to a pulse generator.

Parkinson’s disease researchers are currently researching with stem cells to produce specific cell types like dopamine producing cells which can be used to treat the disease. While this approach is promising, more research is required before it can have any therapeutic value.

General lifestyle  changes including rest and exercise, physical therapy , occupational therapy, speech therapy and so on, work towards making the patient feel better. Thus, in addition to medications and surgery this too may be beneficial to the patient.

Coping up with Parkinson’s Disease

The progression of Parkinson’s disease may be slow but it eventually will affect one’s life in every way, be it social engagements, work, or basic tasks and routines. It can also have a psychological impact in the patient, as accepting to losing one’s independence can be difficult. When one is well informed of the disease, it can reduce the stress and anxiety felt by one in dealing with what is in the near future. Many support groups for the disease are available which function to provide helpful information for the patient and their families about coping up with the disease. Local groups may also be beneficial as they work towards providing emotional support and advise about the best doctors out there, therapists, and other information related to the disease. Most importantly, being in touch with health care providers is also beneficial as they will monitor the progression of Parkinson’s disease and adjust and alter therapies which will best benefit you.

Prevention and Prognosis of Parkinson’s Disease

As the exact cause for Parkinson’s disease is still not known, the disease cannot be prevented at present. However, scientists believe that genetic susceptibility, exposure to toxins and other environmental factors, illness and trauma contribute to triggering the disease.

The severity of the symptoms of Parkinson’s disease is not the same from one individual to another. Therefore, you cannot predict how quickly the disease will progress in one suffering from the disease. The disease itself is not deadly, where the life expectancy of one suffering from it is close to one who is not. Secondary problems like pneumonia, injuries that come due to falls, and choking may lead to death. Furthermore,  there are many treatment strategies that can be applied to reduce the severity of some of the symptoms and improve one’s quality of life.

Conclusion

Parkinson’s disease is a neurodegenerative disorder which brings about a progressive decline in motor function as a result of reduction of dopamine producing cells in the brain. Main symptoms related to Parkinson’s disease include tremor, rigidity, slowness, impaired balance and shuffling gait. Other secondary symptoms include depression, anxiety and dementia. Most of the sufferers of Parkinson’s disease have been diagnosed when they are 60 years of age or older. Having said that, early onset Parkinson’s disease also can occur. With proper and effective treatment, individuals can lead long productive lives for several years after the diagnosis.  

 

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We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

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The Team Manager Web Diseases

 

 

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