Parkinson's disease | Symptoms & diagnosis & treatment in Turkey

Symptoms of Parkinson's disease

Parkinson's disease is a degenerative neurological disorder characterized by an extrapyramidal syndrome. The main motor symptoms include:

• Muscle rigidity: Increased resistance to passive movements, giving the impression of stiffness.
• Tremor: Mainly at rest, but may be exacerbated in situations of stress or anxiety.
• Bradykinesia: A slowing of movements, with difficulty initiating and executing actions, making everyday gestures more laborious.

As the disease progresses, these symptoms worsen and may develop into balance problems, a difficult gait (walking with small steps),and stooping posture. Other non-motor manifestations may also occur, such as:

• Depression: Common in patients and may precede or accompany motor symptoms.
• Slower speech: Speech becomes more monotonous and less articulate.

Anatomopathologic and biochemical substrate

Parkinson's disease results from progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc). This degeneration leads to a marked reduction in dopamine, a neurotransmitter essential for regulating movement.

At the biochemical level, several abnormalities are observed in the SNpc of Parkinson's patients:

• A reduction in neuromelanin is responsible for the visible depigmentation of the substantia nigra.
• Alteration of complex I of the mitochondrial respiratory chain disrupts cellular energy production.
• Decreased activity of alpha-ketoglutarate dehydrogenase, a key enzyme in energy metabolism.

These biochemical and anatomical changes underlie the clinical symptoms of the disease and its relentless progression.

Parkinson's disease: What tests are needed to make a diagnosis?

The diagnosis of Parkinson's disease is based primarily on a thorough clinical evaluation. The doctor analyzes several key elements to make an accurate diagnosis.

First, he or she will review the patient's medical and family history to identify any risk factors. Next, he or she assesses neurological symptoms and signs, including tremors, muscle rigidity, and slowness of movement.

Other tests may be ordered to confirm the diagnosis or rule out other conditions:

• High-field brain MRI: to rule out other neurological disorders.
• PET brain scan: analyzes brain metabolism to detect any abnormalities.
• Myocardial scintigraphy: Assesses the function of the autonomic nervous system.

Neurophysiologic testing of the autonomic nervous system: detects any associated disorders, such as abnormalities in blood pressure regulation or heart rate.
These tests help refine the diagnosis and tailor patient care.

Dat-Scan: New diagnosis for Parkinson's syndrome

Dat-Scan is a new functional imaging technique in nuclear medicine. It can be used to confirm or rule out the involvement of the dopaminergic system, even at an early stage of the disease. A specific tracer is injected intravenously, and the brain is then imaged using a SPECT scanner. The results show a decrease in dopamine levels in the basal ganglia in cases of idiopathic Parkinson's disease or true Parkinsonism. In contrast, the results are normal in cases of essential tremor or other clinical conditions unrelated to Parkinson's disease.

Dat-Scan also allows precise quantification of dopamine levels in the putamen, a key brain region. However, once the characteristic motor signs of Parkinson's disease have been identified by a neurologist, DaTscan becomes less useful. In fact, in such cases, this test is not essential for making a diagnosis of Parkinson's disease. However, it remains a valuable tool in situations where the clinical diagnosis is uncertain or to differentiate Parkinson's disease from other conditions with similar symptoms.

Parkinson's disease treatment in Turkey

Parkinson's disease is a complex neurological pathology for which there is currently no definitive cure. However, innovative and personalized treatments can effectively manage symptoms and offer patients the opportunity to maintain a satisfactory quality of life for many years to come. In Turkey, highly qualified medical teams offer therapeutic solutions tailored to each patient, combining pharmacology, surgery, and rehabilitation. These multidisciplinary approaches, supervised by experienced neurologists, aim to meet the specific needs of each individual while minimizing the negative impact of the disease.

Pharmacological treatment

Medication is often the first step in treating Parkinson's disease. Drugs such as dopamine agonists and levodopa are prescribed to increase dopamine levels in the brain or stimulate affected areas of the brain. Each patient responds differently to these treatments, so dosages and drug combinations must be carefully tailored.

As the disease progresses, adjustments in therapy may be needed to control symptoms. However, these medications can cause side effects such as nausea, dizziness, or dyskinesia that require close medical monitoring. When pharmacological treatment is no longer sufficient to control symptoms, other therapeutic options are considered.

Surgery for Parkinson's disease

Deep brain stimulation (DBS) represents a major advance in the surgical treatment of Parkinson's disease. This safe, reversible and adjustable procedure involves implanting electrodes in specific areas of the brain to modulate the signals responsible for motor symptoms.

PCS is particularly effective in reducing tremors, rigidity and movement disorders, and offers a significant improvement in patients' quality of life. In Turkey, this technique is performed by specialized surgical teams using state-of-the-art technology to ensure optimal results.

Rehabilitation therapy

Rehabilitation plays an important role in the overall management of Parkinson's disease. It includes physical therapy, occupational therapy, and cognitive re-education programs designed to improve motor skills, balance, and cognitive function. These complementary therapies help increase patients' autonomy and maintain their quality of life.

In Turkey, our rehabilitation centers use innovative, personalized methods tailored to the specific needs of each patient.

 Contact our team today to explore personalized treatment options and start your journey to improved quality of life.