Parkinson

An Explanation of Parkinson’s Disease and Epilepsy

Parkinson’s disease (PD) and Epilepsy are two serious diseases in charge of neurology.

Parkinson’s disease is a movement disorder also known as Paralysis agitans and Shaking palsy. This disease means some nerve cells being affected in the part of brain (substantia nigra) that is responsible for muscle movement.

Those neurons producing such chemical as dopamine are killed by the struck and stop to work properly. The chemical called dopamine is needed to coordinate movements through special signals. This illness has been known for a long time, but still there is no common opinion for its reasons.

James Parkinson (1755 ”“ 1824), as English apothecary surgeon, was first to discover it and to conduct a thorough analysis in his work “An Essay on the Shaking Palsy” (1817). Therefore the illness was called after the scientist.

This disease is usually genetic, but the causes are also seen in some other illnesses striking the body or head trauma, some toxins (pesticides, manganese, iron in particular) and drugs also. Most of cases appear to be idiopathic. To determine PD the following symptoms are usually used: trembling (about 5 Hz) of hands and arms, jaw and face on the whole, feet and legs; inflexibility of arms and legs, and a trunk; very slow movements (bradykinesia); bad balance and coordination: and finally, when it’s an extremely serious stage, even complete loss of movement (akinesia). The disorder also entails subtle trouble with speech (i.e. monotonic talking with reduced inflexion of vice versa extremely rapid festinating communication, hypophonia or dysphonia); hypomimia with frequent blinking; micrographia; and depression, partially because endorphin is among those substances which are killed by the illness; apathy and abulia may follow. It’s typical to discover cognitive destruction of high level (slow reaction, allocation of attention; dementia) either. The other thing is that each patient can have individual dissimilar symptoms and disease progression.

Moreover, most of symptoms typical for Parkinson’s disease can inform of other disorders (e.g. Wilson’s disease), and that is one of the reasons why it is so hard to determine and to cure properly. It is usually diagnosed by serum ceruloplasmin levels examination, tests of liver function, and slit lamp examination for Kayser-Fleisdher rings.

Before time signs and symptoms of Parkinson’s disease sometimes are dismissed as the effects of normal aging. The physician may necessitate observing the patient for a long time until it is obvious that the symptoms are constantly present to diagnose accurately. Auspiciously, diagnostic correctness confirmed by autopsy has been much higher (98.6% accuracy) when carried out by practiced neurologists with subspecialty training in movement disorders by means of UK Brain Bank criteria for diagnosis.

Today there is still no remedy to get rid of Parkinson’s disease; there are only medications (combinations of carbidopa/levodopa or benserazide/levodopa; entacapone; some dopamine agonists) and surgery methods (deep brain stimulation with an electrode being put into the brain) which mitigate some of the symptoms. Nevertheless, PD is a chronic disease that needs entire change of life-style, special training for patients and their families, visiting support group services, physiotherapy, and following a diet.

Epilepsy is another chronic neurogical disease which cannot be cured and is widely spread among elderly people. It is not a single disorder, but a grouping of syndromes with different revealing all connected with episodic abnormal electrical activity of brain.

There are several types of epilepsy which differ from one another by location in brain, by the cause, by symptoms and syndromes, by semiology. By precipitants it can be primary reading epilepsy or photosensitive epilepsy, musicogenic epilepsy or hyperventilated epilepsy; it can be also provoked by sleep deprivation or sleep itself, emotional stress, febrile disease, and menstrual cycle too.

Like Parkinson’s disease, epilepsy is often genetic, and in this case it is usually traced in young age. Again equally to Parkinson’s disease it can be caused by head trauma and central nervous system infectons.

This disorder often results in depression leading to suicide, headaches, autism, serious traumas from seizures and sudden unexpected death in epilepsy (Jancovic, 2008).

Depending on what part of the brain is affected epilepsy may be partial (simple partial and complex partial) and generalized (leading to loss of consciousness). These are absence (petit mal), myoclonic, clonic, tonic, tonic-clonic (grand mal) and atonic seizures.

All in all there are more than 40 special types of epilepsy. Each of them appears with its individual inimitable combination of typical age of onset, seizure type, treatment, EEG findings, and prognosis. The most common classification of the epilepsies distinguishes epilepsy syndromes by the cause, by location or distribution of seizures (as revealed by the appearance of the seizures and by EEG). Localization-related epilepsies, generalized epilepsies, or epilepsies of unknown localization are among them.

Localization-related epilepsies, also known as partial or focal epilepsies, come from an epileptic focus, a small section of the brain that works as the irritant driving the epileptic response. Generalized epilepsies vice versa come from many autonomous foci (multifocal epilepsies then) or from epileptic circuits that cover all the brain. Epilepsies of unknown localization stay indistinct whether they come from a part of the brain or from more general circuits (Deuschl, 1998).

Further on, epilepsy syndromes are distinguished by the cause: idiopathic or symptomatic, cryptogenic too. The first usually come from genetic abnormalities that result in changes of basic neuronal regulation. The second come from the effects of an epileptic lesion, focal like tumor, or a fault in metabolism leading to general injury of the brain.

Cryptogenic epilepsies come up with presumptive lesion complex or unattainable to uncover otherwise during estimation.

The specialist to examine and to cure epilepsy is again physician. Besides, it is also in charge of primary caregivers, neurologists and neurosurgeons.

To evaluate the disorder doctors normally use the following tests: Long-term video-EEG monitoring (sometimes with intracranial electrodes), routine EEG, neuropsychological evaluation and neurological examination, Single photon emission computed tomography (SPECT), MRI neuroimaging, positron emission tomography (PET). Some clinics exercise Wada test, that is intracarotid sodium amobarbital test, Magnetoencephalography (MEG) or functional MRI, electrocardiography, brain mapping, as extra checks (Thurman, 2007).

In contrast to Parkinson’s disease, epilepsy sometimes can be curative for lucky patients. Usually it is due to special neurosurgical operations. But mostly they just shorten frequency and strength of seizures. Like in case with Parkinson’s disease, brain stimulation is helpful. The implantation of a stimulator of the vagus nerve is often applied.

The first help for an epileptic at a seizure is intended to protect him from self-injury, from sharp things and edges, to put something under head, to prevent asphyxiation by placing him in a recovery position.

Medications are often the only way to seize sufferings, but as it has already been mentioned, anticonvulsants can lead to other neurological effects, the period of treatment is usually life-long and in any way it changes the quality of life essentially (Cascino, 1994). Today there are 20 drugs approved by the Food and Drug Administration for the use of treatment of epileptic seizures in the US. Phenobarbital, gabapentin, carbamazepine, tiagabine, primidone are among them. The majority of side effects are mild and depend on the dose, consequently it is possible to avoid them or reduce them by the use of the minimal amount effective. A number of cases take in mood changes, drowsiness, or instability in pace. A few anticonvulsants are known for “idiosyncratic” side-effects which can’t be predicted by quantity. Drug rashes, hepatitis (or liver toxicity), aplastic anemia are systematic.

Surgery is attainable when it is localization-related epilepsy. It means that location of the affectation is precisely determined, and hence it can be taken away. Resection of lesions can be rather effective, but a lot of patients give it up because of fearing an operation on brain and its unpredictable consequences. For the meantime selective amygdalahippocampectomy is advised by a number of neurosurgeons since there are promising benefits of postoperative memory and language function (Fisher, 2004).

Callosotomy or commissurotomy put a stop to generalizing of seizures (spreading onto the whole brain) ”“ just of the seizures can’t be restricted in other ways.

Many ways of treatment are still under research.

In this way, epilepsy and Parkinson’s disease are two serious functional disorders, having many similar causes and including parallel treatment. Both of them are still not completely studied, on both of them research is still going on looking for reasons, endangered categories of population and methods to cure as well as to reduce morbidity. This questions are of high importance because every generation worldwide is at risk and it is up to specialists to find the remedy.