4.11 – “World Parkinson’s Disease Day” Full of confidence, happy life (Zhang Guoping, 2011-4-5) Zhang Guoping, Department of Neurology, Beijing Xitantan Hospital, Capital Medical University, Beijing, China On April 11, 1997, the World Health Organization (WHO) designated April 11 each year as “World Parkinson’s Disease Day”. World Parkinson’s Disease Day (WPD)”. This day is the birthday of Dr. James Parkinson, the British physician who discovered Parkinson’s disease. It is the birthday of Dr. James Parkinson, the British physician who discovered Parkinson’s disease. On April 11, 2011, the Parkinson’s Disease Association of Beijing, in collaboration with Parkinson’s disease specialists from major hospitals in Beijing, held a “Consultation and Health Talk” at the Jianguo Hotel in Hao Yuan. “The event is free for patients and their families to attend. Parkinson’s disease is a common neurodegenerative disease in middle-aged and elderly people, mostly after the age of 60. The main manifestations are slow movement of patients, involuntary tremor of hands, head or mouth at rest, muscle rigidity, loss of body flexibility becoming stiff and postural balance disorders. The symptoms first appear on one limb and gradually extend to the opposite side or the whole body, and in the advanced stage of the disease, the patient is bedridden and cannot take care of himself. The earliest systematic description of the disease was by the British physician James Parkinson. At that time, the disease was called “tremor palsy”. Later, the disease was observed more carefully and it was found that in addition to tremor, there were other symptoms such as mask face (reduced facial expression, dull), panic gait (walking with small steps and faster and faster), lowercase syndrome (writing smaller and smaller), and no back and forth swing of the upper limbs when walking, but the strength of the limb muscles was not impaired, so it was thought that “paralysis” was not appropriate. “Therefore, it is suggested that the disease be named “Parkinson’s disease”. To date, the cause of primary Parkinson’s disease is still not completely clear, and it is generally believed that it is mainly related to a combination of factors such as ageing, genetics and the environment. Genetic factors account for about 10% of the disease, and genetic testing can be done to clarify. Epidemiological studies conducted in Beijing, Shanghai and Xi’an have shown that the prevalence of Parkinson’s disease is higher in brain workers than in non-brain workers. It is hypothesized that the onset of Parkinson’s disease is associated with chronic mental stress, low physical activity and a high-fat diet. It was also found that the prevalence of Parkinson’s disease was lower in people with tea drinking habits. Therefore, avoiding excessive stress, actively participating in physical exercise, eating a reasonable diet and drinking tea in moderation can help prevent or delay the onset of Parkinson’s disease. There is no cure for Parkinson’s disease, it is a chronic progressive disease, and if left untreated, patients’ survival period is significantly shortened. With the advent of the world’s aging society, the prevalence of Parkinson’s disease is increasing year by year. There are more than 4 million Parkinson’s disease patients worldwide. China has 2.1 million, ranking first in the world, and every year to increase 100,000 new patients. However, the medical community and the public are seriously under-aware of the disease, believing that tremors, unsteady walking, slow movement and stiffness are normal phenomena when people get old, resulting in a low rate of Parkinson’s disease visits. The latest epidemiological survey shows that the incidence of Parkinson’s disease among 65-year-olds in China is as high as 1.7%, of which 50% to 60% of patients do not seek medical care, and the situation is more serious in rural and western areas. To the hospital Parkinson’s disease patients, a significant proportion of the disease has developed to the middle and late stage, must use expensive imported drugs to control the disease; some patients with poor drug efficacy, but also need to undergo surgical procedures. The average daily drug cost of up to $60 and the cost of nearly $200,000 for the installation of a brain pacemaker have overwhelmed many families and placed a heavy economic burden on society as a whole. Thus, it is clear that popularizing medical knowledge about Parkinson’s disease, raising awareness of prevention and treatment of Parkinson’s disease, and early access to hospitals are of great positive significance to improve the quality of life of the elderly and reduce the burden on families and society. At present, the treatment of Parkinson’s disease includes medication, surgery, and deep brain electrical stimulation (DBS) therapy, etc. In 2006, the Parkinson’s Disease Group of the Chinese Medical Association published guidelines for the treatment of Parkinson’s disease in China, which were revised in 2009. Only if the treatment plan is chosen scientifically and reasonably can good results be achieved. After diagnosis, patients should first be treated with strict medical medication to relieve tremor, stiffness and other limb symptoms. Only after years of regular drug therapy with unsatisfactory results or serious adverse reactions should deep brain electrical stimulation therapy or surgery be considered, and a specialist should determine whether the patient is suitable for surgery. Early treatment suggests oral dopamine agonists such as Tysudar and Senfro, starting with small doses and gradually increasing; if the efficacy is not satisfactory, levodopa preparations such as Medopa and Xanax can be switched or added. oral levodopa preparations can be preferred for patients over 65 years old, with doses increasing gradually from small to appropriate doses. Parkinson’s disease treatment is not only about relieving surface symptoms, but patients’ secondary depression problems and drug side effects (motor complications, such as switching phenomenon) should also be taken very seriously. The switching phenomenon is a fluctuation in the efficacy of levodopa drugs after long-term application in patients with Parkinson’s disease. The early clinical use of levodopa analogues is very effective, and it has a significant effect on eliminating the motor symptoms of Parkinson’s disease such as tremor, rigidity, reduced and slow movements. However, after taking levodopa drugs for 3 to 5 years, the limitations of the drugs will appear, and the long will cause pathological changes in brain tissue, which in turn will cause various motor complications, and the switching phenomenon is only one of the side effects. Switching phenomenon appears late in the drug administration. Throughout the day, the patient’s symptoms fluctuate between sudden remission (on phase) and exacerbation (off phase), which can alternate repeatedly and rapidly several times. This change is very rapid and unpredictable, like a power switch. This physiological phenomenon is clinically and graphically referred to as the on/off phenomenon. In addition to the on/off phenomenon, there are many other side effects associated with taking medications, such as the commonly occurring end-of-dose phenomenon. This refers to the increasingly short duration of drug maintenance and the worsening of Parkinson’s disease symptoms late in each dose. In addition, most patients also experience anisotropy, where dancing-like or simple repetitive involuntary movements can occur in the facial muscles, neck, back and limbs. As research into Parkinson’s disease has intensified, new drugs and techniques have emerged, offering hope for relief of patient suffering. Internationally, deep brain electrical stimulation (DBS) is now being used to treat Parkinson’s disease patients who have failed to take medications or who have severe complications. This procedure was adopted by a French neurosurgeon in 1987 and was successful. China’s Beijing 301 and Tiantan hospitals were the first in China to apply this technique to treat Parkinson’s disease, and some hospitals in China have carried it out one after another. Deep Brain Electrical Stimulation is a stereotactic surgery in which stimulation electrodes are implanted in the areas of lesions in the brain of patients with Parkinson’s disease. The stimulation generator is implanted under the skin of the patient’s anterior chest and stimulates specific areas of the brain through electrical pulses, thereby improving the symptoms of primary tremor, tonicity, motor retardation and other diseases. There are strict indications for deep brain electrical stimulation for Parkinson’s disease, which can be used for patients whose effects have waned after several years of medication and who have developed serious complications, and who must not have severe systemic disease. Experts point out that deep brain electrical stimulation is completely different from deep brain nucleus destruction (also known as cytoknife). Early results of deep brain nucleus destruction are good, but because Parkinson’s disease is a bilateral lesion of the brain, patients can suffer serious complications in speech and intelligence if they undergo bilateral deep brain nucleus destruction, so it is no longer recommended internationally. Clinical studies have shown that 30% to 40% of patients with Parkinson’s disease are accompanied by depressive symptoms. Patients may become sad and depressed, and this mood inevitably affects their family members, which in turn affects their own mood, resulting in an emotional vicious circle that has a huge impact on the quality of family life. Therefore, antidepressant treatment is a new topic in the treatment of Parkinson’s disease. Diet therapy is one of the complementary treatments for Parkinson’s disease. Eat more cereals and vegetables and fruits, and drink 1 cup of milk or yogurt before bedtime. Fava beans contain natural levodopa and their regular consumption can prolong the efficacy of levodopa medication. Limit protein intake to about 50 grams of meat per day, preferably with protein-rich foods such as lean meat or fish scheduled for dinner. Do not eat fatty meats, meat and oil, or animal offal, and eat more green vegetables. A high-fat diet can delay the absorption of levodopa medication and affect its effectiveness. Drinking green tea every day can reduce symptoms and slow down the progression of the disease. It has become imperative to popularize the knowledge of Parkinson’s disease prevention and treatment so that Parkinson’s patients can be diagnosed and treated early. Early drug treatment can not only significantly improve the self-care ability and mobility of Parkinson’s disease patients, but also greatly improve the quality of life and increase the survival rate of patients. Let’s pay attention to Parkinson’s disease, care for Parkinson’s patients, enhance the confidence to overcome Parkinson’s disease, maintain a happy mood, and have a healthy and harmonious life!