[Cyprus Times] Around 2,000 people suffer from Parkinson's disease in Cyprus

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About 2,000 people suffer from Parkinson's disease in Cyprus The prevalence of the disease in the western world is about 0.2% of the population 10-15% of Parkinson's disease cases have abnormal genes. The prevalence of Parkinson's disease in Cyprus is estimated to be around 2,000 people suffering from the disease, according to a statement from the Cyprus Institute of Neurology and Genetics.[/P]

It should be noted that the prevalence of the disease is around 0 in the western world.In Europe it is estimated that about 1% of the population aged > 50 years suffer from Parkinson's disease.

As mentioned, Parkinson's disease dates back to ancient times. The oldest references are found in Hindu scriptures (4,500 years BC) and in descriptions in Homer (Iliad). The disease was first described scientifically by the physician Sir James Parkinson in 1817. It is a neurodegenerative disease that occurs mainly in people over fifty years of age. There is tremor (shaking), bradykinesia and stiffness of movements and difficulty in walking and balance.

The cause of the condition, it is noted, remains unknown. There is probably a genetic predisposition and the influence of an environmental factor (chemical, microorganism, immune disorder) causes a slow and evolutionary destruction of the dopamine-producing brain cells. The destruction of dopamine-producing cells either starts directly in the brain (central mechanism) and is more closely associated with genes (hereditary forms), or it starts in the periphery (peripheral mechanism; sporadic forms).

The periphery can be the olfactory mucosa (located in the nose, responsible for the perception of smells) and/or the intestinal mucosa. Whatever starts in the periphery is slowly carried through the nerves to the brain.

As mentioned, the onset of the destruction of dopamine-producing cells begins long before the symptoms of the disease appear, and these symptoms appear when more than 50-75% of the number of dopamine-producing cells are lost.

About 10-15% of cases of Parkinson's disease have abnormal genes (inherited forms). Such genes can be identified in families with more than one case and in consecutive generations. In cases of inherited forms of the disease the age of onset may be less than fifty years of age.

Loss of sense of smell, chronic severe constipation and sleep disturbances characterized by marked hyperactive-type behaviors may precede motor symptoms for years and may characterize the peripheral mechanism of the disease.

The symptoms of the disease include rest tremor in one hand (usually starting in one hand and then appearing in the other), difficulty writing, slowness and rigidity of movements and balance disturbance.

Slow movements (bradykinesia) are seen in almost all patients. Patients walk more slowly, with a tendency to bend forward, take small steps and have balance problems mainly when turning around themselves. They stumble and/or fall. Lack of facial expressiveness and expressive movements of the hands during speech are early characteristic symptoms of the disease. When walking, the upper limbs do not swing and arthritis often develops in the shoulders. The onset of walking is slow and hesitant, as if the feet were stuck to the floor. Dressing and writing begin to become increasingly difficult. Speech becomes weaker and harder to understand. Swallowing is also affected.

Other symptoms may include pain and discomfort in the hands and feet, neuralgia, anxiety and depression, slowness of thought and memory, and restless sleep. Constipation and urination problems are common, and sexual problems may also occur.

Treatment of Parkinson's disease, it is noted, aims to administer effective drugs against the symptoms of the disease. Antioxidants such as vitamin C and vitamin E, selegiline and polyunsaturated fatty acids may slow the disease. Some of the newer drugs (such as rasagiline and/or pramipexole) may also slow down the progression of the disease. Good physical fitness (exercise, physiotherapy, occupational therapy and various other methods) helps improve movement disorders and slows down the progression of the disease.

Initially patients respond very well to drug therapy (honeymoon period) a period during which with the administration of drug therapy patients are relatively very well throughout the day. Later, however, problems occur (late complications), mainly with fluctuations in patients' mobility with alternating periods of bradykinesia, immobility and/or hypermobility (involuntary and continuous movements of the limbs and/or trunk. The above complications are due both to the progression of Parkinson's disease and to the side effects of the drugs themselves.

As mentioned, for several years now, drugs that enhance dopamine activity (such as bromocriptine, amantadine, pramipexole, ropinirole, rotigotine - the so-called dopamine agonists, but also rasagiline and selegiline - the MAO (monoamine oxidase) inhibitors) have been used as monotherapy at the beginning of the treatment of the disease. By postponing the start of dopamine administration from the beginning of the treatment of the disease, there has always been a perception that it may thereby delay the onset of late motor complications in the treatment of Parkinson's. Today, studies are being carried out with newer therapeutic preparations whose action lasts longer, (even a combination of direct and delayed-acting drugs), which are gastro-resistant and not destroyed in the stomach, or drugs that are absorbed through the olfactory mucosa, etc.

Today, studies are being carried out with newer therapeutic preparations whose action lasts longer, (even a combination of direct and delayed-acting drugs), which are gastro-resistant and not destroyed in the stomach, or drugs that are absorbed through the olfactory mucosa, etc. The reason why the researchers' efforts are focused on drugs that are not destroyed in the stomach or absorbed through the olfactory mucosa, skin or even administered directly into the intestine is entirely due to the disease itself, which essentially causes severe dysfunction in the stomach and the initial part of the intestine (the duodenum), with the result that several drugs are destroyed in the stomach and thus lose their efficacy before they are absorbed.

When severe dyskinesias and severe fluctuations in patients' mobility begin to occur (late complications), it is noted, therapeutic methods such as transdermal administration of the drug roticotine, placement of microelectrodes in the brain (Deep Brain Stimulation) and continuous dopaminergic stimulation with administration of dopamine gel (Gel-Duodopa) in the intestine may be used. Stem cell therapy and, more recently, stereotactic gene therapy using viral vector gene therapy are still under investigation. Even the combination of Deep Brain Stimulation and stem cell therapy.

"Today, surgical brain therapy refers to the stimulation of the hypothalamic nuclei of the brain (Deep Brain Stimulation- DBS) which is performed by implanting thin electrodes into the hypothalamic nuclei and connecting them to a small neurostimulator which is placed in the chest, under the skin. The above method is very effective in patients with severe mobility problems and severe dyskinesias (involuntary movements and dystonia). In recent years efforts have been made to develop and improve the method by placing additional electrodes in other nuclei/areas of the brain that can help balance the trunk both in the upright position and during walking (symptoms in which stimulation of the hypothalamic nuclei does not bring about a substantial improvement)," it adds.

In Cyprus, in the last fifteen years more than 40 patients have been operated on with the DBS method on the initiative of the Movement Disorders Clinic of the Cyprus Institute of Neurology and Genetics, who have shown significant improvement and are under close monitoring by specially trained and equipped staff. Since 2010 a Functional Neurosurgery team has been operating in Cyprus, consisting of neurosurgeons, neurologists and neurophysiologists and since 2012 until today more than 15 such procedures have been performed. The surgeries are performed at the Aretaios Hospital in Nicosia and the cost of performing them was entirely covered by the Ministry of Health. Today the above operation is covered by the Health Insurance Organisation.

It should also be mentioned that in the last few years we have advanced in Cyprus to the administration of dopamine (in gel form) in the intestine. We are very close, it is noted, to starting to provide this alternative treatment through the General Health System.

The Parkinson's Disease Association calls for infrastructure

The Parkinson's Disease Association is sounding the alarm about the prevalence of the disease and stresses the great importance of its course, early diagnosis and the right therapeutic approach, which is multifaceted, and calls for the creation of infrastructures to receive patients, support groups and training programmes for carers.

On the occasion of today's World Day for Parkinson's Disease, the Association says that early and correct treatment of these patients is important, since the progression of the disease depends on it.

It is noted that Parkinson's disease must, in the majority of cases, be treated collectively by a team made up of various specialties and always in collaboration with the patient and his/her environment.

The Association calls for the establishment of teams on a permanent basis so that all patients receive the same appropriate and defined treatment.

It also calls on the State to set up support groups for each patient's immediate family, and for the Association to support the creation of infrastructure to accommodate these patients, noting that this can be done using EU funds.

We ask, they say, for the social state to draw up training programmes for those who undertake the difficult task of caring for our patients.

As mentioned, Parkinson's disease has been proven to be the second most common degenerative brain disease. As a disease, it refers not only to the patient himself, but also to those around him, since it is a disease that the patient's environment also has to deal with, since it is de facto obliged to adapt its daily life based on the needs of its own person diagnosed with Parkinson's Disease.

We are now guiding patients and their close family environment, it is noted, and we call on them to demand, immediately after diagnosis, full information about the disease, how it progresses, about the treatments available and how they are applied, but also, in each case, to ask for information about their rights and to demand them.

"People with Parkinson's disease are among us, and they need the support of their family environment, but even more so the support of the state."

"People with Parkinson's disease are among us, and they need the support of their family environment, but even more so the support of the state. Let's take care of them, they deserve it," the statement concludes.

Source: CNA

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