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There are three phases of Parkinson’s disease. The first is the preclinical phase, in which no symptoms are present. This phase is currently being researched to find clues for early detection of Parkinson’s disease.

The so-called prodromal stage follows and can last from years to decades. This is when the early symptoms appear: reduced sense of smell (hyposmia), depression, constipation and sleep disturbances. Finally comes the clinical phase, in which the movement disorder begins and the diagnosis can be made.

Diagnosis of Parkinson’s syndrome

In order to make the right diagnosis, first of all a detailed conversation and a physical examination must take place. To exclude secondary or atypical Parkinson’s syndrome, a magnetic resonance tomography of the brain is performed. In the case of Parkinson’s disease, this should be inconspicuous.

A further examination is the L-dopa test, in which the effectiveness of a dopamine preparation is tested. In the case of Parkinson’s disease, it should significantly improve the symptoms. In addition, there is the possibility of special imaging diagnostics (IBZM-SPECT) if the distinction between Parkinson’s disease and atypical Parkinson’s disease is not clear.

Treatment of a Parkinson’s syndrome

The main goal of treatment for Parkinson’s disease is to correct the dopamine deficiency. There are several preparations for this. However, the most important one is L-dopa.

The choice of medication depends on the severity of the symptoms, the age of the patient and concomitant diseases. In the initial phase with milder symptoms, a so-called MAO-B inhibitor can be taken. If the symptoms are more pronounced and the patient is under 70 years of age, a non-ergot dopamine agonist is given.

If this is insufficient, it can be combined with L-dopa. If the patient is over 70 years old or seriously ill, L-dopa is started directly. In the course of time, the effect of L-dopa may become less reliable and fluctuate during the day.

In order to avoid these fluctuations, L-Dopa is combined with other drugs that stabilize its effect. In cases of swallowing disorders and digestive problems, there is also the possibility of placing a probe into the intestine via the abdominal wall and administering the medication through it. Another possibility would be a pump that is placed under the skin. In some cases, deep brain stimulation can also be considered, in which a kind of pacemaker controls the movement centre in the brain. Finally, supportive therapies such as physiotherapy, speech therapy and occupational therapy are very important to slow down the symptoms and avoid complications.

Duration of a Parkinson’s syndrome

The duration of a Parkinson’s syndrome depends on the form. With secondary forms, healing can occur by eliminating the cause. The other forms are unfortunately not curable and therefore the duration is lifelong.