Resting tremor, rigidity, postural instability, slowness of automatic movements, depression and slowness of speech. These are among the main symptoms associated with Parkinson, a "movement disease" resulting from the degeneration of a very limited area of the brain, the substantia nigra, which produces dopamine and helps coordinate motor activity. To learn more, Dire interviewed Dr. Giuseppe Frazzitta, head of the Neurorehabilitation Group at the Society of Hospital Neurosciences (SNO), during the 62nd National Congress of Hospital Neurological Sciences (SNO), which will be held in Florence from September 27 to 30, at the Palazzo degli Affari.
After Alzheimer's, Parkinson's is the most common degenerative disease: "It is certainly a very widespread pathology, although comparing Alzheimer's with Parkinson's disease in terms of severity and severity is, in my opinion, inappropriate," commented Dr. Frazzitta. "This is because Alzheimer's disease affects the cerebral cortex, while Parkinson's exclusively affects the substantia nigra." Today, approximately 300 patients in Italy live with this disease.
This number has grown over the last 30 years: "There are two reasons: the first is that the population is aging and therefore has a greater risk of developing it," the expert explained. "The second is that diagnoses have increased. This is because until the XNUMXs and XNUMXs, the onset of a mild tremor or slowed motor activity in an elderly member of the family was considered a normal part of their life, and the disease often went undiagnosed. Today, in short, the total number of patients is increasing, while the overall situation remains stable."
Parkinson's, meanwhile, predominantly affects the elderly but is not a disease of the elderly and, according to Dr. Frazzitta, has "never been" strictly speaking: "Parkinson's was first described in London (in the study 'An Assay on the Shaking Palsy') in 1817, when life expectancy was 39 years. Onset is generally between the ages of 45 and 55, but since this disease doesn't kill, all patients develop it at an advanced age. This is why we tend to think of it as a disease of the elderly."
Speaking of warning signs, Parkinson's is essentially a disease that causes impaired automatic movement. "A mild tremor may begin to appear in the patient, and this occurs in 50% of patients," Dr. Frazzitta noted, "but more often than not, the patient's family members notice slower movements or a foot that's perhaps 'shuffling' a little. Often, the patient doesn't notice these changes because they occur very slowly and don't have a significant impact on their overall clinical condition."
The hypothesis of a multifactorial origin of the disease, in which genetic and environmental components interact, is now accepted.
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Factors that can increase the risk of developing the disease include exposure to exogenous toxins such as pesticides, metals, and industrial chemicals, as well as lifestyle (diet and smoking). "The only certainty is that we know that pesticides and certain drugs facilitate damage to the substantia nigra," Frazzitta commented, "but this condition alone is not sufficient. The same can be said for those who smoke a pack of cigarettes a day without ever developing lung cancer; there always needs to be a predisposition."
There is currently no known cure for Parkinson's, but several treatments exist that can control the symptoms. "Unfortunately, we don't have a preventative therapy, that is, a way to make an early diagnosis that can then halt the progression of the degeneration. By the time the patient begins to experience symptoms," the expert noted, "the degeneration is essentially already complete: symptoms appear when 70% of the substantia nigra has already been destroyed. Even the most recent studies using monoclonal antibodies to eliminate alpha-synuclein proteins, which have been rightly or wrongly implicated as one of the causes of the disease, have been shown to have absolutely no effect on the progression of symptoms."
There are currently no drugs capable of reversing this disease, but it has been discovered that physical activity can play an important role, especially when combined with personalized training. In this regard, the MIRT (Multidisciplinary Intensive Rehabilitation Treatment) protocol, which involves a multidisciplinary rehabilitation approach for patients with Parkinson's disease, has proven effective in reducing the progression of motor symptoms, improving personal independence, and improving the patients' quality of life. The method, published in over 70 international scientific journals (including Nature Reviews Neurology), is developed by Dr. Frazzitta himself: "We have demonstrated that thanks to a multidisciplinary approach, that is, the intervention of various professionals (including the physiotherapist, the speech therapist, and of course the neurologist), the progression of symptoms, that is, the worsening of motor function, is slowed. This is true in both the initial and intermediate stages of the disease."
Until the 2000s, it was believed that the brain, once developed, was no longer capable of change. "But this has been widely refuted, including by Rita Levi Montalcini," Frazzitta recalled. "Movement rehabilitation is therefore essential: MIRT demonstrates that if a patient receives at least an hour of physiotherapy every day, this activity stops the progression of symptoms." The MIRT method, developed in 2, has been tested on approximately XNUMX patients and has been widely replicated "to our great satisfaction both in China and Tel Aviv." Furthermore, it is precisely this approach that forms the basis of the International Parkinson and Movement Disorder Society's guidelines for multidisciplinary patient care and for organizing Parkinson's centers.
But what is the situation in our country? "Unfortunately, in Italy, Parkinson's centers are generally staffed only by neurologists who prescribe medications. This is why we decided to open a network of MIRT centers, where, in addition to the neurologist, who does his or her part, patients can find all the different professionals they need. Unfortunately, the opening of the centers coincided with the outbreak of the pandemic, and we haven't been fortunate in this regard. Currently, there are eight centers (Pescara, Livorno, Venice, Turin, Como, Brescia, Pavia, and Sondrio), mostly in the north, where, as always, it's less complex to develop new projects," the neurologist concluded, "but the goal is to have a MIRT center for every region."
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