How can we describe axial symptoms in Parkinson's disease? Are there any treatments to reduce these symptoms?
We thank Dr. Moreau of the Lille University Hospital and Cedric Heda for allowing us to relay this information and provide our expertise on the subject.
How are these axial symptoms defined in Parkinson's disease?
Axial symptoms are disorders of the body axis.
These symptoms usually appear in the advanced stage of the disease, after 10 years of evolution. In some forms of the disease, these disorders may occur earlier (about 3 years after diagnosis).
The 4 main axial symptoms in Parkinson's disease are: walking disorders, posture disorders, speech disorders and swallowing disorders.
What are the neurological bases for the development of these axial symptoms?
Parkinson's disease results from a progressive degradation of dopaminergic neurons and a decrease in the concentration of dopamine in the central nervous system.
As axial symptoms are poorly affected by conventional dopaminergic treatment, it is assumed that they are the result of neuronal degeneration in other brain areas.
It is not yet possible to know the precise origin of these axial symptoms. However, some studies indicate that an impairment of the GABAergic and glutamaergic system could explain the appearance of these symptoms.
What are the impacts of these symptoms on the patient's life?
These disorders are very important to be aware of for the following reasons:
They occur in 80% of patients after 10 years of disease progression and negatively impact the patient's quality of life.
They are not very sensitive to conventional treatment (drugs, deep brain stimulation).
Walking and posture disorders often lead to repeated falls.
Swallowing disorders can lead to wrong way and must therefore be detected and taken into account rapidly by the family and friends.
What are the solutions to manage these axial symptoms?
These disorders must be managed by a multidisciplinary approach, with physiotherapists and speech therapists playing a key role in the rehabilitation of the patient.
For speech disorders: treatment by a speech therapist to help maintain speech.
For swallowing disorders: speech therapist and neurologist to provide full treatment. Appointment with a nutritionist and notification of caregivers. If the problems are too severe, consider enteral nutrition (through the digestive tract directly).
For postural disorders: physical therapy with postural and axial musculature rehabilitation. It is possible to consider the installation of a neck brace or a corset in the case of a deformation of the spine and the development of a camptocormia.
For gait disorders (festination, freezing): physical therapy with rehabilitation oriented on gait disorders. The use of sensory cues (auditory or visual) can be used to support this therapy and to limit freezing of gait. The rehabilitation method implemented by WALK consists in using sound stimulation to support the patient's walking, allowing him to recover a smooth and rhythmic gait. It is recommended to practice a regular physical activity, and to privilege activities involving the mobilization of motor capacities and rhythm (dance, tai-chi, Nordic walking).
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References
O’Gorman Tuura, R.L., Baumann, C.R., Baumann-Vogel, H., 2018. Beyond Dopamine: GABA, Glutamate, and the Axial Symptoms of Parkinson Disease. Front. Neurol. 9.
Ziégler, M., 2006. Advanced Parkinson’s disease. Psychologie & NeuroPsychiatrie du vieillissement 4, 5–10.
