PATOFYSIOLOGIEN TIL PARKINSON SYKDOM I LYS AV HEIKO BRAAK SIN TEORI

Abstract

Parkinson’s disease (PD), first described by James Parkinson in 1817, is a chronically progressive neurodegenerative disorder with a prevalence of 1-2 % in people over the age of 50. Fully developed PD comprises motor symptoms such as tremor, rigidity, brady- and hypokinesia. The hallmark of PD is degeneration of the DAergic nigrostriatal neurons and DAdeficiency in the striatum, a pathway essential for motor function. Another important pathological feature in PD is the presence of filamentous, cytoplasmic inclusions called Lewybodies. Lewy bodies are present in DAergic neurons of the substantia nigra as well as in other brain regions such as the cortex. Neuropathological damage to the amygdala, hippocampus, cholinergic cell bodies and other catecholaminergic cells is also common.

Dr. Heiko Braak, from the Institute of Clinical Neuroanatomy, J. W. Goethe University, Germany, shared his own insights about the progression of Parkinson's disease (PD) in 2003. Specifically, he identified 6 major stages about the process of PD. Moreover, he and some of his colleagues have found that idiopathic Parkinson's disease (IPD) is a multi-system disorder in the course of which only a few predisposed nerve cell types in specific regions of the human brain become progressively involved. He found that the underlying neuropathological process begins in clearly defined sites and advances in a predictable sequence.

When Braak first published his theory many neurologist all over the world found it revolutionary in its new way of describing the six stages in patophysiology. Since then, the Braak-theory has got neurologists around the world to discuss whether it is true or not. Most of the discussion is related to whether all patients can be put in the same stages of the process in PD. Some find it hard to believe that the underlying neuropathological process begins in the same clearly defined sites in all patients with PD. Why don’t all patients have the same symptoms if the disease advances in a predictable sequence. Also, why have Braak defined six different stages and called the three first only pre-symptomatically. Up to date we are used to define fully developed PD with motor symptoms such as tremor, rigidity, brady- and hypokinesia. If Braak’s theory is true, the definition has to be altered. My intention in this article is to see whether this theory can explain all forms of parkinsonism, it’s pathophysiology, symptoms and treatment, including the non-motoric symptoms.