Parkinson ' s Disease "From Past to Future"

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Hülya ÖZDEMİR
Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Tıbbi Farmakoloji ABD, Van, Türkiye
Article Language: TR
Parkinson hastalığı (PH); tremor, rijidite, bradikinezi ve postural instabilite gibi motor semptomlar ve depresyon, hipozmi, konstipasyon gibi non-motor semptomlarla seyreden, dopaminerjik nöron kaybı ile karakterize ilerleyici bir nörodejeneratif bir hastalıktır. Daha çok erkeklerde ve özellikle 60 yaşın üstündeki bireylerde son zamanlarda ise 35 yaş üzeri gençlerde de görülmeye başladığı bildirilmiştir. Son yıllarda yapılan çalışmalarda PH'nin prevalansının iki kat arttığı, Alzheimer ve diğer nörodejeneratif hastalıklar içerisinde artış hızının çok fazla olduğu belirtilmektedir. Parkinson hastalığı yaşlılık hastalığı olarak tanımlansa da son çalışmalarla yaşlanmanın yanı sıra genetik yatkınlığın ve bazı çevresel risk faktörlerinin de hastalığın gelişimi ve ilerleyişini hızlandırdığı gösterilmiştir.

PH'yi ilk 1817 yılında tanımlayan İngiliz bilim insanı Dr. James Parkinson'dur. Parkinson, 'An Essay on the Shaking Palsy' isimli eserinde PH'den 'titrek felç' olarak bahsetmiştir. James Parkinson'un 'sinsi başlangıçlı ve ilerleyici' olarak tanımladığı hastalık, daha sonra 1937 yılında, Fransız bir araştırmacı hekim olan Jean Marie Charcot tarafından incelenmiş, hastalığa ait olan bradikinezi, rijidite, mikrografi ve duyusal değişiklikler ortaya konmuş ve hastalığa onu ilk tarif eden kişinin adına ithafen 'Parkinson' adı verilmiştir.

PH; nedeni tam olarak bilinmeyen ve bir o kadar da karmaşık nörolojik bir hastalıktır. Parkinsonizm uzun süre, Lewy cisimcikleri ile ilişkili klasik motor özelliklerin ve substantia nigra'daki dopaminerjik nöronların kaybı olarak tanımlanmıştır. Parkinson hastalığının patogenezi tam olarak anlaşılamadığından tedavisinde dopamin replasmanı yaygın olarak kullanılmaktadır. L-dopa'nın hastalığın semptomlarını düzelttiğinin keşfi, PH tarihinde dönüm noktası olmuştur. Gerald, L-Dopa'yı hastalarda tedavi amaçlı ilk kullanan nörologdur. Mevcut dopaminerjik tedaviler, non-motor semptomlara ve nörodejenerasyona etkili değildir. Gerald ayrıca PH'de Monoamin oksidaz inhibitörleri (MAOi) ve direkt etki gösteren dopamin agonistler (DA) gibi diğer tedavi yaklaşımlarının da öncüsüdür. Ek olarak, bu ilaçların ciddi motor dalgalanmalara neden olması ile hastalığın ilerleyişini yavaşlatacak mevcut bir strateji olmaması, yeni ilaçlara olan ihtiyacı artırmıştır. Bu amaçla, yeni dopaminerjik ilaçlar, sürekli dopaminerjik ilaç salımı yapabilen farmasötik formlar, biyoterapötik ajanlar ve alfa-sinükleini hedefleyen immünoterapiler araştırılmaktadır. Yeni ilaç çalışmaları ve alternatif tedavi arayışları hâlen devam etmektedir.

Biz bu kitapta PH'ye dair birçok konunun anlatılması ile araştırıcıya yararlı olmasını ve aynı zamanda PH'nin tarihçesinden deneysel modellerine, hâlihazırda uygulanan tedavilerden yeni tedavi stratejilerine ve alternatif tedavi yöntemlerine kadar Parkinson hakkında yapılan son çalışmaları ve güncel yaklaşımları bütünsel bir bakış açısıyla okuyucuya sunmayı amaçladık. Bunun yanısıra PH'nin mikrobiyota ve beslenme ile ilişkisini araştırıp çevresel faktörler ile genetiğin hastalığa yakalanmada ve tedavide ne kadar etkili olduğunu da ortaya koymayı istedik. Son derece güncel ve önemli olan COVID-19 virüsünün Parkinson hastalarındaki seyrini de ele aldık. Dolayısıyla PH ile ilgilenen herkes için özel bir kitap oldu. Bu kitabın gerçekleşmesinde emeği geçen tüm değerli yazarlara katkılarından dolayı teşekkür eder ve ayrıca bu kitabın hazırlanmasında desteğini esirgemeyen Türkiye Klinikleri'nin değerli çalışanlarına da teşekkürü bir borç bilirim.

Saygılarımla...

Prof. Dr. Hülya ÖZDEMİR
Editör
Parkinson's disease (PD); It is a progressive neurodegenerative disease characterized by loss of dopaminergic neurons, which is characterized by motor symptoms such as tremor, rigidity, bradykinesia and postural instability, and non-motor symptoms such as depression, hyposmia, and constipation. It has been reported that it is mostly seen in men, especially in individuals over the age of 60, and recently in young people over the age of 35. In recent studies, it has been stated that the prevalence of PD has doubled, and the rate of increase is very high in Alzheimer's and other neurodegenerative diseases. Although Parkinson's disease is defined as a disease of old age, recent studies have shown that genetic predisposition and some environmental risk factors, as well as aging, accelerate the development and progression of the disease.

The British scientist who first described PH in 1817, Dr. It is James Parkinson. Parkinson referred to PD as 'shaking palsy' in his work 'An Essay on the Shaking Palsy'. The disease, which James Parkinson described as "insidious onset and progressive", was later examined by Jean Marie Charcot, a French research physician, in 1937, the bradykinesia, rigidity, micrographia and sensorial changes belonging to the disease were revealed and the disease was named as 'Parkinson', in honor of the person who first described it.

PH is a complex neurological disease of unknown cause. Parkinsonism has long been defined as the loss of classical motor features associated with Lewy bodies and dopaminergic neurons in the substantia nigra. Since the pathogenesis of Parkinson's disease is not fully understood, dopamine replacement is widely used in the treatment. The discovery that L-dopa improves the symptoms of the disease was a landmark in the history of PD. Gerald was the first neurologist to use L-Dopa for therapeutic purposes in patients. Current dopaminergic treatments are not effective on non-motor symptoms and neurodegeneration. Gerald is also a pioneer of other treatment approaches in PD, such as monoamine oxidase inhibitors (MAOi) and direct-acting dopamine agonists (DA). In addition, the fact that these drugs cause severe motor fluctuations and there is no existing strategy to slow the progression of the disease has increased the need for new drugs. For this purpose, new dopaminergic drugs, pharmaceutical forms capable of sustained dopaminergic drug release, biotherapeutic agents and immunotherapies targeting alpha-synuclein are being investigated. New drug studies and alternative treatments are still in progress.

In this book, we aimed to be useful to the researcher by explaining many topics related to PD and at the same time to present the latest studies and current approaches on Parkinson's from the history of PD to experimental models, from current treatments to new treatment strategies and alternative treatment methods, with a holistic perspective. In addition, we wanted to investigate the relationship between PD and microbiota and nutrition and to reveal how effective environmental factors and genetics are in catching and treating the disease. We also discussed the course of the extremely current and important COVID-19 virus in Parkinson's patients. So it has become a book for anyone dealing with PD. I would like to thank all the valuable authors who contributed to the realization of this book, and I would also like to thank the valuable staff of Türkiye Klinikleri for their unwavering support in the preparation of this book.

Your's respectfully...

Prof. Dr. Hülya ÖZDEMİR
Editor

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