Parkinson's Is Far More Than a Tremor: What Is Really Happening in the Brain?
Video: Prof. Roy Alkalay in the Walla studio explains Parkinson's disease and new ways of coping / Editing: Sivan Shuster
When people hear the word Parkinson's, the first image that comes to many is a tremor in the hand. But behind that familiar picture lies a much more complex disease, one that can affect movement, sleep, mood, the digestive system, the confidence to leave the house, and the ability to plan an ordinary day. In the video podcast “Talking Parkinson's,” Prof. Roy Alkalay, a neurologist and director of the Movement Disorders Center in the neurology division at Ichilov Medical Center, seeks to broaden the perspective.
“Dopamine is a neurotransmitter in the brain that carries messages,” he explains. “The pathways that contain dopamine are damaged in Parkinson's disease, and when they are damaged, motor symptoms appear that we identify with the disease, such as tremor, slowness and muscle stiffness.” But לדבריו, this is only part of the picture. “Parkinson's is not only a disease of dopamine,” he emphasizes. “There is damage in other areas of the brain, which are not necessarily related to dopamine.”
Not just tremor, and not just in older age
One of the main myths surrounding the disease is that it belongs mainly to older people and is expressed mainly by tremor. In practice, Prof. Alkalay explains, the picture is more varied. “Tremor, slowness and muscle stiffness are the three well-known motor signs of the disease,” he says, “but there are also non-motor symptoms.”
Among the less familiar symptoms, he lists reduced sense of smell, constipation, sleep disorders, anxiety, depression and sometimes another type of cognitive difficulty, for example difficulty performing several tasks at once. “People can report a reduced sense of smell years before the motor symptoms,” he explains. There is also a certain sleep disorder in which people “shout, talk in their sleep, kick or fall out of bed,” and it is more closely associated with Parkinson's.
According to him, there is also greater openness around the disease today. “What is definitely greater is that people coping with Parkinson's are much more open to talking about the disease,” he says. “That way you can teach people, cope better, and spend less energy hiding and more energy dealing with the symptoms.”
When the day is divided into good hours and bad hours
One of the central challenges that appears as the disease progresses is fluctuation. Patients describe hours when they function better, alongside hours when the body struggles to respond. “There is a certain stage, for some people, when the medicine works, but it works for a few hours,” Prof. Alkalay explains. “Sometimes there are those who need to take it five or six times a day so there won't be ups and downs.”
This fluctuation is not only a medical matter. It affects the confidence to leave the house, the ability to work, drive, spend time with family or plan a simple activity. “Patients coping with these symptoms are a bit on a roller coaster,” he describes. “Sometimes they are down, sometimes they are up. And clearly something that balances that can significantly change quality of life.”
This is where more advanced treatment options come in. Without naming commercial products, Prof. Alkalay explains that there are surgical treatments such as deep brain stimulation, as well as continuous treatments intended to provide the substance that turns into dopamine in a more stable way. One option is a subcutaneous pump. “This is a treatment that was added to the health basket at the end of 2024,” he says. “It gives people a choice in how to manage the disease as well as possible.”
“There are more options, but also more responsibility”
Alongside advances in treatment, Prof. Alkalay emphasizes that there is no substitute for the patient’s own involvement. “The more people are involved in their own treatment, the better,” he says. “It is important to know that many of the symptoms and quality of life also depend on the patient, on how much physical activity they do, how active they are, how much they go outside.”
According to him, medication alone is not enough. “Just giving a Parkinson's medication and sitting at home waiting for it to improve, that will not happen,” he says. “You have to exercise, work on walking, physiotherapy.” He also mentions active groups such as ping pong, dancing and sailing for people with Parkinson's, and stresses the importance of a multidisciplinary framework: a nurse, social worker, occupational therapy, physiotherapy and speech therapy.
Even for those who feel the disease already runs their lives, he wants to leave a clear message: “If someone says the word fate, it is necessary to help change that. I am in favor of fighting.”
And in the end, perhaps this is the most important line: Parkinson's is a chronic and complex disease, but it is not only a story of loss. The better it is understood, the earlier changes are identified, and the more the available options are known, the more quality of life can be improved, day and night.
For personal stories, professional information and additional content on coping, treatment and quality of life alongside the disease, you are invited to enter the special content hub >> Talking Parkinson's
*The information in this article is provided as a public service and does not constitute medical advice or a substitute for consultation with a physician. Any change in treatment should be discussed with the treating medical team. Public service. Sponsored by AbbVie without involvement in the content
