Parkinson's syndrome. Parkinsonism is a syndrome that can destroy life The most common etiological form of parkinsonism

17.05.2020

Parkinsonism is a neurological syndrome characterized by voluntary movement disorder. This pathology accompanies a variety of diseases and always causes slowness of movement, trembling of the limbs, muscle stiffness.

Medical history

The symptoms of the disease in neurology have been known for a long time. But they are most fully described in Essay on Shaking Palsy by James Parkinson.

Its publication took place in 1817. In this work, the distinguishing features of this disease were given. The doctor noted a strange condition, which was accompanied by impaired motor functions, resting tremors, and muscle stiffness.

In addition, the scientist was able to assess the dynamics of these signs as the pathology develops. After that, a question arose regarding the etiology of the disease.

So, Edouard Brissot put forward a hypothesis that the legs and the subthalamic nucleus of the brain are responsible for the development of pathology. Frederick Lewy was able to identify specific cellular inclusions, which were then called "Lewy bodies". And the Russian neurologist Tretyakov K.N. found that pathological disorders develop in the substantia nigra.

Forms

Specialists distinguish two forms of parkinsonism:

Primary... This species is Parkinson's disease, which is directly related to the death of nerve cells. In this case, the following features are characteristic:

elderly age;
the presence of at least two main manifestations of pathology;
asymmetry of signs or unilateral manifestation.

Secondary... Such parkinsonism is associated with external factors. These include infections, medication use, and injury. This type of pathology is characterized by:

vascular disorders;
vegetative disorders;
acute onset of the disease with subsequent stabilization;
symmetry of features;
negative event before the onset of symptoms - trauma, contact with chemicals, excess dosage of antipsychotics, encephalitis.

Etiology

The development of the disease is associated with a variety of reasons that affect the subcortical ganglia. These include:

insufficiency of enzyme structures;
poisoning with toxic substances, including medications;
encephalitis;
brain tumor;
brain injury.

This condition is accompanied by a decrease in the level of catecholamines in the substantia nigra and caudate nucleus of the brain, which causes disturbances in the work of the extrapyramidal system.

Neurophysiological causes of parkinsonism

Control over movements occurs with the help of neurotransmitters, which are biologically active components that transfer impulses between cells. An imbalance between these substances leads to a disorder of the body's motor functions.

Parkinsonism is a consequence of this imbalance. In patients suffering from this disorder, the level of excitatory neurotransmitters, namely glutamate, exceeds the level of inhibitory components - dopamine.

That is why the principle of disease treatment is to artificially maintain the correct balance of neurotransmitters.

Symptoms

Typical movement disorders in parkinsonism are:

Trembling or. This is perhaps the most frequently mentioned feature, although experts say that it does not always appear. Tremor occurs as a result of rhythmic muscle contraction. When performing directed movements, the tremor may disappear or become less pronounced.
Muscle stiffness or stiffness. This symptom is associated with an increase in muscle tone in the limbs. Also, this symptom can manifest itself in a stooped posture of a person. Stiffness often causes pain, which forces a person to see a doctor. If the doctor does not identify other manifestations, he may put misdiagnosis - for example, rheumatism.
Slowing down and reducing the number of movements. The patient may have great difficulty starting to move. In addition, others may notice the impoverishment of a person's gestures and facial expressions. As the disease progresses, a person may have difficulty changing the position of the torso during sleep.
Imbalance or postural instability. With this disease, postural reflexes may be completely absent or significantly weakened.
It is not uncommon for people with parkinsonism to lose their balance and may even fall over. This symptom is considered one of the main ones in this pathology.

A patient with parkinsonism describes her feelings, symptoms and talks about what treatment was prescribed in a simple clinic:

Classification of types of parkinsonism

It is accompanied by impaired speech, coordination of movements, swallowing and other signs. In this case, there is no resting tremor.

The development of this condition may be based on impaired cerebral circulation. The hallmarks of this form of parkinsonism include:

symmetry of symptoms;
lack of tremor;
the predominance of signs in the legs and axial sections;
no deterioration with the abolition of dopaminergic drugs;
change in gait at the onset of the disease.

This disease develops as a result of the appearance of cerebrovascular disorders. This could be:

Lesion of small arteries of the brain.
Brain damage of a cardiogenic nature.
Disruption of the large arteries of the brain.

For the purpose of diagnosis, perform. As a rule, this disease has characteristic clinical symptoms, and all changes can be easily identified through this type of study.

Neuroimaging may also be required to rule out the presence of a tumor. Modern treatment of vascular parkinsonism includes a set of measures aimed at preventing further damage to cerebral vessels.

Most often, antiparkinsonian drugs are prescribed:

dopamine receptor agonists;
amantadine;
levodopa drugs;
mAO-B inhibitors.

Treatment of this type of parkinsonism is carried out in many clinics in Russia and other countries. Among domestic institutions, one can single out "Euromedprestige" and "Clinic of restorative neurology".

As for other countries, it is worth paying attention to Israeli clinics - Sheba Medical Center, Hadassah Hospital, Assuta Hospital. The German clinic Friedrichshafen deals with the treatment of this pathology quite successfully. And in the Czech Republic, you can contact the Clinic of Neurology.

It should be borne in mind that vascular parkinsonism usually has a progressive course. However, the forecast of the rate of its development directly depends on the dynamics of the vascular process and the timeliness of the assistance provided.

Toxic parkinsonism

It develops as a result of poisoning with toxic substances. Often, its appearance is caused by the ingestion of carbon monoxide, manganese, lead, carbon disulfide, ethyl or methyl alcohol.

Medicinal parkinsonism

Its appearance is caused by the use of various medications - for example, antipsychotics.

Post-traumatic parkinsonism

This form of pathology develops as a result of damage to the brain structures - very often it occurs in boxers. One of the varieties of the disease is Martland syndrome, which causes dystrophic changes in the brain.

Post-encephalitic parkinsonism

This species is characterized by an infectious origin. Its development is associated with disorders in the upper brainstem in the case of epidemic encephalitis. Moreover, a distinctive symptom of such parkinsonism is oculomotor disorders.

Juvenile parkinsonism

This term is understood as a special form of primary parkinsonism, which is distinguished by hereditary origin. It is most commonly found in women and is inherited in an autosomal recessive manner.

Manganese parkinsonism

This syndrome is associated with an increase in the content of manganese in the body. Most often, such intoxication is observed in workers employed in the mining industry and among welders.

Atherosclerotic parkinsonism

Usually appears due to diffuse atherosclerotic lesions of the brain, which cause the development of lacunar strokes. This pathology is difficult to treat and in a short time becomes the cause of the patient's disability.

It is characterized by:

rapid development;
incomplete effect of the use of levodopa drugs;
manifestations atypical for Parkinson's disease - disorder of cognitive functions, postural disorders, pyramidal signs, autonomic dysfunctions, cerebellar signs, etc.

Timely diagnosis of atypical forms of the disease is very important for the choice of therapy tactics. In addition, making the correct diagnosis will help to avoid not only ineffective, but even dangerous treatment.

Drugs that increase the risk of parkinsonism

The development of the disease can be provoked by such drugs:

Antipsychotics.
Drugs that reduce the turnover of dopamine in synapses are alpha-methyldopa.
Dopamine receptor antagonists - flunarizine and metoclopramide.
Serotonergic drugs that reduce neuronal activity - fluoxetine.
Agents that reduce the sensitivity to dopamine of the postsynaptic membrane are lithium agents.
Central sympatholytics that reduce dopamine stores are rauwolfia drugs.

Also, the development of the disease can be influenced by drugs such as amoxapine, diprazine, calcium antagonists.

Parkinsonism is a serious pathology that leads to dangerous health consequences. Despite the fact that the reasons for its development are not fully understood, in the arsenal of doctors there are quite effective means that help stop the progression of this disease. Therefore, when a disease appears, you should immediately contact a specialist.

In the video, Alexander Misharin, he is 53 years old, 13 of them are diagnosed with parkinsonism, but he does not give up and looks healthy enough, which is facilitated by physical exercises:

The content of the article

In 1817, the English physician James Parkinson described a disease, the main manifestation of which was general stiffness and trembling, and called it the not entirely successful term "paralisis agitans" - "trembling paralysis". In 1877, the famous French neurologist Charcot gave more detailed description clinical symptoms of the disease and suggested another name - Parkinson's disease.

Epidemiology of Parkinson's Syndrome

The disease occurs among the population of all continents of the globe. Its frequency, according to different authors, ranges from 60 to 140 per 100,000 population, sharply increasing with age. According to Kurland (1958), in the age group over 60 years old, patients account for 1%, and in the population over 85 years old - 2.6%. The onset of the disease most often refers to the age of 55-60 years. Men get sick more often than women.

Etiology of Parkinson's Syndrome

Clinical manifestations Parkinson's syndrome can be caused by a wide variety of factors. During an epidemic of lethargic encephalitis, in most cases, the development clinical picture the diseases were associated with the previously transferred Economo encephalitis. It is assumed that parkinsonism syndrome can be caused by other infections, including the Coxsackie virus type B, Japanese encephalitis virus, St. Louis encephalitis, etc., although such cases are much less common than encephalitis during the epidemic. A certain role of slow infections in the origin of this disease is also not excluded. But all these assumptions require further proof.
The combination of parkinsonism syndrome with atherosclerosis was the reason to consider the latter one of the possible reasons diseases, however, specially conducted studies have shown that the severity and prevalence of cerebral vascular lesions in Parkinson's syndrome does not differ from those in the control group of patients of the same age and sex.
Undoubtedly, cases of cerebral circulation disorders in the substantia nigra and other subcortical nodes are possible. As a result, symptoms characteristic of parkinsonism occur, but such cases are relatively rare. Currently, the prevailing opinion is that cerebral atherosclerosis, as a rule, is not the cause of the development of parkinsonism. These two diseases - parkinsonism and atherosclerosis - run in parallel and only a small proportion of patients who have indications of an acute onset of manifestations of parkinsonism, accompanied by the above neurological symptoms, can be attributed to atherosclerotic parkinsonism.
A hereditary inferiority of the subcortical ganglia can play a certain role in the occurrence of akinetic-rigid syndrome. These cases are referred to as Parkinson's disease.
More etiologically defined is the group of patients with drug-induced parkinsonism. Widespread use in medical practice drugs of the phenothiazine series, derivatives of rauwolfia, methyldopa are often accompanied by the onset of parkinson's syndrome. The onset of manifestations of parkinsonism syndrome can also be caused by multiple head injuries (in boxers), intoxication with manganese, carbon monoxide, brain tumor, subdural hematoma and many other factors. The detection of a decrease in the content of catecholamines in the basal ganglia in these patients revealed the common pathogenetic mechanisms of akinetic-rigid syndrome, regardless of etiological factors.
It became obvious that certain features of the syndrome, which were previously given differential diagnostic significance, are determined not by etiological factors, but by the localization of the process, its prevalence and severity. So, for example, oculogyric crises, which have long been regarded as a specific symptom of parkinsonism syndrome of post-encephalitic genesis, are more common with an overdose of phenothiazine drugs.
Thus, holding differential diagnosis according to etiological data is very difficult, a striking example of which is a significant discrepancy in statistical data on etiological forms published by different authors. It is most likely to assume that in all cases of Parkinson's syndrome there is a genetically determined inferiority of the enzyme systems that control the exchange of catecholamines in the brain. The most varied external factors, including atherosclerosis, infections, intoxication, repeated craniocerebral trauma, exhibit a genetically determined inferiority of the subcortical structures. This can be confirmed by observations of the course of drug-induced parkinsonism syndrome. In some patients who took large doses of phenothiazine drugs, the developed parkinsonism syndrome disappears after drug withdrawal, while in others the manifestations of the disease, arising against the background of taking phenothiazine drugs, remain after their withdrawal.
In most cases, the true cause of the disease remains unclear. Anamnestic data can serve as the only criterion of its etiological nature in the overwhelming majority of cases. Only in cases where the etiological factor (hypersomnia, oculomotor disorders, drug overdose, manganese intoxication) is beyond doubt can we talk about one or another etiological form of the disease.

Pathological anatomy of Parkinson's syndrome

It is assumed that the basal ganglia are the main substrate affected in parkinsonism. Back in 1919, Tretyakov suggested that the cause of the disease was the lesion of the substantia nigra. This assumption was then repeatedly confirmed and refined by other authors. It has been shown that in Parkinson's syndrome there are degenerative changes in the area of \u200b\u200bthe compact zone of the substantia nigra and the gray spot, which consist in a decrease in the number of cells and proliferation of glial elements. Many of the neurons of the substantia nigra that have not yet died are depigmented and do not contain myelin. This is especially evident with Parkinson's syndrome, which developed on one side.
The detection in ganglion cells of peculiar clusters of spheroid glial inclusions, called Lewy bodies, was considered specific for Parkinson's disease. Usually they are located in the substantia nigra, in the gray patch of the bridge tire, in the dorsal nuclei vagus nerve, sympathetic ganglia. Lewy bodies are found less frequently in postencephalitic parkinsonism. For postencephalitic parkinsonism, neurofibrillary changes in ganglion cells are more characteristic.
The changes found in the globus pallidus are less definite. In some cases, the atrophy of this structure is determined, in others, the phenomena of demyelination are detected, and in many cases no changes are found at all. Consequently, akinetic-rigid syndrome is not pallidary, as previously assumed, but a nigral syndrome. It should be emphasized that the described histopathological features have a very relative diagnostic value, since the severity of the detected morphological changes can vary quite widely.

Parkinson's syndrome pathogenesis

The basis of all forms of parkinsonism syndrome is a sharp decrease in the concentration of dopamine in the subcortical nodes and substantia nigra. Normally, the concentration of dopamine in these formations is hundreds of times higher than the concentration of dopamine in other brain structures, which undoubtedly indicates its important role in the activity of the extrapyramidal system. The destruction of the substantia nigra in animal experiments is invariably accompanied by a decrease in the concentration of dopamine in the striatum. The explanation for this is found in the fact that dopamine, produced in the substantia nigra, enters the striatum through the nigrostriatal pathways. The destruction of the substantia nigra by the pathological process in parkinsonism syndrome sharply reduces the level of dopamine in the striatum. This disrupts the normal balance between dopamine and serotonin on the one hand and acetylcholine and histamine on the other. The specific mechanisms of the implementation of biochemical disorders in movement disorders, characteristic of parkinsonism syndrome, have not been definitively established.
It is assumed that the main defect is a violation of the relationship between the alpha and gamma systems with suppression of gamma and increased alpha activity, which leads to an increase in the tonic reflex to stretch and the appearance of rigidity and hypokinesia.

Parkinson's syndrome clinic

The main manifestations of parkinsonism are hypokinesia, rigidity and tremor. Typically, these symptoms develop gradually. One of the first manifestations of hypokinesia can be a change in handwriting - the size and clarity of the letters are reduced. Gradually there is a feeling of muscle stiffness. As the disease progresses, muscle stiffness increases, which is accompanied by the development of a characteristic posture with a predominance of flexors: the head is bent and tilted forward, the arms are bent at the elbow joints and brought to the body; the back is bent, the legs are slightly bent at the hip and knee joints. The general stiffness of the patient is accompanied by a slowdown and poverty of movement. Hypomimia is striking. The face becomes masked, sometimes expressing a frozen grimace of surprise or sadness. The change from one emotional manifestation to another is much slower than normal, there are no blinking movements of the eyelids, speech becomes monotonous and indistinct. Patients may long time Maintain postures that are not possible for healthy people, such as lying with your head above a pillow (called the air cushion symptom). The gait changes dramatically. The first steps are taken with great effort, and then the patient moves in small, mincing steps, the pace of which gradually increases, the patient seems to "catch up" with his own center of gravity (propulsion). It is as difficult for him to stop as it is to start moving.
At the same time, paradoxical kinesia can be observed: the patient, with difficulty getting up from the chair, can easily run up the stairs, walk, stepping over small obstacles, and dance. Temporary "disinhibition" can occur under the influence of the effects of joy or fear.
In the study of passive movements in patients, an increased resistance is felt, expressed during the entire time of performing the movements, both during flexion and extension (extrapyramidal rigidity). Extension of the arms in the elbow joints is accompanied by a sensation of uneven resistance to the movement produced, which creates the impression that the gear teeth meshing with each other are jumping off - a symptom of a "cogwheel". The position of the fingers of the hand is characteristic - they are bent at the metacarpophalangeal joints, the first finger is brought to the palm. In most cases, involuntary movements - tremors - are noted in the fingers. The most typical rhythmic movements of the first finger of the hand towards the rest, reminiscent of the counting of coins or the rolling of pills. Usually, the tremor is more pronounced at rest and decreases markedly during the execution of targeted movements. Starting with the fingers, the tremor as the disease progresses spreads to other muscle groups, capturing the lower jaw, tongue, lips, lower limbs... The propagation speed and amplitude of jitter can vary widely. Emotional stress, increased attention usually increase the severity of the tremor. It disappears during sleep.
A characteristic feature of tremor in parkinsonism is its frequency - 4-8 vibrations per second. The frequency of tremors in different parts of the body may be different, which indicates the absence of a single generator of parkinsonian rhythm. A significant increase in rigidity in the later stages of the disease may be accompanied by a decrease in the amplitude of the tremor or even its complete cessation.
Quite often, patients develop accommodation disorders, less often blepharospasm. Oculogyric crises are difficult to tolerate by patients - involuntary prolonged deviation eyeballswhich occurs more often when looking up. As already mentioned, ocular crises were considered characteristic feature parkinsonism of postencephalitic genesis, however, recently they are often observed in drug parkinsonism. Most patients have disorders of autonomic functions: hypersalivation, greasiness of the face, excessive play of vasomotors, increased sweating or, conversely, dry skin, urinary disorder. Patients often complain of constipation due to atony of the large intestine. Vegetative crises occur relatively often, accompanied by sharp flushing of the face, excessive sweating, tachycardia, emotional stress. Intelligence in parkinsonism usually does not suffer, but quite often there is increased irritability, clinginess, tearfulness, depression, sometimes leading to suicidal actions.
Pyramidal symptoms are uncommon for Parkinson's syndrome. The appearance of pathological reflexes in other cases is associated with the effect on the spinal cord of osteophytes of the cervical vertebrae.
The ratio of the severity of the main symptoms of the disease in different patients can vary significantly. In this regard, akinetic-rigid, rigid-trembling and trembling forms are distinguished. Identifying the form of the disease is a very important factor when choosing a method of treatment.
Parkinson's syndrome diagnosis does not present any particular difficulties and in the overwhelming majority of cases is determined at the first examination. However, there may be cases where it is necessary to carry out a differential diagnosis with some similar forms. Parkinsonian tremor should be distinguished from increased physiological tremor that occurs in healthy people as a result of emotional stress, in the elderly, in patients with alcoholism, with thyrotoxicosis. The frequency of increased physiological tremor is usually higher than that of Parkinsonian (10-12 Hz), tremor of the fingers is not accompanied by adduction and abduction of the first finger in relation to the rest. The speed of other movements is not reduced. The same signs characterize genetically determined essential tremor. Atrophic processes in the cerebellum, developing in some patients with age, may be accompanied by the onset of intentional tremor. In contrast to parkinsonian tremor, intentional tremor is not expressed at rest and is intensified when the hand moves towards a specific target, for example, the tip of the nose when performing a finger-nose test.
A clinical picture resembling Parkinson's disease can be observed in atherosclerotic dementia, accompanied by general apathy and increased muscle tone.
The detection of increased tendon reflexes, pathological reflexes, and pseudobulbar symptoms in them helps to differentiate this group of patients. When carrying out a differential diagnosis, a number of clinical syndromes, similar in their symptomatology to parkinsonism, but requiring different therapeutic approaches and differing in prognostic terms. This includes Shay-Drager syndrome, characterized by a combination of symptoms of parkinsonism with urinary incontinence, impotence, anhidrosis, orthostatic hypotension, to which cerebellar dyskinesia, muscle atrophy and fasciculations can join during the development of the disease. The onset of autonomic disorders may precede the development of symptoms of parkinsonism. The disease develops in middle age, usually at a younger age than with normal parkinsonism. Morphological studies reveal changes not only in the substantia nigra, but signs of olivopontocerebellar atrophy, as well as disorders in the lateral and anterior horns of the spinal cord. Mineralocorticoids are used to treat the disease, as well as 1-dopa.
Hypokinesia and stiffness may be manifestations of progressive supranuclear palsy as described by Steel et al. in 1964 Tremor is rare in this disease.
Peculiar oculomotor disorders are typical: first, there is a restriction of eye movements in the vertical direction, then ophthalmoplegia develops; at the same time, the movements of the eyes associated with fixation of the object by the gaze are fully preserved, with the passive movement of the head. The described oculomotor disorders can be combined with dystonia of the cervical muscles, pyramidal symptoms, moderate dementia. Hypokinesia and rigidity can be observed in Creutzfeldt-Jacobi disease along with dementia, pyramidal tract symptoms, myoclonus, and signs of peripheral motor neuron involvement. Certain parkinsonian symptoms, most often hypokinesia and rigidity, may be accompanied by degenerative diseases such as olivopontocerebellar dystrophy, usually characterized by progressive symptoms of cerebellar ataxia. At autopsy in such cases, along with the atrophy of the cerebellar cortex, olives and brain nuclei, typical for this disease, a lesion of the substantia nigra, striatum is found.
Parkinsonism - the disease is chronic, slowly flowing. It, as a rule, does not lead to death, but the mortality rate among these patients is three times higher than that in the general population of people of the same age. Patients die from associated intercurrent diseases (pneumonia, bedsores).

Parkinson's syndrome treatment

Since the time of Charcot, belladonna preparations have been used to treat parkinsonism. Their choice was largely random, but in recent years it received a theoretical basis - the suppression of cholinergic mechanisms is accompanied by some leveling of the disturbed equilibrium of acetylcholine - dopamine. Currently, they often resort not to natural, but to synthetic anticholinergic drugs (cyclodol, ridinol, mebedrol, dinesin, amedin). The large number of these drugs suggests that none of them are effective enough. The choice of drug is usually determined by the individual patient's response. The selection of the dose begins with small amounts of the drug, then it is gradually increased until an effect is obtained or the appearance of side effects, most often sensations of blurred vision and dry mouth. The occurrence of these symptoms serves as a signal to reduce the daily dose of the drug.
The use of anticholinergic drugs can be accompanied by more serious complications - hallucinations, especially visual, mental disorders (atropine psychosis), anxiety, urinary retention, the onset or exacerbation of glaucoma, often requiring discontinuation of the drug. It is necessary to prescribe drugs that have a central anticholinergic effect and minimally expressed peripheral effects (ridinol, etc.). Anticholinergic drugs improve the condition of patients, reduce stiffness, tremors and akinesia. Sudden withdrawal of anticholinergics can cause a significant increase in the manifestations of the disease. Since a certain role in the development of parkinsonism can play not only dopamine, but also other mediators, in particular histamine, antihistamines (diphenhydramine, suprastin, etc.) are also indicated for the treatment of parkinsonism, especially in the presence of severe tremor.
Significant importance is also attached to the group of drugs inhibiting monoamine oxidase (MAO), an enzyme involved in the conversion of dopamine to norepinephrine. These drugs, in particular nialamide, have an antidepressant effect and are especially indicated in the presence of depressive conditions. For all initial forms of the disease, treatment should be started with the use of anticholinergic drugs or their combinations with antihistamines.
Elucidation of the role of dopaminergic systems in the pathogenesis of parkinsonism has led to the introduction into practice of much more effective drugs, in particular 1-dopa. Unlike dopamine, 1-dopa crosses the blood-brain barrier. In the human body, under the influence of the enzyme dopa-decarboxylase, it is converted into dopamine and compensates for its deficiency in the striatum. Contraindications for the use of 1-dopa are pronounced disturbances in the activity of the cardiovascular system with symptoms of persistent decompensation and heart rhythm disturbances, bleeding stomach ulcers and duodenum, hepatitis, liver cirrhosis, nephritis, mental illness, glaucoma.
The use of the drug begins with small doses (0.125 g), which are gradually increased. The drug is taken according to a scheme that provides for its repeated administration - 5-6 times a day. Since the drug can have an irritating effect on the mucous membrane of the stomach and gastrointestinal tract, it is recommended to take it while eating. The most pronounced effect in the treatment of 1-dopa is observed in relation to hypokinesia, the general stiffness decreases, the mobility of patients increases. Rigidity is also noticeably reduced. The use of 1-dopa is less effective in tremor, therefore, treatment of 1-dopa is more indicated in akinetic-rigid and rigid forms of the disease, and less - in tremors or tremors-rigid forms.
In all cases, the combined use of anticholinergic drugs and 1-dopa is more effective, but it is especially indicated for the trembling-rigid and trembling forms in the initial period. You should not rush to increase the dose of 1-dopa, which allows you to get rid of many side effects that may accompany taking the drug.
Nausea, vomiting, and anorexia are relatively common complications arising from the treatment of 1-dopa. These disorders are most often noted at the initial stage of treatment, during the period of increasing the dose of the drug. Their occurrence is noted in about half of patients. To eliminate or reduce them, as already mentioned, the drug is taken with meals, the dose is increased slowly, washed down with alkaline mineral waters... Among other complications of the early period, postural hypotension should be indicated, which can occur without any precursors. Arrhythmia sometimes develops. In order to avoid harmful consequences, patients are advised to lie down for a while after taking the drug. There are many combination drugs, causing fewer complications, in particular sinemet, madopar, nakom. The use of combination drugs has dramatically reduced the amount of 1-dopa required to achieve clinical benefit. The use of bluemet is accompanied by a 10-fold dose reduction (25 mg instead of 250 mg), madopar - 4 times. Unfortunately, combined treatment with 1-dopa and a dopa-decarboxylase inhibitor had a lesser effect on the development of other complications, such as rapid hyperkinesis and mental disorders, but they occur at a later date than when taking 1-dopa.
Mental disorders in the form of aggressiveness, general excitement occur in about XU cases. Some patients develop depression up to suicidal attempts. Sometimes psychoses occur, usually of a paranoid nature. Increased libido in both sexes is possible.
Most frequent complication, which occurs when taking 1-dopa, is the development of rapid hyperkinesis. They usually begin in the oral muscles, then spread to the muscles of the face, expressed in the form of grimacing, chewing movements, rotational movements of the tongue. Oral dyskinesias may be further accompanied by flexion and extension of the limbs, dystonic phenomena in the form of spastic torticollis, rotary spasms of the trunk, etc. Dyskinesias usually occur when high doses of the drug are taken, but in some patients they occur even at low doses. As a rule, the appearance of rapid hyperkinesis indicates an overdose of the drug. To eliminate them, the dose of 1-dopa should be reduced, a solution of vitamin B6 in / m should be administered, and dopegit should be prescribed. A further increase in the dosage of 1-dopa should be done at a slower pace. It should be emphasized that the early appearance of oral hyperkinesis is usually a sign of a high efficacy of 1-dopa v treatment in this patient.
It is better to combine the therapy of 1-dopa and its derivatives with the use of anticholinergics, antihistamines (diphenhydramine, suprastin), vasodilators (cinnarizine - stugeron, dibazol) and anti-sclerotic drugs (miscleron, prodectin). In the treatment of parkinsonism syndrome, amantadine and its analogs (viregit, midantan) are widely used. Initially, it was used as an antiviral agent, but soon its antiparkinsonian effect was noted purely empirically. Amandatin works faster than 1-dopa, usually between the second and fourth weeks after starting treatment, but its effectiveness is lower. Amantadine has a greater effect on hypokinesia and rigidity and less pronounced on tremor. Its side effects are similar to the complications arising from the appointment of 1-dopa, but to a lesser extent.
The combination of amantadine and 1-dopa has a synergistic effect and is widely used in practice. The mechanism of action of amantadine is not fully understood, it is assumed that it facilitates the synthesis of dopamine. Amantadine can be administered in pure form or in combination with anticholinergic drugs to patients who do not tolerate 1-dopa or its derivatives (Sinemet, Nakom, Madopar) poorly. Most recently, bromocriptine, an activator of dopaminergic receptors, has been proposed for the treatment of parkinsonism syndrome.
In the early stages of treatment, the effect of the use of 1-dopa is observed in about 2/3 of patients, mainly with a rigid or rigid-trembling form of the disease, but over time it positive action decreases. The most unpleasant complication in the late period of 1-dopa treatment is the development of the so-called on-off effect.
The clinical picture of this phenomenon is expressed in the unexpected occurrence of pronounced hyperkinesis, gait disturbance, severe hypotension, which occur soon after taking the usual dose of the drug. The duration of these disorders can range from several minutes to several hours and also unexpectedly give way to complete freezing, a pronounced manifestation of akinesia, stiffness. Such abrupt changes in state can be repeated several times a day. They are very difficult to tolerate by patients. As a rule, the occurrence of this phenomenon is noted in patients who have had a good effect from the use of 1-dopa. To combat such complications, one should resort to more frequent intake of 1-dopa without changing or with a decrease in the total daily dose of the drug. Treatment with combined drugs delays the onset of this serious complication, but does not completely eliminate it.
Surgical methods of treatment with the introduction into practice of treatment of 1-dopa have lost their importance and are used by those patients who turned out to be resistant to the action of 3-dopa. Usually these are patients with a trembling or rigid-trembling form, especially with its unilateral manifestation. The ventrolateral nucleus of the thalamus and the Forel field are currently being destroyed. This achieves the most favorable effect, which is expressed in the instant disappearance of tremor and rigidity already on the operating table. Long-term results of surgical treatment of Parkinson's syndrome are satisfactory. On the example of this serious disease, the current successes of the pathogenetic treatment of many degenerative diseases, which were previously considered poorly treatable or generally incurable, are especially clearly visible.

Limb tremors, slow motion, and other signs of Parkinson's syndrome can be caused by a variety of conditions. Due to the improvement of treatment results various diseases, the life expectancy of the population is growing, the frequency of the development of this syndrome is increasing. This condition is typical for older age groups of the population, mainly for men.

The concept of parkinsonism syndrome includes a symptom complex characterized by:

tremor;
inability to maintain balance;
increased muscle tone;
the appearance of uncontrolled resistance of muscle tissue in response to an attempt to change the position of the body;
slow motion;
inability to start a movement adequate in speed and strength, etc.

Parkinson's syndrome is a consequence of the following diseases:

past hemorrhagic or ischemic strokes in the basal parts of the brain;
repeated multiple craniocerebral trauma;
an indication of a history of encephalitis;
drug intoxication with neuroleptics, lithium preparations;
neurosyphilis;
multiple sclerosis, syringomyelia, lateral amyotrophic sclerosis, dementia;
ataxia-telangiectasia;
glioma of the third ventricle;
against the background of hepatocerebral insufficiency, thyroid pathology;
cerebellar atrophy with communicating hydrocephalus, increased intracranial pressure (ICP);
acute encephalitis Economo.

Parkinson's syndrome is classified for reasons of occurrence:

The primary idiopathic is Parkinson's disease.
A genetic defect that manifests itself at a young age is juvenile parkinsonism.
Secondary - Parkinson's syndrome, which developed as a complication, a consequence of other diseases and injuries of the central nervous system (CNS).
Parkinsonism-plus is a condition when symptoms of parkinsonism are present along with various other syndromes of severe diseases of the central nervous system, for example, essential tremor.

Clinical picture

Parkinson's disease, juvenile parkinsonism, Parkinson's syndrome and parkinsonism-plus are characterized by common symptoms and distinguishing features.

Common Symptoms

Common symptoms include the following disorders:

motor;
vegetative;
sensory;
mental;
pathology of sleep and wakefulness.

Motor symptoms

Movement disorders are represented by a lack of active movement, tremors at rest, stiffness and tension in the muscles.

Tremors, or tremors, of the fingers are found in a large number of diseases. In each situation, it is characterized by its own characteristics:
A tremor that occurs at rest is more common in parkinsonism. Weakens with movement, walking, if the patient's attention is distracted.
Cerebellar tremor is manifested by tremors of the head, arms, trunk. Important! Large-sweeping movements in cerebellar pathology develop mainly at the end of the movement, and in parkinsonism - at rest. It is checked when performing a finger-nose and heel-knee test.
Tremor that develops in the pathology of the thyroid gland, psychoemotional overexertion, alcohol withdrawal syndrome, metabolic diseases. It manifests itself as much as possible when trying to maintain a pose. It is clearly visible on the fingertips of the hands with outstretched arms.
Orthostatic tremor is not observed in parkinsonism, appears in the legs while walking, tremors in the quadriceps femoris are noted.

The main difference between the trembling phenomenon in parkinsonism is asymmetry. With this pathology, patients have a characteristic posture of the petitioner: a head tilted forward, shoulders lowered.

Movement disorders include:

shuffling gait;
slow, monotonous speech;
hypomimic facial expression;
handwriting becomes small;
the friendly movements of the hands are lost when walking, which all people normally have;
it is difficult for a person to start performing any movement and it is just as difficult to stop.

Vegetative symptoms

Vegetative failure is characterized by the following manifestations:

swallowing disorder, choking sensation;
a tendency to constipation;
various disorders of urination from imperative urge to difficulty with incomplete emptying of the bladder, urinary incontinence;
erectile dysfunction, decreased libido;
tendency to orthostatic collapse;
decreased sweating, hyper- or hyposalivation.

Sensory symptoms

Patients do not pay attention to sensitivity disorders or sensory symptoms, which are early manifestations of Parkinson's syndrome. Sensory disturbances form earlier than parkinsonian movement disorders. These include:

violation of the sense of smell;
feeling of running creepy, burning or pain in the limbs, mainly in the legs.

Mental symptoms

Parkinson's disease and parkinsonism are equally often accompanied by mental disorders:

Depression. People prone to depression, guilt, and low self-esteem are more prone to parkinsonism. Important! Patients fix their attention on movement disorders and do not talk about existing anxiety, despair. But these phenomena are always present.
Psychoses alternating with apathy, indifference, lethargy. The development of confused consciousness with hallucinations and psychosis is possible. The longer there is a clinical symptomatology of parkinsonism, the more often psychotic reactions appear. At first, the criticism is saved. Over time, the patient's critical attitude to hallucinations disappears and a condition such as paranoid psychosis develops.
Reduced performance, a feeling of fatigue, lethargy, a constant feeling of fatigue. There is no joyful mood, no need to get pleasure and enjoyment.
Violation of cognitive functions, viscosity of thinking appears, attention sharply decreases. Memory impairment is distinguished by its characteristic features. Patients can memorize mechanical information and are generally unable to fix emotionally colored information.
Obsessive states, pathological drives.

Sleep and wakefulness disorders

Sleep and wakefulness disorders are present in 98% of patients with parkinsonism and appear 5 to 10 years earlier than the main motor symptoms of Parkinson's syndrome.

There are the following manifestations:

falling asleep is disturbed;
daytime sleepiness;
frequent night or early morning awakenings;
the duration of night sleep increases, the feeling of fatigue and weakness remains after waking up;
too bright frightening dreams.

In Parkinson's syndrome, the symptomatology of the disease that led to its development comes to the fore.

Diagnostics

For the correct treatment of Parkinson's syndrome, it is necessary to identify the cause that caused it, and exclude similar conditions that can simulate the disease.

Parkinson's syndrome develops as a complication of the following acquired diseases:

drug;
post-traumatic;
toxic;
postencephalitic;
parkinsonism with other neuroinfections;
parkinsonism with hydrocephalus;
vascular;
posthypoxic.

The symptomatology of the above diseases manifests itself first, and then the tremor-rigid syndrome joins as a complication.

With degenerative diseases of the central nervous system, parkinsonism-plus develops, in which neurological syndromes come to the fore:

pyramidal;
cerebellar;
vegetative-vascular dystonia;
dementia;
parkinsonism-plus joins the last.

This group includes:

multisystem atrophy;
progressive supranuclear palsy;
diffuse levi body disease;
corticobasal degeneration;
hemiparkinsonism-hemiatrophy;
alzheimer's disease;
creutzfeldt-Jakob disease;
hereditary forms;
huntington's disease;
spinocerebellar degeneration;
hallerworden-Spatz disease;
hepatolenticular degeneration;
pallidal degeneration;
familial calcification of the basal ganglia;
neuroacanthocytosis;
dystonia-parkinsonism.

Treatment

There are 4 important areas of treatment:

Treat the underlying disorder, if possible.
Drugs aimed at stopping the phenomena of parkinsonism.
The use of nootropics, vascular agents to protect the brain from further destruction.
Rehabilitation.

For symptomatic treatment use the following means:

levodopa drugs;
dopamine receptor agonists;
anticholinergics;
amantadine preparations;
type B monoamine oxidase inhibitors;
inhibitors of catechol-O-methyltransferase.

Treatment of parkinsonism is prescribed individually by the attending physician, taking into account the underlying disease, the severity of additional neurological disorders, individual sensitivity.

The main objective of the treatment of patients with parkinsonism is the restoration of impaired motor functions. In some cases, when the manifestations of the disease are minimal, the medicine may not be prescribed.

With an increase in symptoms, monotherapy is used, and in the future, combined drug therapy.

For the treatment of autonomic disorders, the following are used:

wearing elastic stockings;
increased intake of salt, water;
fludrocortisone;
Midodrin is an adrenaline-like sympathomimetic with a vasoconstrictor effect. It is prescribed orally 2.5 mg 3 times;
"Indomethacin" relieves headache, muscle, joint pain in sensory manifestations;
Caffeine improves the endurance of the central nervous system to stress and resistance to damaging factors. Increases blood pressure, is used to treat orthostatic disorders;
"Dihydroergotamine" has a stimulating effect on serotonin receptors, is a blocker of vascular adrenergic receptors. The drug constricts the blood vessels of the brain.

For neurogenic urinary disorders, use:

"Oxybutynin" is used for neurogenic bladder weakness and urinary incontinence. It is also effective in increasing the spasm of smooth muscles of the gastrointestinal tract, uterus, gallbladder. Duration of treatment is up to 2 years.
"Tolterodine" is an m-anticholinergic drug used for overactive bladder, urge, urination.
"Alfuzosin" blocks alpha-1-adrenergic receptors of the genitourinary organs, is prescribed for functional disorders, 5 mg 2 times.
"Doxazosin" lowers blood pressure, cholesterol and high-density lipids in the blood, gives a good effect in Parkinson's syndrome against the background of chronic ischemic disease of the brain with arterial hypertension.
"Prazosin" is an antihypertensive drug that has the ability to relax the muscles of the vessels in the periphery and does not affect the arteries and veins of the brain.
"Tamsulosin" is effective in elderly men with dysuric disorders developing against the background of prostatic hyperplasia.
"Terazosin" is used for the symptomatic treatment of benign prostatic hyperplasia, arterial hypertension.
"Desmopressin" is effective against urinary disorders, nocturia.

With a tendency to constipation:

a diet rich in fiber;
sufficient physical activity;
"Domperidone" or "Motilium" improve gastrointestinal motility, while blocking the vomiting center;
"Cisapride" is a serotonergic agent that stimulates the motility of the gastrointestinal tract in gastroesophageal reflux, gastroparesis, anorexia, functional and idiopathic constipation, functional dyspepsia, gallbladder hypokinesia;
laxatives are best used of plant origin. They have a milder, gradual effect, do not cause disturbances in water and electrolyte balance, deficiency of vitamins and microelements in the body. These drugs include "Guttalax", "Regulax", Senna, Belladonna, "Mucofalk", "RectActive".

For the treatment of cognitive disorders, the following are used:

Rivastigmine;
"Donepezil";
Galantamine;
Memantine;
"Ipidacrine";
Choline alfoscerat;
Piracetam.

For the treatment of affective disorders, use:

"Piribedil";
Pramipexole;
"Melipramine" - an antidepressant, well eliminating the phenomena of anxiety, is applied at 25 mg 3 times;
psychotherapy.

Treating sleep problems requires:

adjust the evening dose of antiparkinsonian drugs;
if this is not enough, then "Clozapine" is prescribed for the night;
Trazodone, Amitriptyline, Doxepin;
sleeping pills are prescribed for a very short time due to the real threat of addiction development.

Drug-free treatment

To maintain a high-quality socially active life, the patient must have the necessary information about his disease, learn to live with it in order to control the disease.

Typically, treatment includes:

neuropsychological training;
speech therapy;
adherence to diet, daily regimen.

Prevention

There are no specific preventive measures for Parkinson's syndrome. But given that it develops as a symptom or complication of other diseases of the nervous system, it is necessary to carry out primary prevention of diseases and injuries of the central nervous system.

The main areas of prevention include:

avoidance of stress;
conducting healthy way life;
sufficient physical activity;
refusal to use alcohol, nicotine;
prevention of industrial and road traffic injuries, etc.

Being a fairly frequent disease of the central nervous system, especially in old age, parkinsonism develops against the background of chronic ischemic brain disease. The consequences of ischemic and hemorrhagic strokes, discirculatory encephalopathy, atherosclerotic vascular lesions can lead to Parkinson's syndrome. Therefore, the prevention of the above diseases is a prerequisite for preventing the phenomena of parkinsonism.

Parkinson's disease is a neurological disease with chronic symptoms. It progresses slowly and affects older people. Clinical symptoms and data are required to establish a diagnosis instrumental methods research. To slow the progression of the disease and the deterioration of the condition, a patient with Parkinson's disease must constantly take medications.

In more detail what this disease is, what factors are the impetus for its appearance, as well as the first signs and symptoms of Parkinson's disease, we will consider further.

Parkinson's disease: what is it?

Parkinson's disease is a degenerative disease of the central nervous system, the main manifestation of which is a pronounced impairment of motor functions. This disease is typical for older people and is otherwise called "tremor paralysis", which indicates the main symptoms of this disease: constant tremors and increased muscle stiffness, as well as the difficulty of performing directed movements.

The symptoms of Parkinson's disease in the early 19th century were first described by a doctor James Parkinson in the "Essay on the paralysis of tremors", due to which the disease and received the name of the scientist.

Parkinson's syndrome develops due to the death in the brain of the corresponding nerve cells responsible for controlling the movements performed.

Destroyed neurons lose the ability to perform their tasks, as a result - a decrease in the synthesis of dopamine (dopamine) and the development of symptoms of the disease:

Increased muscle tone (rigidity);
Decreased physical activity (hypokinesia);
Difficulty walking and maintaining balance;
Tremors (tremors);
Vegetative disorders and mental disorders.

The early stages of Parkinson's disease usually go unnoticed. In rare cases, those around them pay attention to some inhibition of movements and less expressiveness of facial expressions.

As the pathology progresses, at the next stage of Parkinson's, the patient himself draws attention to the fact that it is difficult for him to perform some subtle movements. The handwriting is gradually changing - up to serious difficulties in writing. It becomes difficult to carry out the usual hygiene procedures (brushing your teeth, shaving). Over time, facial expressions become so impoverished that the face becomes masked. In addition, speech is noticeably impaired.

Causes of occurrence

Scientists have not yet been able to identify the exact causes of Parkinson's disease, but there is a certain group of factors that can trigger the development of this disease.

According to statistics, Parkinson's disease is diagnosed in 1% of the population under 60 and in 5% of older people. Morbidity among men it is slightly higher.

The causes of Parkinson's disease can be identified as follows:

aging of the body, in which the number of neurons naturally decreases, which leads to a decrease in the production of dopamine;
hereditary predisposition;
permanent residence near highways, industrial plants or railways;
lack of vitamin D, formed when exposed to ultraviolet rays in the body, and protects the cellular formations of the brain from the harmful effects of free radicals and various toxins;
poisoning with some chemical compounds;
the appearance due to mutation of defective mitochondria, which often leads to degeneration of neurons;
neuroinfection ();
tumor processes occurring in the brain or its injury.

Parkinson's disease can also develop, according to some statements, against the background of drug intoxication associated with long-term patients with medications representing the phenothiazine series, as well as with certain narcotic drugs.

Scientists come to the conclusion that most often leads to the development of the disease rather, a combination of several of the reasons listed.

The causes of the disease also depend on the type:

Primary parkinsonism - in 80% of cases, it is caused by a genetic predisposition.
Secondary parkinsonism - occurs against the background of various pathologies and existing diseases.

Risk groups include people 60-65 years old, most often the male population. It also occurs in young people. In this case, it proceeds more slowly than in people of the older age group.

It is worth noting that signs of Parkinson's disease in women and in men have no obvious differences, since cell damage occurs, regardless of the sex of the person.

Forms and stages of Parkinson's

In medicine, there are 3 forms of Parkinson's disease:

Rigid-bradykinetic... It is characterized mainly by an increase in muscle tone (especially flexors) of the plastic type. Active movements slow down until immobility. This form is characterized by the classic "hunched over" posture.
Trembling-rigid... It is manifested by a tremor of the distal parts of the extremities, to which, over time, stiffness of movements is added.
Shivering. It is manifested by a constant tremor of the limbs, lower jaw, tongue. The amplitude of oscillatory movements can be large, but the tempo of voluntary movements is always maintained. Muscle tone is usually increased.

Parkinson's syndrome is divided into stages according to the principle of the severity of symptoms, each of them has its own characteristics in the methods of treatment. The stages of Parkinson's disease, disability groups are described in more detail according to the Hen-Yaru scale:

At the first stage, signs of the disease are noted on one limb (with the transition to the trunk);
The second stage is characterized by the manifestation of postural instability already on both sides;
In the third stage, postural instability progresses, but the patient, albeit with difficulty, still overcomes the inertia of movement when he is pushed, and is able to serve himself;
Although the patient can still stand or walk, he begins to greatly require outside help;
Complete immobility. Disability. Constant outside care.

According to the rate of development of the disease, the transition from one stage to the next is distinguished:

In the terminal stage of Parkinson's disease, the main difficulties are associated with cachexia, loss of the ability to stand, walk and self-care. At this time, it is necessary to carry out a whole range of rehabilitation measures aimed at ensuring optimal conditions for the patient's daily everyday activities.

Parkinson's disease: symptoms and signs

It is impossible to predict the appearance of the disease, because it is not genetic in nature, however, you can stop its development in the early stages. Signs of Parkinson's disease at the very beginning, when the cells of the substantia nigra are just beginning to break down, are difficult to identify. When the disease acquires more and more stages, new symptoms of a disorder of the nervous system appear. Parkinson's syndrome is rapidly changing a person.

Parkinson's disease symptoms:

Tremor (constant involuntary tremor). Excessive stimulating effect of the central nervous system on muscles leads to the appearance of constant tremors of the limbs, head, eyelids, lower jaw, etc.
Stiffness (stiffness and reduced muscle mobility). The absence of the inhibitory effect of dopamine leads to an excessive increase in muscle tone, which makes them hard, immobile, and lose elasticity.
Limited and slow motion (which is defined as bradykinesia), especially this symptom manifests itself during a prolonged state of rest, followed by the onset of movements on the part of the patient. A similar condition can occur when trying to roll over in bed to the other side or get up after sitting in a chair, etc.
Impaired coordination of movements. The danger of this symptom is that a person loses stability and can fall at any time. Also, people with this disease often have a stoop, and they tend to lower their shoulders and tilt their head forward.

It is important to note that Parkinson's disease is a progressive disease, and quite often at the initial stage, the disease has a latent course.

Despite the fact that tremor is one of the main symptoms indicating Parkinson's disease, its presence, nevertheless, is not exclusive evidence that a person has this disease. Tremor caused by other painful conditions, in contrast to tremor in Parkinson's disease, is less pronounced with immobility of the limb and, conversely, is more noticeable in movement.

Other signs of Parkinson's disease

In addition to the above-mentioned main manifestations of parkinsonism, Parkinson's disease is accompanied by other symptoms, which in some cases may come to the fore in the clinical picture. Moreover, the degree of maladjustment of the patient in such cases is no less. We list just a few of them:

salivation,
dysarthria and / or dysphagia,
constipation,
dementia,
depression,
sleep disorders,
dysuric disorders
restless legs syndrome and others.

Parkinsonism and mental disorders are accompanied by:

Changes in the affective sphere (decreased mood according to the depressive type or alternating depression with periods of high mood).
Dementia. Cognitive impairments of the type of deficit. Patients have a sharp decrease in intelligence, they can not solve everyday problems.

The first phenomena of psychosis (fear, confusion, hallucinations, with disorientation) are observed in 20% of individuals with parkinsonism. The decrease in intellectual function is less pronounced than in senile dementia.

Dream disorders and excessive fatigue are noted in 40% of individuals with parkinsonism, and in 47% depressive states. Patients are inactive, apathetic, annoying. They tend to ask the same questions.

Consequences for humans

With parkinsonism, getting out of bed and armchairs, turning over in bed, difficulties in brushing teeth and performing simple household chores become a problem. Sometimes a slow gait is replaced by a fast run, which the patient cannot cope with until he collides with an obstacle or falls. The patient's speech becomes monotonous, without modulations.

The consequences of Parkinson's disease are:

violation of the intellectual sphere;
mental disorders;
a decrease, up to complete disappearance, of the ability to self-service;
complete immobilization, loss of speech function.

Diagnostics

The diagnosis of Parkinson's disease consists of 3 stages:

Stage 1

Identifying symptoms suggestive of parkinsonism. This stage includes a physical examination of the patient at the time of the visit to the doctor. It allows you to identify the main signs of Parkinson's disease: constant muscle tremors, muscle stiffness, difficulty maintaining balance or performing directed movements.

Stage 2

It is important for the doctor to exclude all possible diseases with similar symptoms. These can be oculogyric crises, repeated strokes, secondary traumatic brain injuries, brain tumors, poisoning, etc.

Stage 3 - confirmation of the presence of Parkinson's disease

The final stage of diagnosis is based on the presence of at least three signs. It:

the duration of the illness is more than 10 years,
disease progression,
asymmetry of symptoms with predominance on the side of the body where the disease debuted, the presence of resting tremor, one-sided manifestations of the disease at the initial stage of its development.

In addition to these three diagnostic steps for a neurological examination, a person may be referred for an EEG, CT, or MRI of the brain. Rheoencephalography is also used.

Treatment

A patient who has the initial symptoms of Parkinson's disease requires careful treatment with an individual course, due to the fact that missed treatment leads to serious consequences.

The main tasks in the treatment are:

to maintain the patient's physical activity as long as possible;
development of a special program physical exercise;
drug therapy.

Drug treatment

When detecting a disease and its stage, the doctor prescribes drugs for Parkinson's disease, corresponding to the stage of development of the syndrome:

Initially, amantadine tablets are effective, which stimulates dopamine production.
At the first stage, dopamine receptor agonists (mirapex, pramipexole) are also effective.
The drug levodopa in combination with other drugs is prescribed in complex therapy at later stages of the development of the syndrome.

The basic drug that can inhibit the development of Parkinson's syndrome is Levodopa. It should be noted that the drug has a number of side effects. Before the introduction of this drug into clinical practice, the only meaningful method treatment was the destruction of the basal nuclei.

Symptomatic treatment:

Hallucinations, psychoses - psychoanaleptics (Exelon, Reminil), antipsychotics (Seroquel, Clozapine, Azaleptin, Leponex)
Vegetative disorders - laxatives for constipation, stimulants of gastrointestinal motility (Motilium), antispasmodics (Detrusitol), antidepressants (Amitriptyline)
Sleep disturbance, pain, depression, anxiety - antidepressants (cipramil, ixel, amitriptyline, paxil) zolpidem, sedatives
Decreased concentration, memory impairment - Exelon, Memantine-Akatinol, Reminil

The choice of treatment method depends on the severity of the disease and the state of health, and is carried out only by a doctor after a complete diagnosis of Parkinson's disease has been carried out.

Exercise therapy

Exercise therapy is one of the best ways to treat the symptoms of Parkinson's disease. Simple exercises can be done both indoors and outdoors. Exercise helps keep your muscles toned. In order for the effect to be better, exercise must be done every day. If the patient cannot do them on his own, then it is necessary to help him.

Surgical intervention

Surgical intervention is performed only when medications have not helped. Modern medicine reaches good results even with partial surgery, it is a pallidotomy. The operation reduces hypokinesia by almost 100 percent.

Minimally invasive surgical intervention - neurostimulation - is also widely used. This is a pointwise directed effect of an electric current on certain parts of the brain.

The basis of a normal life with such a diagnosis is a list of rules:

Follow the recommendations of the attending physician;
Calculate your strength so that this does not cause aggravation of health problems;
Systematically engage in physical exercise and follow proper nutrition;
If there is a need, seek advice from a qualified psychologist who will tell you how to overcome difficulties for a person with such a diagnosis.
Do not resort to self-medication. Ignore information regarding examples and advice from people who have conquered an illness or improved their health with the help of any outside means.

Forecast

Life expectancy in Parkinson's disease is reduced, as symptoms progress, the quality of life irreversibly deteriorates, and the ability to work is lost.

Modern medicine allows a person with Parkinson's disease to live an active life for at least 15 years, only then the person will begin to need outside care. And death usually occurs due to other reasons - heart disease, pneumonia, and so on. If all the doctor's recommendations are followed, a person can not only be independent in everyday life, but also be professionally in demand.

If untreated, unfortunately, after 10-12 years, a person may be bedridden. And it is impossible to make up for lost time, the changes are irreversible.

Prevention

There are no specific preventive measures for Parkinson's disease. However, it is within the power of a person to significantly reduce the risk of the likelihood of getting sick. To do this, you should:

Maintain an adequate level of physical activity. Physical inactivity increases the risk of developing parkinsonism.
Train your brain regularly. Solve problems, solve crosswords, play chess. It is a universal preventive measure against Parkinson's and Alzheimer's.
Use antipsychotics with caution. These drugs should only be taken under medical supervision.
Regularly undergo preventive examinations by a neurologist.

Parkinson's disease refers to enough dangerous diseasesthat have a serious impact on human activity. Therefore, it is so important to know what symptoms are characteristic of this pathology. Timely identification of signs and an immediate visit to a doctor will allow a person to live a full life for a long time.

It's all about Parkinson's disease: what are the causes, the first signs and symptoms, stages, treatment features. Do not be ill!

The pathology caused by the slow progressive death in humans of nerve cells that are responsible for motor functions is called Parkinson's disease. The first symptoms of the disease are tremors (tremors) of the muscles and an unstable position at rest of certain parts of the body (head, fingers and hands). Most often they appear at 55-60 years of age, but in some cases the early onset of Parkinson's disease was recorded in people under 40 years of age. In the future, as the pathology develops, a person completely loses physical activity, mental abilities, which leads to the inevitable attenuation of all vital functions and death. This is one of the most serious diseases in terms of treatment. How long can people with Parkinson's disease live at the current level of medicine?

Etiology of Parkinson's disease

Physiology of the nervous system.

All human movements are controlled by the central nervous system, which includes the brain and spinal cord. As soon as a person thinks about any intentional movement, the cerebral cortex already sets in readiness all the parts of the nervous system responsible for this movement. One of these departments is the so-called basal ganglia... It is an auxiliary propulsion system that is responsible for how quickly a movement is made, as well as for the accuracy and quality of these movements.

Information about movement comes from the cerebral cortex to the basal ganglia, which determine which muscles will participate in it, and how much each muscle must be tense in order for the movements to be as precise and targeted as possible.

The basal ganglia transmit their impulses using special chemical compounds called neurotransmitters. How the muscles will work depends on their number and mechanism of action (exciting or inhibiting). The main neurotransmitter is dopamine, which inhibits excess impulses, and thereby controls the accuracy of movements and the degree of muscle contraction.

Black substance (Substantia nigra) is involved in complex coordination of movements, supplying dopamine to the striatum and transmitting signals from the basal ganglia to other brain structures. The substantia nigra is so named because this area of \u200b\u200bthe brain has a dark color: neurons there contain a certain amount of melanin, a byproduct of dopamine synthesis. It is the lack of dopamine in the substantia nigra of the brain that leads to Parkinson's disease.

Parkinson's disease - what is it

Parkinson's disease Is a neurodegenerative brain disease that progresses slowly in most patients. Symptoms of the disease can gradually appear over several years.

The disease occurs against the background of the death of a large number of neurons in certain areas of the basal ganglia and destruction nerve fibers... In order for the symptoms of Parkinson's disease to begin to appear, about 80% of neurons must lose their function. In this case, it is incurable and progresses over the years, even in spite of the treatment undertaken.

Neurodegenerative diseases are a group of slowly progressive, hereditary or acquired diseases of the nervous system.

Also a characteristic feature of this disease is a decrease in the amount of dopamine. It becomes insufficient for inhibition of constant excitatory signals of the cerebral cortex. The impulses are able to travel right up to the muscles and stimulate their contraction. This explains the main symptoms of Parkinson's disease: constant muscle contractions (tremors, tremors), muscle stiffness due to excessively increased tone (rigidity), impaired voluntary body movements.

Parkinsonism and Parkinson's disease, differences

Distinguish:

primary parkinsonism or Parkinson's disease, it is more common and irreversible;
secondary parkinsonism - this pathology is caused by infectious, traumatic and other brain lesions, as a rule, it is reversible.

Secondary parkinsonism can occur at absolutely any age under the influence of external factors.

encephalitis;
brain injury;
poisoning with toxic substances;
vascular diseases, in particular, atherosclerosis, stroke, ischemic attack, etc.

Symptoms and Signs

How does Parkinson's disease manifest?

resting tremor;
stiffness and decreased muscle mobility (rigidity);
limited volume and speed of movement;
decreased ability to maintain balance (postural instability).

Rest tremor is a tremor that is observed at rest and disappears with movement. The most common examples of resting tremors are jerky hand movements and yes-no head movements.

depression;
pathological fatigue;
loss of smell;
increased salivation;
excessive sweating;
metabolic disease;
problems with the gastrointestinal tract;
mental disorders and psychosis;
violation of mental activity;
impairment of cognitive functions.

memory impairment;
slowness of thinking;
violations of visual-spatial orientation.

Young

Sometimes Parkinson's disease occurs in young people between the ages of 20 and 40, which is called early parkinsonism. According to statistics, there are few such patients - 10-20%. Parkinson's disease in young people has the same symptoms, but is milder and progresses more slowly than in older patients.

In half of patients, the disease begins with painful muscle contractions in the limbs (most often in the feet or shoulders). This symptom can make it difficult to diagnose early parkinsonism, as it is similar to the manifestation of arthritis.
Involuntary movements in the body and limbs (which often occur during dopamine therapy).

In the future, signs characteristic of the classic course of Parkinson's disease at any age become noticeable.

Among women

The symptoms and signs of Parkinson's disease in women are no different from general symptoms.

In men

Likewise, the symptoms and signs of the disease in men are unremarkable. Is that the fact that men get sick a little more often than women.

Diagnostics

At the moment, there are no laboratory tests, the results of which could be used to diagnose Parkinson's disease.

Diagnosis is based on medical history, physical examination, and test results. The doctor may order certain tests to identify or rule out others possible diseasesthat cause similar symptoms.

One of the hallmarks of Parkinson's disease is that there is improvement after starting antiparkinsonian medications.

There is also another diagnostic test called PET (positron emission tomography). In some cases, PET can detect low levels of dopamine in the brain, which is the main symptom of Parkinson's disease. But PET scans are generally not used to diagnose Parkinson's disease because it is very expensive and many hospitals are not equipped with the necessary equipment.

Stages of Parkinson's disease according to Hen-Yar

This system was proposed by the English doctors Melvin Yar and Margaret Hen in 1967.

Stage 0.
The person is healthy, there are no signs of the disease.

Stage 1.
Minor movement disorders in one hand. Nonspecific symptoms appear: impaired sense of smell, unmotivated fatigue, sleep and mood disorders. Then the fingers begin to tremble with excitement. Later, the tremor intensifies, and the tremor appears at rest.

Intermediate stage ("One and a half").
Localization of symptoms in one limb or part of the trunk. Constant tremor that disappears in sleep. The whole hand can tremble. Fine motor skills are difficult and handwriting deteriorates. There is some stiffness in the neck and upper back, limitation of swinging movements of the arm when walking.

Stage 2.
Movement disorders extend to both sides. Tremor of the tongue and lower jaw is likely. Drooling is possible. Difficulty moving in the joints, deterioration of facial expressions, speech retardation. Sweating disorders; the skin can be dry or, on the contrary, oily (dry palms are characteristic). The patient is sometimes able to restrain involuntary movements. A person copes with simple actions, although they slow down noticeably.

Stage 3.
Hypokinesia and rigidity increase. The gait acquires a "puppet" character, which is expressed in small steps with parallel feet. The face becomes masked. There may be a tremor of the head by the type of nodding movements ("yes-yes" or "no-no"). The formation of the “supplicant's pose” is characteristic - the head bent forward, the stooped back, the arms pressed to the body and bent at the elbows, the legs bent at the hip and knee joints. The movements in the joints are of the "gear mechanism" type. Speech disorders progress - the patient "gets hung up" on the repetition of the same words. The person serves himself, but with sufficient difficulty. It is not always possible to fasten the buttons and get into the sleeve (help is desirable when dressing). Hygiene procedures take several times longer.

Stage 4.
Severe postural instability - it is difficult for the patient to maintain balance when getting out of bed (may fall forward). If a standing or moving person is slightly pushed, he continues to move by inertia in the "given" direction (forward, backward or sideways) until he encounters an obstacle. Falls are frequent, which are fraught with fractures. Difficulty changing body position while sleeping. Speech becomes quiet, nasal, blurry. Depression develops, suicidal attempts are possible. Dementia may develop. In most cases, outside help is required to carry out simple daily activities.

Stage 5.
The last stage of Parkinson's disease is characterized by the progression of all movement disorders. The patient cannot get up or sit down, does not walk. He cannot eat on his own, not only because of tremors or stiffness of movements, but also because of swallowing disorders. Control over urination and stool is impaired. A person is completely dependent on others, his speech is difficult to understand. Often complicated by severe depression and dementia.

Dementia is a syndrome in which there is a degradation of cognitive function (that is, the ability to think) to a greater extent than is expected with normal aging. It is expressed in a persistent decrease in cognitive activity with the loss of previously acquired knowledge and practical skills.

Causes

could not identify the exact reasons

Aging - with age, the number of nerve cells decreases, this also leads to a decrease in the amount of dopamine in the basal ganglia, which in turn can provoke Parkinson's disease.
Heredity - the gene for Parkinson's disease has not yet been identified, but 20% of patients have relatives with signs of parkinsonism.
Environmental factors - various pesticides, toxins, toxic substances, heavy metals, free radicals can provoke the death of nerve cells and lead to the development of the disease.
Medications - some antipsychotics (for example, antidepressants) interfere with the metabolism of dopamine in the central nervous system and cause side effects, similar to the symptoms of Parkinson's disease.
Brain injuries and diseases - bruises, concussions, as well as encephalitis of bacterial or viral origin can damage the structures of the basal ganglia and provoke illness.
Wrong way of life - such risk factors as lack of sleep, constant stress, unhealthy diet, vitamin deficiency, etc. can lead to the onset of pathology.
Other diseases - atherosclerosis, malignant tumors, diseases of the endocrine glands can lead to complications such as Parkinson's disease.

How to treat Parkinson's disease

Parkinson's disease in the initial stages is treated with medication, by introducing the missing substance. The substantia nigra is the main target of chemical therapy. With this treatment, almost all patients experience a weakening of symptoms, it becomes possible to lead a lifestyle close to normal and return to the previous way of life.
However, if after several years the patients do not improve (despite the increase in the dose and frequency of drug intake), or complications appear, a variant of the operation is used, during which a brain stimulator is implanted.

Under local anesthesia, two electrodes are sequentially inserted (along a path pre-determined by a computer) for deep brain stimulation.
Under general anesthesia in the area chest an electrostimulator is inserted subcutaneously, to which electrodes are connected.

Parkinsonism treatment, drugs

Levodopa. With Parkinson's disease the best medicine has long been considered levodopa. This drug is a chemical precursor to dopamine. However, it is characterized by a large number of serious side effects, including mental disorders. It is best to administer levodopa in combination with peripheral decarboxylase inhibitors (carbidopa or benserazide). They increase the amount of levodopa reaching the brain and at the same time reduce the severity of side effects.

Madopar - one of these combination drugs. Madopar capsule contains levodopa and benserazide. Madopar comes in various forms. So, madopar GSS is in a special capsule, the density of which is less than the density of gastric juice. Such a capsule is in the stomach for 5 to 12 hours, and the release of levodopa is gradual. And dispersible madopar has a liquid consistency, acts faster and is more preferable for patients with swallowing disorders.

Amantadine. One of medicines, with which treatment is usually started - amantadine (midantan). This drug promotes the formation of dopamine, reduces its reuptake, protects the neurons of the substantia nigra by blocking glutamate receptors and has other positive properties. Amantadine is good at reducing rigidity and hypokinesia, it has less effect on tremor. The drug is well tolerated, side effects are rare with monotherapy.

Miralex. Miralex tablets for Parkinson's disease are used both for monotherapy in the early stages and in combination with levodopa in the later stages. Miralex has fewer side effects than nonselective agonists, but more than amantadine: nausea, pressure instability, drowsiness, swelling of the legs, increased levels of liver enzymes may develop, patients with dementia may develop hallucinations.

(Newpro). Another modern representative of dopamine receptor agonists is rotigotine. The drug is made in the form of a patch applied to the skin. The patch, called the transdermal therapeutic system (TTS), measures 10 to 40 cm² and is applied once a day. Newpro is a prescription drug for monotherapy idiopathic disease Parkinson's at an early stage (without the use of levodopa).

This form has advantages over traditional agonists: the effective dose is less, the side effects are much less pronounced.

MAO inhibitors. Monoamine oxidase inhibitors inhibit the oxidation of dopamine in the striatum, thereby increasing its concentration in the synapses. The most commonly used treatment for Parkinson's disease is selegiline. In the early stages, selegiline is used as monotherapy, and half of patients with treatment report significant improvement. Side effects of selegiline are not frequent and not pronounced.

Selegiline therapy can delay the appointment of levodopa by 9-12 months. In advanced stages, selegiline can be used in combination with levodopa - it can increase the effectiveness of levodopa by 30%.

Mydocalm reduces muscle tone. This property is based on its use in parkinsonism as an auxiliary medicine. Mydocalm is taken both orally (tablets) and intramuscularly or intravenously.

B vitamins are actively used in the treatment of most diseases of the nervous system. For the transformation of L-Dopa into dopamine, vitamin B₆ and niacin are required. Thiamin (vitamin B₁) also helps increase dopamine in the brain.

How long do people live with Parkinson's?

research by British scientists

persons whose disease began at the age of 25-39 live on average 38 years;
at the onset of 40-65 years old, they live about 21 years;
and those who fall ill over the age of 65 live for about 5 years.

Prevention of Parkinson's Disease

to eat well;
lead a healthy and fulfilling life;
protect yourself from unnecessary worries and stress;
do not abuse alcohol;
move more often;
train memory;
engage in active mental activity.

The author of the article: Sergey Vladimirovich, an adherent of sensible biohacking and an opponent of modern diets and fast weight loss. I will tell you how a man aged 50+ to remain fashionable, beautiful and healthy, how to feel in his 50s at 30. about the author.

Medical history

Forms

Etiology

Neurophysiological causes of parkinsonism

Symptoms

Classification of types of parkinsonism

Toxic parkinsonism

Medicinal parkinsonism

Post-traumatic parkinsonism

Post-encephalitic parkinsonism

Juvenile parkinsonism

Manganese parkinsonism

Atherosclerotic parkinsonism

Drugs that increase the risk of parkinsonism

Epidemiology of Parkinson's Syndrome

Etiology of Parkinson's Syndrome

Pathological anatomy of Parkinson's syndrome

Parkinson's syndrome pathogenesis

Parkinson's syndrome clinic

Parkinson's syndrome treatment

Clinical picture

Common Symptoms

Motor symptoms

Vegetative symptoms

Sensory symptoms

Mental symptoms

Sleep and wakefulness disorders

Diagnostics

Treatment

Drug-free treatment

Prevention

Parkinson's disease: what is it?

Causes of occurrence

Forms and stages of Parkinson's

Parkinson's disease: symptoms and signs

Other signs of Parkinson's disease

Consequences for humans

Diagnostics

Stage 1

Stage 2

Stage 3 - confirmation of the presence of Parkinson's disease

Treatment

Drug treatment

Exercise therapy

Surgical intervention

Forecast

Prevention

Etiology of Parkinson's disease

Physiology of the nervous system.

Parkinson's disease - what is it

Parkinsonism and Parkinson's disease, differences

Symptoms and Signs

Young

Among women

In men

Diagnostics

Stages of Parkinson's disease according to Hen-Yar

Causes

How to treat Parkinson's disease

Parkinsonism treatment, drugs

Prevention of Parkinson's Disease

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