Parkinson's disease: symptoms and treatment

Parkinson's disease (tremor paralysis) is a fairly common degenerative disease of the central nervous system, which is manifested by a complex of motor disorders in the form of tremor, slowness of movements, rigidity (inelasticity) of muscles and instability body. The disease is accompanied by mental and vegetative disorders, personality changes. To establish the diagnosis requires the presence of clinical symptoms and data of instrumental research methods. To slow the progression of the disease and deterioration, a patient with Parkinson's disease must constantly take medication.

A tremor paralysis develops in 1% of the population up to 60 years of age. The onset of the disease most often falls on the age of 55-60 years, occasionally occurs in people younger than 40 years, and very rarely - up to 20 years. In the latter case, this is a special form: juvenile parkinsonism.

The incidence rate is 60-140 cases per 100 000 population. Men are sick more often than women, the ratio is approximately:.

Causes

The true cause of Parkinson's disease has not been clarified to this day. It is considered that the combination of genetic predisposition and external factors of influence trigger the process of degeneration in the central nervous system. With Parkinson's disease, the subcortical formations of the brain are destroyed, they lose their function, and as a result, this results in certain clinical symptoms.

Very often you can hear the concept of "parkinsonism" (Parkinson's syndrome). Parkinson's disease and parkinsonism are not exactly the same. Parkinsonism syndrome clinically looks like a trembling paralysis, but it has a well-defined cause (for example, the transferred infection of the nervous system, cerebrovascular diseases, long-term use of certain drugs, drugs, etc.). And with Parkinson's disease as such, there is no reason, and the symptoms appear. 80% of all cases of Parkinson's syndrome are Parkinson's disease.

What happens with Parkinson's disease?

The process of degeneration occurs in the so-called black substance - a group of brain cells related to the subcortical formations. The destruction of these cells leads to a decrease in the content of dopamine. Dopamine is a substance through which information is transmitted between the subcortical formations of a programmable movement. T. e. all motor acts are planned in the cerebral cortex, and are realized with the help of subcortical formations.

Reducing the concentration of dopamine leads to disruption of the connections between the neurons responsible for movement, contributing to increased inhibitory effects. T. e. the execution of the motor program is difficult, slowing down. In addition to dopamine, the formation of the motor act is influenced by acetylcholine, norepinephrine, serotonin. These substances (mediators) also play a role in the transmission of nerve impulses between neurons. Imbalance of mediators leads to the formation of an incorrect program of movements, and the motor act is not implemented as required by the situation. Movement becomes slow, there is trembling of the limbs at rest, muscle tone is disturbed.

The process of neuronal destruction in Parkinson's disease does not stop. Progression leads to the appearance of more and more new symptoms, to the strengthening of the already existing ones. Degeneration also captures other structures of the brain, mental and mental, vegetative disorders join in.

Symptoms

All symptoms of Parkinson's disease can be divided into two large groups: basic and additional. The main symptoms to some extent (depending on the stage of the disease) are present in each patient, and additional ones can vary considerably in their manifestations.

The main symptoms include:

1. hypokinesia (akinesia) - difficulties in the implementation of arbitrary movements. Muscles are not prepared for action. The impulse to the muscles comes through the nerve fiber, and they can not immediately, "from the start perform the required. There is a slow motion with a decrease in the amplitude of their implementation. First, there are difficulties in fastening buttons, tying shoelaces, using cutlery, shaving, writing. The handwriting changes: the letters become small (micrographs). When walking, accompanying her normal movements with her hands are lost (swinging from side to side), steps become shorter. The speed of the movement is also reduced. There are changes in mimicry: the face looks like a mask, a frozen grimace. A rare blinking of the eyelids (normally 15-18 movements per minute) is characteristic. Speech becomes monotonous, devoid of emotional coloring, indistinct. At the initial stages, these changes may not be noticeable, but they can be provoked. To do this, the patient is asked to rhythmically tap with his fingers on the table, alternating fingers with each other, squeeze and unclench fists, etc. When these requests are fulfilled, there will be a certain slowing of the motor act. In the later stages of the disease, the phenomenon of "congealing" may appear. The picture in this case looks like a freeze frame: all activities are abruptly and unexpectedly stopped, the patient "turns off". In this case, the posture may be most uncomfortable (especially for a healthy person), for example, when trying to get up from a chair, the patient freezes in a half-bent position above it. Sometimes they speak of the symptom of the "air pillow when the patient can lie on the bed for a long time to keep his head elevated, as if it lies on a pillow;
2. Muscle rigidity is an increase in muscle tone. It arises as a result of simultaneous tension of flexor muscles and extensors, i.e. opposite in their effect. It feels during passive movements in the joint. Rigidity does not develop simultaneously in the whole body, usually it is asymmetric, especially at the onset of the disease. The degree of expression of the increase in muscle tone fluctuates throughout the day, stiffness decreases after rest and sleep, increases with stress. The patients themselves may not feel stiff in the early stages. Later, because of it, a pose, specific to Parkinson's disease, is formed - the "petition pose". It consists of the following: the head is bent, tilted down and forward, hands are pressed to the trunk and bent in elbow joints, the back is bent by an arch (stooped), hip and knee joints in a state of insignificant bending. Muscular rigidity becomes the cause of pain in the back, joints. When the doctor conducts tests to determine rigidity, then in Parkinson's disease they say that there is a phenomenon of a "cogwheel". This is a sensation that arises in the doctor when trying to bend and unbend limbs. Movement is not uniform, with jerks, as if something is clinging to the teeth of the gear. This symptom is specific for Parkinson's disease;
3. tremor of rest is a trembling in the extremities, insignificant in amplitude, disappearing when trying to perform any action by this limb. The oscillation frequency is 4-8 per second. The strength of the oscillations increases with excitement, mental strain, while moving by other limbs (in which there is no tremor). During sleep, the shaking stops. The most common is a tremor in the hands like "counting coins" or "rolling pills when the thumb rhythmically slides along all the others stacked together. Appearing in one limb, the tremor spreads to others. In the legs occurs in the supine position or sitting (if the limbs do not touch the floor), when walking disappears. There may be a tremor of the chin or lips and tongue, eyelids, whole head like "yes-yes" or "no-no sometimes patients complain of a feeling of trembling inside the body. The severity of tremor with the progression of the disease varies, as muscle rigidity helps to reduce it. Occasionally, with Parkinson's disease, intentional tremor may be observed, i.e., tremor arising during movement and absent in rest;
4. postural instability - a violation of the ability to maintain the center of gravity of one's body, maintain balance when moving. This symptom does not develop immediately, but after several years of the disease. Postural instability causes falls. Because of hypokinesia, the patient can not start movement, and then because of the postural instability can not stop, as if catching up with its center of gravity, semenovat small steps. If the patient is slightly pushed, then to stay on his feet and not fall, he will make a few steps back or to the side, without bending the limbs, without changing the pose. Maybe even a fall. Those. muscle tone does not manage to redistribute adequately changed situation, there is no necessary flexibility. This symptom is called a retro-pulse (when moving backwards) and lateral impulse (when moving to the side).

These four symptoms are considered basic, but can occur in various combinations or even one at a time in the onset of the disease. Depending on the prevalence of this or that symptom, the akinetic-rigid, rigid-trembling and trembling forms of Parkinson's disease are distinguished. The form of the disease affects the choice of the method of treatment.

Of the other symptoms of Parkinson's disease, it should be noted:

• vegetative manifestations - increased salivation, greasiness of the skin of the face and hair, dandruff, sweating or dry skin, delayed urination, constipation, violation of sexual function;
• mental disorders (develop gradually). At first it concerns certain spheres of life and seems to be peculiarities of character: the patient becomes petty, scrupulous and meticulous, fixated, grouchy (always mumbling to himself). Frequent become unmotivated mood changes, narrowed horizons, there is stickiness (acaiya), the viscosity of thinking (bradyphrenia). The patient avoids communication with others, sometimes the closest people, becomes embittered. Parkinson's disease leads to a decrease in interest in life and the development of depression. Memory worsens. Mental disorders progress with time, reaching a degree of dementia. The situation is aggravated by the fact that some medicines used to treat the disease Parkinson's, can contribute to the emergence of mental disorders (even such as hallucinations, psychoses);
• sleep disorders - there are difficulties with falling asleep, general dissatisfaction with sleep, disturbing frequent night awakenings. Not the least role in this play the motor violations: the inability to turn on one's side, change the position of the body in the bed;
• pain, burning, numbness, crawling sensation, restless leg syndrome and similar disorders from the sensitive area.

Parkinson's disease is characterized by a steady, but very slow progression. The classification according to the degree of motor disorders was adopted (proposed in 1967 Hyon and Yar), which is used all over the world. The establishment of a stage according to this classification helps to determine the treatment, since the approaches, depending on the severity of the process, are different.

According to the scale of Hen-Yar, there are 5 stages of the disease:

• 0 stage - no motor manifestations;
• I stage - hypokinesia, rigidity, tremor is in the extremities on one side (hemiparkinsonism on the left or on the right);
• The second stage is the same, but on both sides;
• III stage - postural instability joins, but the patient is able to move without help;
• Stage IV - marked motor disorders, which lead to the need for periodic external help, but the patient can stand alone and even walk a little;
• V stage - the patient needs constant external help, without which he is simply chained to a bed or a wheelchair.

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

• rapid rate of progression - the change of stages from one to another occurs within 2 years or less;
• a moderate rate of progression - a transition more than 2 years, but less than 5 years;
• a slow rate of progression - a transition in more than 5 years.

The period during which the transition occurs from one stage to the next is also taken into account by the doctor when prescribing treatment.

Before the appearance of drugs for the treatment of Parkinson's disease, the life expectancy of patients from the time of the onset of the first symptoms did not exceed 8-10 years. Today, the use of medicines allows not only to extend the life of the patient, but also to make it as possible as high-quality and high-grade as possible, while keeping the Hyun Yar stage as far as possible.

Diagnostics

For the process of establishing a diagnosis, the main role is played by clinical symptoms. In order to suspect the presence of Parkinson's disease, it is necessary that the patient has a combination hypokinesia with one of the other main manifestations of the disease: tremor, rigidity, postural the instability. The presence of similar symptoms in relatives testifies to the diagnosis of Parkinson's disease.

Since there is a syndrome of Parkinsonism, caused by some other disease and having only a similar clinical picture, then patients with suspected Parkinson's disease are prescribed additional diagnostic methods to exclude this "other disease". T. e. additional methods are needed for differential diagnosis, while Parkinson's disease itself is not very informative. Only positron emission computer tomography (PET) with the use of fluororodope allows to detect changes in neurons of a black substance. However, this method is not common because of its high cost.

With the difficulties in diagnosis, it is possible to use a trial treatment with levodopa, a drug, a precursor of dopamine. Patients with Parkinson's disease noted the disappearance of symptoms on the background of the use of Levodopa.

Thus, Parkinson's disease is a neurological disease that has rather specific clinical symptoms: hypokinesia, muscle rigidity, tremor and postural instability. Diagnosis is associated with the recognition of these symptoms. The established diagnosis requires the implementation of therapeutic measures on an ongoing basis, which can slow the progression of the disease. You can find out about the ways of treatment and the prognosis of the disease from the next article.

Medical Animation "Parkinson's Disease

The first city canal in Odessa, TV project on health "Consilium theme "Parkinson's disease and parkinsonism