Parkinson's disease: symptoms and treatment, the prognosis for life

Parkinson's disease - a chronic degenerative disease of the nervous system, in which a person loses the ability to control their movements. The disease develops relatively slow, but has a tendency to progression. It is a fairly common problem - 4% of the elderly suffer from manifestations of parkinsonism.

At the heart of the development of the disease are changes that occur in the substantia nigra of the brain. Cells in the area responsible for producing the chemical dopamine. It provides signal transmission between neurons of the substantia nigra and the striatum in the brain. Violation of this mechanism leads to the fact that a person loses the ability to coordinate their movements.

What it is?

Parkinson's disease - a degenerative changes in the central nervous system, having the properties to progress at a slow speed. The first symptoms of the disease have been described physician D. Parkinson in 1877. While he described the disease as shaking palsy. This is due to the fact that the main features of CNS manifest tremor in limbs, muscle rigidity and slowness of movement.

Epidemiology

Parkinson's disease is 70-80% of cases of Parkinson's syndrome. It is the most common neurodegenerative disease after Alzheimer's disease.

The disease is found everywhere. Its frequency ranges from 60 to 140 people per 100,000 population, the number of patients increases significantly among the older age group. The share of people with Parkinson's disease is 1% in the age group over 60 years old and older than 85 years - from 2.6% to 4%. Most often the first symptoms of the disease appear in 55-60 years. However, in some cases, the disease can develop before the age of 40 (Parkinson's disease with early onset) or 20 years (juvenile form of the disease).

Men get sick more often than women. There were no significant racial differences were found in the structure of morbidity.

Parkinson's disease - causes of

The exact cause of Parkinson's disease remains a mystery to this day, however, some factors, Speaking at the forefront, nevertheless take over the function of leading, therefore, considered to be the perpetrators of this pathology.

These include:

1. Aging, where the number of neurons is naturally reduced, and, therefore, decreases in dopamine production;
2. Some drugs used to treat various diseases, and as a side effect having extrapyramidal effects on brain structure (chlorpromazine, rauwolfia preparations);
3. Environmental factors: residence in rural areas (processing plant substances intended to kill pests Agriculture), near the railways, motorways (for the transport of dangerous goods environmental) and industrial (harmful production);
4. Hereditary predisposition (disease gene is not identified, but the family character is indicated - in 15% of patients relatives suffer from Parkinson's disease);
5. Acute and chronic CNS (e.g., tick-borne encephalitis);
6. Vascular cerebral pathology;
7. Carbon monoxide poisoning and heavy metal salts;
8. Tumors and brain injury.

However, considering the causes of Parkinson's disease, it should be noted an interesting fact, pleasing smokers and "the coffee." For those who smoke "chance" to be ill is reduced by 3 times. They say it's tobacco smoke has a "beneficial" effects, because it contains a substance resembling MAOIs (monoamine oxidase inhibitors), and nicotine stimulate the production of dopamine. As for caffeine, and is its positive effect is the ability to increase the production of dopamine and other neurotransmitters.

Form and stage of the disease

Several distinct forms of the disease:

Shaking-rigid	In this situation, the typical symptom is tremor. Such pathology is diagnosed in 37% of cases.
Rigidity, tremor	the main features are the general slowness of movement and increase muscle tone. These symptoms occurs in about 21% of cases.
shaking	at the beginning of the main symptom is tremor. When this is not increased muscle tone, and slowness of movement, or poverty of facial expression appears negligible. This kind of disease is diagnosed in 7% of cases.
Akinetic-rigid	jitter may be manifested or completely absent slightly - e.g., during periods of excitement. This type of disease detected in 33% of cases.
akinetic	characterized by the absence of voluntary movements. This type of pathology is found only 2% of cases.

The common grading stages of the disease, which reflects the degree of severity is as follows:

• Stage 0 - lack of movement disorders;
• Step 1 - unilateral disease manifestations;
• Stage 2 - bilateral manifestations of the disease, the ability to maintain balance is not suffering;
• Stage 3 - moderately severe postural instability, the patient is able to move independently;
• step 4 - severe loss of motor activity, the ability to move is stored;
• Stage 5 - the patient is confined to bed or a wheelchair, walking without assistance is impossible.

Scale Modified Hen and Yar (Hoehn and Yarh, 1967) proposes the following division of the following stages:

• Step 0.0 - there are no signs of parkinsonism;
• Step 1.0 - unilateral manifestation;
• Step 1.5 - manifestations involving unilateral axial muscles (neck muscles and muscles located along the backbone);
• Step 2.0 - double-sided displays no signs of disequilibrium;
• Step 2.5 - soft double sided display, the patient is able to overcome induced retropulsion (acceleration patient at a push back the front);
• Step 3.0 - mild or moderate bilateral manifestations, small postural instability, the patient does not need any assistance;
• Step 4.0 - severe immobility, the patient's ability to walk or stand without support maintained;
• Step 5.0 - unassisted patient chained to a chair or bed.

Symptoms of Parkinson's disease

In the early stages of Parkinson's disease is difficult to diagnose because of the slow development of clinical symptoms (see. Photo). She can manifest pain in the extremities, which can be wrongly attributed to diseases of the spine. Often can occur depression.

The main manifestation of Parkinson's disease is akinetic-rigid syndrome, which is characterized by the following symptoms:

1. Tremor. It is quite a dynamic symptom. Its appearance may be related to the emotional state of the patient and his movements. For example, a hand tremor may be reduced during lucid movements, and amplified when walking or movement of the other arm. Sometimes it may not be. The frequency of the vibrational movements is small - 4-7 Hz. They can occur in the hand, the foot, the individual fingers. In addition to the course, the "jitter" can be marked in the lower jaw, lips and tongue. Characteristic parkinsonian tremor in the thumb and forefinger reminiscent of the "horse pills" or "by the coin." In some patients, it can occur not only alone, but also when driving, causing additional difficulties when eating or writing.
2. rigidity. Movement disorders caused by akinesia, rigidity enhanced by - increasing muscle tone. At external examination of the patient is shown increased resistance to passive movements. Most often, it is non-uniform, which leads to the emergence of the phenomenon of "gear" (the feeling that the joint is made up of gears). Normally, the tone of the flexor muscle tone prevails over the extensor muscles so stiff in them is stronger. Consequently, the observed characteristic changes in posture and gait: the torso and the head of such patients tilted forward, arms bent at the elbows and brought to the torso, legs slightly bent at the knees ( "Pose the petitioner ").
3. bradykinesia. It represents a significant slowing of the motor and depletion of activity and is the main symptom of Parkinson's disease. It manifests itself in all muscle groups but is most noticeable on the face of the weakening of the facial muscle activity (gipomimiya). Because of the rare blinking eye sight it seems heavy, piercing. Bradykinesia when it becomes monotonous, muffled. Due to violation of swallowing movements may appear excessive salivation. Exhausted and fine motor skills of the fingers: the patients can hardly make habitual movements, such as doing up buttons. When the letter observed transient micrograph: the end of the letter strings become small, illegible.
4. Postural instability. It represents a special incoordination when walking, due to loss of postural reflexes involved in maintaining balance. This symptom is manifested in the late stage of the disease. These patients experience some difficulty when changing the posture change direction and start of walk. If a small push to bring the patient out of balance, it will be forced to make some quick short moves forward or backward (or propulsion retropulsion) to "catch up" with the center of gravity of the body and not lose equilibrium. Gait then becomes mincing, "shuffling". The consequence of these changes are frequent incidence. Postural instability more difficult to therapy, so often the reason why a patient with Parkinson's disease is confined to bed. Movement disorders in Parkinson's are often combined with other disabilities.

Mental disorders:

1. Cognitive disorders (dementia) - impaired memory, there is a slowness of sight. In severe course of disease, there are serious cognitive problems - dementia, cognitive decline of activity, the ability to think straight, to express thoughts. Effective way of slowing down the development of dementia, no, but clinical studies show that the use of rivastigmine, donepezil somewhat reduce such symptoms.
2. Emotional changes - depression, it is the first symptom of Parkinson's disease. Patients lose their self-confidence, fear of new situations, avoid contact even with friends, there is pessimism, irritability. There is an increased daytime sleepiness, disturbed sleep at night, nightmares, dreams too emotional. It is unacceptable to use any drugs to improve sleep without a doctor's recommendation.

Autonomic disorders:

1. Orthostatic hypotension - decreased blood pressure when changing body position (when a person stands up abruptly), this leads to a decrease in blood supply to the brain, dizziness and sometimes fainting.
2. Gastrointestinal disorders associated with impaired intestinal motility - constipation associated with inactivity, poor diet, limiting drinking. Also cause constipation is taking medication from parkinsonism.
3. Decreased sweating and increased skin greasiness - the skin on your face becomes oily, especially in the area of ​​the nose, forehead, scalp (dandruff provokes). In some cases, it may be the opposite, the skin becomes too dry. Average dermatological treatment improves skin condition.
4. Frequent urination or difficulty contrary to the process of emptying the bladder.

Other characteristic symptoms:

1. Difficulties with meal - this is due to the restriction of motor activity of muscles responsible for chewing, swallowing, excessive salivation occurs. Latency saliva in the oral cavity can lead to suffocation.
2. Speech problems - difficulties with the start of the conversation, the monotony of speech, repetition of words, too fast or slurred speech observed in 50% of patients.
3. Sexual dysfunction - depression, antidepressants, circulatory deterioration lead to erectile dysfunction, decreased sexual desire.
4. Muscle pain - aching joints and muscles caused by a violation of posture and muscle tension, reduce the use of levodopa such pain also help some kinds of exercises.
5. Muscle cramps - due to the lack of movement in patients (muscle stiffness), muscle spasms occur, most often in the lower limbs, to reduce the frequency of seizures helps massage, warming up, stretching.
6. Fatigue, weakness - increased fatigue is usually worse in the evening and is associated with the problems of the beginning and end of the movement, it can also be linked to depression, insomnia. Establishing clear sleep, relaxation, reduction of physical activity can help reduce the degree of fatigue.

It is worth noting that the disease each person individually. Therefore, some symptoms may predominate, while others have mild. Symptoms of the disease amenable to drug therapy. In some cases, effectively fight the disease helps the surgery.

Diagnostics

A comprehensive diagnosis of the disease based on the neurological status of the study, the patient's complaints and the combination of a number of criteria.

From instrumental methods reliable is positron emission tomography (PET), in which intravenously injected radioactive flyuorodopa and evaluated the degree of accumulation at specific sites of the brain brain. The disadvantage of this method is its high cost and rarity. The rest of the laboratory and instrumental methods can not reliably identify the causes disease and assign its treatment, are therefore used to rule out other diseases with similar symptoms.

For diagnosis, a combination hypokinesia with one or more signs (resting tremor (frequency 6.4 Hz), muscular rigidity, postural disorders).

Parkinson's Disease Treatment

This disease is incurable, all modern drugs for the treatment of only relieve the symptoms of Parkinson's disease. Symptomatic treatment is aimed at eliminating the movement disorders.

How to treat Parkinson's disease? In the early stages of the disease is a feasible exercise, physiotherapy. drug treatment should be started as late as possible, because in the long years of receiving medications the patient develops addictive, forced dosage increase and as a result gain side effects.

• When expressed clinical manifestations of Parkinsonism are currently the basic drug is levodopa, usually in combination with a decarboxylase inhibitor. Doses increase slowly over several weeks to obtain a clinical effect. Side effects of the drug - dystonic disorders and psychoses. Levodopa entering the central nervous system, is decarboxylated to dopamine, necessary for normal function of the basal ganglia. The drug affects primarily on the akinesia and to a lesser extent - on the other symptoms. With the combination of levodopa with a decarboxylase inhibitor can reduce the dose of levodopa and thereby reduce the risk of side effects.
• In the arsenal of symptomatic anti-Parkinsonian agents occupy an important place holinoliticheskie drugs that blocking and m- n-cholinergic receptors, promote relaxation of smooth muscles and striated reduce violent movements and events bradykinesia. These are natural and synthetic drugs atropine: bellazon (romparquine) norakin, kombipark. Also used drugs phenothiazine series: dinezin, deparkol, parsidol, Promethazine. The main reason for the variety of drugs used to treat parkinsonism in the lack of therapeutic efficacy, the presence of side effects, hypersensitivity and fast getting used to them.
• Morphological and biochemical changes in Parkinson's disease is so complex, and the course of the disease and its consequences are so heavy, but also compounded by the effects of substitution therapy - levodopa that treatment of such patients is considered to be the top of the medical skill and is subject virtuosos - neurologists. Therefore, open and operate special centers for the treatment of Parkinson's disease, where the diagnosis is refined, monitored, selected dose necessary drugs and treatment regimens. Independently appoint and can not take drugs.

For replacement therapy using levodopa, carbidopa, NAC. It stimulates the release of dopamine adamantine, memantine, bromocriptine inhibit dopamine reuptake process - anticholinesterase drugs and tricyclic antidepressants (Amitriptillin) inhibits dopamine decay process selegiline neuroprotective antioxidants used YES-neuronal - selegiline, tocopherol, calcium channel blockers - nifidipin.

In the early stages to preserve the quality of life proved the use of pramipexole (mirapex). He is the first-line treatment of Parkinson's disease with a high level of efficiency and safety. In the treatment of used yumeks, neomidantan, neuroprotective, anti-oxidants. Patients need physiotherapy for the individual program - how to move more and longer can be maintained active.

neurostimulation

Neurostimulation is a modern method of treatment, which is a minimally invasive neurosurgical operation.

This method is applied in the following cases:

1. Although at the correct medication, the patient is not possible to achieve a significant reduction in symptoms.
2. The patient is socially active and is afraid of losing their jobs due to the disease.
3. Progression of the disease leads to the need to increase the dose of drugs, the side effects of drugs become intolerable.
4. The patient loses the ability to self-sufficiency and becomes dependent on his family in the performance of daily activities.

The results of operations:

1. It allows non-invasively adjust stimulation settings with the progression of the disease;
2. Unlike palidotomii thalamotomy and it is reversible;
3. Increases during the effective control of the symptoms of the disease;
4. Greatly reduced need for anti-Parkinsonian drugs;
5. It can be bilateral (ie effective and the symptoms on both sides of the body);
6. Easy to carry and it is a safe method.

The disadvantages of neurostimulation:

1. The relatively high cost;
2. The probability of bias electrodes or breakdown; in these cases (15%) required reoperation;
3. The need to replace the generator (3-7 years);
4. Some risk of infectious complications (3-5%).

The essence of the method: the therapeutic effect is achieved through stimulation of carefully calculated a small amplitude electrocution certain brain structures responsible for control of the movements body. For this patient entered into the brain thin electrodes which are connected to the neurostimulator (like a Pacemaker), implanted subcutaneously in the chest below the clavicle.

Treatment with stem cells.

The results of the first tests on the use of stem cells in Parkinson's disease were published in 2009. According to information received, after 36 months after administration of stem cells a positive effect was observed in 80% of patients. Treatment involves the transplantation of neurons derived from the differentiation of stem cells into the brain. Theoretically, they should replace the dead cells dofaminsekretiruyuschie. The method of the second half of 2011 studied enough and does not have broad clinical applications.

In 2003, the first time a person with Parkinson's disease in the subthalamic nucleus were introduced genetic vectors containing the gene responsible for synthesis of glutamate decarboxylase. This enzyme reduces the activity of the subthalamic nucleus. Consequently it has a positive therapeutic effect. Despite the good results obtained by the treatment, for the first half of 2011 the method is almost never used, and It is in clinical studies.

Physiotherapy

Patients can develop joint contractures resulting from disturbances of tone and hypokinesia, such as shoulder - scapular periartroz. Patients are encouraged low-cholesterol diet and low protein diet. For the normal absorption of levodopa protein foods should be taken no earlier than an hour after taking the medicine. It shows psychotherapy, reflexology.

Saving locomotor activity stimulates the production of internal (endogenous) neurotransmitters. Conduct scientific research on the treatment of Parkinson's disease: these stem cells and dofaminprodutsiruyuschie, and a vaccine against Parkinson's disease, surgical treatment - thalamotomy, pallidotomy, high-frequency stimulation of the deep subtalamicheskgo core or internal segment of the globus pallidus and new pharmacological prepraty.

Folk remedies

Without medical treatment, the patient will not be able to do. Methods of traditional medicine in Parkinson's disease only slightly facilitate his condition.

• Patients often suffer from sleep disorders; They may wake up several times during the night and walk around the room in a half-asleep state. In this case, they stumble on the furniture and can cause a serious injury. Therefore, a patient suffering from Parkinson's disease, it is necessary to create a very comfortable environment for a night's rest.
• Patient help foot baths with a decoction of fern. To prepare the broth should take 5 tablespoons. l. dry rhizomes pour 5 liters of water and boil for at least 2 hours. Cool the broth and cook a foot bath.
• Reduce the clinical manifestations can help the mixture of fresh juices leaf plantain, nettle and celery.
• Herbal teas are made from lime blossom, chamomile, sage or thyme. Plants take better individually, adding 1 tbsp. l. substrate 1 hour. l. dry grass Leonurus for sedation. 2 Art. l. medicinal plants take 500 ml of boiling water and infused dishes, wrapped up with a towel.

Before using any funds from this category should consult with your doctor!

Forecast for life

Conditionally unfavorable prognosis - Parkinson's disease has been steadily progressing. The symptoms of movement disorders develop most rapidly. Patients who are not receiving treatment, on average, lose their ability to care for themselves independently through 8 years from onset, and 10 years later become bedridden.

• On the second half of 2011 the vast majority of patients receiving appropriate treatment. Forecast in this group better than patients who do not receive adequate treatment. Persons taking levodopa, become dependent on serving their faces an average of 15 years. However, in each case the rate of disease progression varies. It is noted that at a relatively early development of Parkinson's disease most rapidly progressing symptoms of motor activity, and when the first symptoms of the disease in individuals 70 years or older at the forefront mental disorder.
• Adequate therapy slows the progression of symptoms, leading to disability patients (muscular rigidity, hypokinesia, postural instability, and others.). However, after 10 years since the onset of the disease the ability to work the majority of patients is significantly reduced.

Life expectancy of patients is reduced. Ability to work in these patients firmly and irreversibly lost, depending on the severity of neurological disorders patients assigned disability group.

prevention

In order to reduce the occurrence of Parkinson's disease risk, should adhere to the following preventive measures:

1. Timely diagnosis and treatment of vascular brain pathology associated with injury or infection. Thus it will be avoided dysfunction produce dopamine.
2. Observe reception timing neyroliepticheskih preparations. They can be used within 1 month without interruption.
3. To consult a doctor when it detects the slightest signs of Parkinson's disease.
4. Substances that are really able to protect neurons - is flavonoids and anthocyanins. They can be found in apples and citrus.
5. It should take care of the nervous system by avoiding stress, maintain a healthy lifestyle, engage in physical exercise.
6. More and more scientific evidence suggests that smokers and lovers of coffee drinks Parkinson's disease practically does not occur. But it's quite a specific preventive measure, which should not be construed as a recommendation. By the detection of the disease there is no point in starting to smoke or consume coffee as this has no effect on the course of pathological processes. Nevertheless, in the absence of contraindications, it is possible to consume the minimum dose of natural coffee on a regular basis.
7. It is useful to stick to a diet that is rich in B vitamins and fiber.
8. Avoid contact with harmful substances, influencing the development of the disease, such as manganese, carbon monoxide, opioids, pesticides.

New research shows that the berries are able to influence the risk of disease.