Parkinson's disease (paralysis agitans) - slowly progressive disease of the central nervous system characterized by slowness of motions, tremor at rest and impaired reflexes.
At the heart disease - damage of the nerve cells of the brain stem.
The average age of onset of the disease - 57 years. Parkinson's disease rarely occurs in smokers, which is associated with the ability of tobacco smoke to inhibit the enzyme monoamine oxidase. In 5-24% of patients - family history (family history of the disease).
The incidence of 1% of the population older than 65 years; 0.4% of the population older than 40 years. Most of the cases recorded in people born to closely related marriages.
Typical symptoms of the disease develop after losing 80% or more neurons.
Manifestations of Parkinson's disease
Tremor at rest in 50-80% of patients. Jitter in Parkinson's disease - rhythmic twitching II, III and I contrasted them fingers; in typical cases resembles rolling fingers grain ball (on the "pill rolling", "Coins Account" type); early unilateral disease; maximum alone, decreases or disappears during the motion; absent during sleep; is amplified under emotional stress and fatigue; It occurs more often on the hands, at least on my feet; also observed tremor of the jaw, tongue, eyelids.
The progressive slowing of movements, limit the volume and speed of movement, difficulty in initiating motor act. Movement disorders in Parkinson's disease leads to the appearance of mask-like face with his mouth open, hunched posture, shuffling mincing gait, lack of friendly hand movements when walking.
Violation of postural reflexes leads to propulsion (irresistible acceleration movements of the patient while walking forward or after shock lung) and retropulsion (involuntary motion acceleration jolt back after this direction).
Muscle tone is changed according to the type of lead pipe.
Parkinsonism it slow, inexpressive, obscure, silent, stammering. No tone (monotone voice).
Visual disturbances: loss of blinking movements, spasmodic blinking or reduction of the circular muscles of the eye and century cramp gaze (eye involuntary upward rotation with prolonged (up to several minutes) holding them in this position); Eye symptom puppet - when tilted forward head eyeballs move upwards, eyeballs lowered by tilting the head.
seborrhea - strengthening the functions of the sebaceous glands, which leads to excessive secretion of sebum.
Autonomic disorders: constipation, lower blood pressure, incontinence, sexual dysfunction.
Dementia occurs in 50% of patients, usually at the beginning of the disease with bilateral lesions.
Diagnostics
- Computer or magnetic rezonanskaya tomography,
- positron emission tomography.
therapies
The therapy is carried out for the entire life of the patient.
Acute deterioration evidence of non-compliance, depression or comorbidities.
It is important as long as possible to maintain the maximum level of physical activity.
As the progression of motor disorders is necessary to develop an individual program of regular exercise.
- Levodopa + carbidopa tablet of I (25/250 mg) I-2 p / day after meals (if tolerated dose gradually is incremented by 1 tablet every 4-7 days until the resistant but not more than 8 tablets / d), or Levodopa + Carbidopa.
Side effects include nausea, vomiting, psychoses, dyskinesias mouth, face, limbs dystonia.
After 2-5 years of treatment, 50% of patients due to reception of preparations containing levodopa occurs on-off phenomenon: stiffness is quickly replaced by uncontrolled hyperactivity (Grimacing).
To mitigate this side effect recommend switch to frequent receptions (1-2 hours) low doses of levodopa, dopamine agonists supplemental assignment or selegiline. Pyridoxine those receiving levodopa preparations, is contraindicated.
- Bromocriptine at 5-60 mg / day, mainly in combination with low doses of levodopa for later (at lower efficiency, or development of side-effects of levodopa) and the early stages of the disease.
Side effects: nausea, mental disorders, lowering blood pressure, headache. Tolerability degrades alcohol.
- M-holinoblokatory - early and as an adjunct to levodopa in more advanced stages; most effective for removing jitter. Treatment starts with small doses, gradually increasing them.
Biperiden 1-2 mg 3 / day.
Trihexyphenidyl of 1-5 mg 3 / day.
Difeniltropin at 10-12.5 mg 1-2 p / day.Adverse reactions: dry mouth, urinary volume decrease, constipation, Blurred vision, confusion, impaired thermoregulation. Contraindicated during closure glaucoma, Urinary retention, atrial fibrillation. Caution must be exercised hypertension, expressed atherosclerosis, Diseases of the heart, liver and kidneys.
- Selegiline 5-10 mg / day, it can be combined with levodopa + benserazide or carbidopa + levodopa; sometimes potentiate the side effects of levodopa.
- Diphenhydramine of 25-100 mg / day, with tremor.
- 25-50 mg of amitriptyline at bedtime) in combination with levodopa - depression, anxiety, insomnia.
- 10-40 mg Propranolol 2-4 p / d is sometimes effective in the amplification of jitter during physical activity.
Surgical treatment: the rough-sided tremor and no effect of drug therapy.
Method of treatment of Parkinsonism by transplanting cells secreting dopamine (embryonic or derived by genetic engineering) in the region of the basal ganglia to date can only experimental.
The prognosis of Parkinson's disease
For Parkinson's disease is characterized by slow steadily progressive course leading to death of the patient.
After 5 years of treatment 50% of patients do not have a chance to improve.
