Parkinson's disease is a pathological process that affects the nervous system and is accompanied by impaired motor coordination. It is more often observed at patients of old age.
Symptomatic manifestations of the disease are associated with pathological damage, and subsequently - neuron death. In Parkinson’s disease, muscle rigidity is encountered, difficulties in taking a certain position of the body, trembling of the arms and legs.
The exact causes of the disease remain unknown, but scientists have put forward several versions regarding this issue. It is impossible to completely cure the pathology, and therapeutic manipulations bring only short-term relief.
What it is?
Parkinson's disease is a degenerative lesion of the central nervous system, characterized by slow progression. In this pathology, along with the main symptoms, vegetative, affective and other disorders are also observed.
The disease is divided into 2 types:
- True Parkinsonism, or Parkinson's Disease. It develops as a primary pathology for, as already noted, for as yet unidentified reasons.
- Parkinsonism syndrome. This disorder of the central nervous system develops as a secondary pathological process. Its occurrence may occur on the background of craniocerebral injuries, brain tumors, hemorrhages in HS, encephalitis and other neurological and neurosurgical diseases.
If you suspect the development of the disease or Parkinson's syndrome, you should immediately consult a doctor and pass all necessary examinations.
Parkinson's disease is the second most common (after Alzheimer's disease) neurodegenerative disorder. From this pathology suffers from 60 to 140 people per 100 thousand population.
In most cases, the first symptoms of the disease occur in patients aged 55-60 years. However, under certain circumstances, the development of the disease can occur in people under 40, or even in young people under 20 years of age (the juvenile form of Parkinson's disease).
The percentage of morbidity among men is higher than among women. Significant differences in the frequency of development of pathology among representatives of different races were not identified.
Causes of development
Today it is known that the hormone dopamine is directly involved in the development of the disease. More precisely, a violation of the process of its synthesis. But this is only one of many hypotheses.
Another theory is based on the claims that the disease occurs under the influence of certain toxic elements. Thus, it was found that administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropridine to the patient by injection led to the development of parkinsonism. Therefore, it is considered that substances similar in structure to MPTP may cause the occurrence of this pathology.
There is an oxidative theory, according to which the disease develops under the negative influence of free radicals, which are formed during the oxidation of dopamine.
Interesting fact. Medical statistics show that the probability of developing parkinsonism in non-smokers is 3 times higher than that in smokers. It is believed that this is due to the ability of nicotine to stimulate the synthesis of dopamine.
Parkinson's disease is classified according to the age of the patient. So, the pathology is divided into:
- early-onset Parkinson's disease;
- BP with a late debut.
Also, according to various medical sources, pathology can be divided into other classifications: shaky, akinetiko-rigid, shaky-rigid, mixed or rigid-shaky.
But none of these classifications is perfect from the point of view of symptomatology and etiology of the disease; therefore, the only correct, generally accepted, division of PD into subspecies does not exist today.
Stages of the disease
The classification of Parkinson's disease by severity divides it into 5 stages:
- At stage 0, there are no movement disorders.
- At the first stage, disorders of motor function occur only on one side of the body.
- In the third phase, both sides are already affected, but the movement disorders do not yet affect the patient's ability to walk or maintain body balance.
- At the third stage, moderate postural instability arises, but the patient is still capable of self-care.
- The last, 4th stage of Parkinson's disease is characterized by the inability of the patient to move independently, without assistance.
Pathology begins to manifest itself gradually. Moreover, its first signs are often completely unrelated to physical impairment.
So, Parkinson's disease can manifest itself:
- Violation of the olfactory function. This deviation occurs in 80% of patients with this diagnosis.
- Depressive states. In many patients, this symptom manifests itself long before the active development of the disease.
- Constipation. This symptom of Parkinson's disease is noted in most patients. In this case, defecation occurs 1 time in 2-3 days.
- Sleep disturbance They are manifested, above all, by sudden screams and shudders, falls from a bed, etc. At the same time, such deviations occur in that phase of sleep, which is accompanied by the rapid movement of the eyeballs.
- Violations of the urogenital sphere.
- Apathetic condition of the patient.
- Loss of strength, in connection with which it becomes more difficult for the patient to serve themselves and to perform basic everyday tasks: prepare food, clean the house, etc.
So, the first signs of Parkinson's disease affect primarily the vegetative, sensitive and neuropsychic sphere. This is due to the peculiarity of the progression of the pathological process. Before it hits the black substance, extragranial brain structures will suffer. They are formed from the olfactory and peripheral parts of the autonomic nervous systems, as well as from the lower parts of the brain stem.
If we talk about the first motor changes in this disease, then you can notice them by changing the patient's handwriting. Letters become small, the patient has problems with their designation.
Often there are symptoms in the form of twitching fingers on the hand or stiffness of the facial muscles. As a result, it becomes difficult for the patient to blink, his speech slows down, which makes it less clear to others.
The symptomatology of pathology is aggravated when the patient starts to get nervous or is stressed. As soon as his psycho-emotional state normalizes, all these signs disappear for a while.
Due to the fact that the first precursors of pathology are often neglected, it is extremely difficult to make a diagnosis at the very beginning of the development of Parkinson's disease. Moreover, between the occurrence of the first symptoms and the obvious manifestations of the disease, it takes quite a long time, and a person can write off their ailments to the development of other diseases or nervous disorders.
Symptoms of Parkinson's Disease
First of all, the symptoms of pathology is accompanied by movement disorders. But there are other signs by which you can recognize the disease. These include:
- Tremor of the hands and feet - a symptom that can not go unnoticed. Often the shivering is noted while the patient is at rest. But sometimes it can appear when trying to keep the limb in a certain position (postural tremor). It is also possible twitching of the arms and legs, which has a clear motor pattern (intentional tremor). So, with rest tremor accompanied by rough, sharp movements of the limbs, postural tremor appears weak, and intentional is expressed weakly. Such symptoms are observed in the form of parkinsonism.
- Rhythmic twitching of the jaw muscles, tongue, eyelids.
- Muscular rigidity. This symptom is mild in both the initial and late stages of the development of Parkinson's disease. But the patient may note the constant tension of the musculature of the body, which eventually leads to the appearance of the so-called "posture of the suppliant." It is characterized by a stooped back and permanently bent joints of elbows and knees. This leads to muscle and joint pain.
- Hypokinesia is a symptom that accompanies all forms of Parkinson's disease. It is characterized by a slowing down of movements, which leads to a decrease in their amplitudes and a decrease in the speed of the movements performed.
- Postural abnormalities. They manifest themselves in the form of changes in gait and postures taken by the patient. Due to difficulties in controlling the center of gravity, the patient is prone to spontaneous falls. Before turning to the side he has to trample a little in one place. Gait becomes unsure, shaky, mincing and shuffling.
- Parkinson's disease may be accompanied by abundant salivation. Due to the increased secretion of saliva, it is difficult for the patient to speak, and the swallowing reflex is disturbed.
- Cognitive disorders, manifested in violations of memory, attention, thinking and logic. The patient's ability to learn is reduced, and various personality changes may occur. Dementia does not manifest itself in all forms of Parkinson's disease, but if it has already begun to develop, then in the future it will only progressively progress.
- Depressive states are deepening, becoming a constant companion of a patient with parkinsonism.
- In men, Parkinson's disease leads to the development of impotence.
What do people with Parkinson's look like?
Patients with this diagnosis can be identified by slouching, restricted movement, body slightly tilted forward. In addition, in Parkinsonian patients, the arms are tightly pressed to the body and bent at the elbows, and the legs are parallel to each other. The head is stretched forward, and as if supported by a pillow. In some cases, there is a tremor in the body, which affects primarily limbs, head, eyelids, lower jaw.
Paralysis of facial muscles leads to the acquisition by the face of the patient the expression "mask". This is manifested by the absence of the expression of emotions, a rare blinking or smile, the retention of the gaze at one point over a certain period of time.
The gait of patients suffering from parkinsonism is shaky, unstable. The steps become small, shuffling, mincing. Hands while walking remain pressed to the body and do not move at all.
The psycho-emotional state of the patient is characterized as apathetic, depressive. He suffers from a constant feeling of tiredness and general malaise.
The specific clinical picture gives grounds for making a preliminary diagnosis of "Parkinson's disease." However, it is important to differentiate this pathology from other neurological syndromes. For this it is necessary to conduct a number of studies, where a special place is given to instrumental diagnostic methods:
- GM ultrasound;
- computed tomography;
- MRI of the brain.
Additionally blood tests are performed. However, these manipulations help only indirectly confirm the correctness of the diagnosis. Diagnostic procedures that would accurately indicate Parkinson's disease in a particular patient, no.
The definition of parkinsonism is carried out according to the following criteria:
- symptoms of the pathology are exacerbated even during therapy;
- domination of tremor from the side of the body that was first affected by the pathological process;
- the absence in the patient's history of other neurological syndromes that could lead to poor coordination;
- hypokinesia is combined with muscle stiffness and postural disorders, or with rest tremor.
How to treat Parkinson's disease?
The disease is incurable, and all drugs used only temporarily alleviate the symptoms. First of all, their action is aimed at eliminating violations of the motor system.
In the early stages of the pathology, the patient is advised to perform moderate exercise, as well as undergo a course of exercise therapy. Pharmacotherapy is recommended to start as late as possible, because a long, long-term medication is addictive in a patient. This leads to the need to increase the dosage of the drug, which, in turn, causes side effects.
Symptomatic treatment can be carried out using:
- with psychoses and hallucinations - psychoanaleptics (Reminil, Ekselon), neuroleptics (Seroquel, Azaleptina, etc.);
- laxatives or stimulating GI motility (with constipation): Motilium, Picolax, Picosen, etc .;
- antispasmodics (for example, Detruzitol) and antidepressants (Amitriptyline) - with other vegetative disorders;
- sedatives (Persen, Novo-Passit, Bifren) - for sleep disorders;
- antidepressants (Tsipramila, Iksela, Paksila, etc.) - with prolonged and deep depressions;
- with a decrease in concentration and deterioration of memory - Memantine, Ekselon and others.
It is possible to avoid habituation of the patient’s body to medicines used in Parkinson’s disease only under the following conditions:
- treatment should begin with mildly acting drugs in small dosages;
- drugs should be combined to achieve a more pronounced therapeutic effect;
- New pharmacological agents are added only when urgently needed;
- Levodopa is prescribed to patients only as a last resort (as a rule, they are prescribed to persons over 65);
- potent drugs are prescribed only for serious disorders of motor functions.
The objectives of pharmacotherapy in Parkinson's disease are to slow the neuronal death process and reduce the intensity of other symptoms. Comprehensive treatment of Parkinson's disease includes the use of antioxidants (natural, not synthetic vitamin E) and exercise therapy.
Drugs that increase the inhibition of neustriatum neurons by dopamine
Levodopa is a dopamine precursor belonging to the group of spatial isotopes of dioxophenylalanine (DOPA). Unlike dopamine, it penetrates well into the cells of the central nervous system. The effect of the enzyme DOPA-decarboxylase contributes to the transformation of levodopa into dopamine, which, in turn, increases its level in the non-striatum.
Through this treatment, you can get rid of the symptoms of parkinsonism as soon as possible. It is important to maintain the level of levodopa in the body - only in this case it will be effective. However, with the progression of the disease there is a sharp reduction in the neurons of the black brain substance. 97-99% of levodopa is converted to dopamine in the cells of peripheral tissues. This entails the development of serious side effects.
In order to stop them, levodopa is used in combination with DOPA decarboxylase inhibitors (Carbidopa, Benserazide). They do not penetrate into the central nervous system cells, and the metabolism of levodopa occurs only in the brain.
The following is a list of levodopa combination products:
- The main drugs: levodopa, carbidopa. Combined preparations: Nacom (10 to 1), Sinemet (10 to 1 or 4 to 1).The combination of these drugs can lead to side effects in the form of dyskinesia, anxiety, depression, delusions, hallucinations.
- Primary drugs: Levodopa, Benserazid. Preparation: Madopar (4 to 1). This is a potent agent used in Parkinson's disease.
Monoamine oxidase-B inhibitors (MAO-B) are drugs that selectively inhibit MAO-B. They are recommended to be prescribed in parallel with levodopa, which helps to reduce the dosage of the latter. Preparations: Selegilin, Razagilin.
Inhibitors of catechol-O-methyltransfease, or COMT, the enzyme responsible for dopamine distribution in brain cells. Combined dopamine precursors contribute to compensatory activation of COMT. Preparations: Tolcapon, Entakapon. By blocking MT, Levodopa dosage can be reduced. But the effectiveness of the therapy on this background decreases.
The following is a list of medications that reduce reuptake and increase the release of dopamine:
- Amantadine. Treats antiviral drugs, possessing smaller efficiency, than Levodopa. Under its influence, there is a decrease in muscle rigidity and akinesia. The use of medication does not eliminate trembling of the extremities.
- Gludantan. Unlike the previous preparation, it effectively eliminates tremor, but it has less effect on akinesia and rigidity. The drug is advisable to use in combination with Levodopa and Trihexyphenidyl.
The following are drugs that stimulate dopamine receptors:
- Bromocriptine. It is a partial dopamine receptor agonist.
- Lesurid is a drug belonging to the group of ergot alkaloids.
- Pergolide is an agonist of dopamine receptors.
Drugs that inhibit the excitation of neostriatum neurons with acetylcholine
Trihexyphenidyl is a drug that is an antagonist of muscarine, but is less effective than Levodopa. The drug quickly relieves muscle rigidity and tremors, but does not affect the manifestations of bradykinesia. Used exclusively as part of complex treatment.
Glutamate Receptor Blockers (NMDA)
This is a relatively new group of drugs. Glutamate is an excitotoxic substance, a transmitter for pathways. The mechanism of its effect on NMDA receptors is to induce calcium ions intake, under the influence of which brain neurons begin to actively die, which only aggravates the course of Parkinson's disease.
To stop this process, drugs that block glutamate receptors are used:
- Midantan, Symetrel. This is a drug that is derived from adamantine. The mechanism of their action is to reduce the toxic effects of glutamate, which consists in stimulating NMDA receptors.
- Procyclidine, Etopropazin - drugs from the group of anticholinergics. They are quite weak glutamate receptor antagonists.
Despite the wide variety of drugs and their high efficiency, it is not always possible to stabilize the patient's condition only by conservative methods of therapy. To date, good results in the treatment of Parkinson's disease are provided by destructive surgical interventions, namely:
- thalamotomy to help fight tremor of the limbs;
- pallidotomy, which helps to eliminate movement disorders.
A minimally invasive, and at the same time highly effective, surgery for Parkinson's disease is neurostimulation. By its principle, it is somewhat similar to cardiac stimulation, but only in this case the stimulator has a direct impact on the functioning of the brain.
The manipulation is carried out under the control of the MRI apparatus. The use of electric current to stimulate the work of the brain structures responsible for motor activity gives hope for its recovery.
However, this therapeutic procedure has its positive and negative sides, which need to be aware of. So, the advantages of neurostimulation are:
- high efficiency;
- absolute security;
- good patient tolerance;
- reversibility of the process.
The disadvantages of this therapeutic technique are:
- high cost of the operation;
- the possibility of failure of the electrodes;
- the need to replace generators several years after the installation of the device;
- risk of infection.
A novelty in the treatment of this disease is the operation on the transplantation of neurons that replace the destroyed cells that previously produced dopamine into the brain.
It is very early to speak about how successful the innovative methods of treatment of Parkinson's disease (in particular, the introduction of genetic vectors, the melting of Levi's bodies, which are specific markers of this disease), are. But it is quite possible that in the coming decades, scientists, nevertheless, will find a way to completely cure dangerous pathology.
What determines the duration of life?
The life expectancy of a patient with parkinsonism directly depends on when the diagnosis was made.
The identification of a dangerous illness in the early stages of its development and the timely start of treatment (including physiotherapy, massage, gymnastics), combined with a diet and a healthy lifestyle, give the patient the chance to live as long as possible without any special damage to his quality of life.
The prognosis - how much do people live with Parkinson's?
Since Parkinson's disease is prone to progression, the prognosis for the patient can hardly be called favorable. The symptoms of movement disorders are especially rapidly progressing. If the patient does not receive the necessary treatment, then approximately 8 years after the onset of the development of the disease, he loses the ability to self-care. After 10 years, he loses the ability to move.
For patients who receive the necessary treatment, the prognosis is more or less favorable. Patients taking Levodopa begin to need help, on average, 15 years after diagnosis.
However, each case is individual, as is the rate of progression of the pathological process in a particular patient. It is reliably known that persons in whom Parkinson's disease was detected at a young age suffer from movement disorders much more. But in patients older than 70 years, mental disorders are the first to progress.
Properly prescribed treatment significantly inhibits the development of many symptoms that can cause the patient to lose his ability to work. But 10 years after the onset of the development of the disease, the working capacity in most patients is still significantly reduced. Life expectancy also becomes less.
To date, there are no specific methods for preventing Parkinson's disease.
According to experts, the use of coffee can help reduce the risk of developing this pathology, if there are no contraindications for it, avoiding contact with harmful substances, maintaining a physically active lifestyle and sufficient intake of B vitamins.