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Parkinson's disease: symptoms and signs, treatment, prognosis of life

The old name for this very characteristic disease is “trembling paralysis.” This disease has received its own name on behalf of the English doctor James Parkinson, who first drew attention to him by publishing the book Essay on Shivering Paralysis.

Parkinson died in 1824, shortly before the discovery of anesthesia. But his ideas and work were in demand in the future. The great French neuropathologist Jean-Martin Charcot (who was born a year after Parkinson’s death) studied a lot of trembling paralysis, and called it the name of its predecessor.

In fairness, it should be noted that the first information about the symptoms of the disease is found in ancient Egyptian papyrus, and in Ayurveda, as well as in the texts of the Old Testament.

What is Parkinson's disease, what are its causes, how does it occur and how is it treated? We will understand these issues.

Content

Parkinson's disease - what is it?

Parkinson's disease

Two perfectly fair definitions of this disease can be given. The first is morphological, more “scientific”: Parkinson's disease is a motor disorder of idiopathic etiology (unknown cause), which is based on a change in dopaminergic neurons of the subcortical structures of the brain that lie in the dense part of the substantia nigra and other nuclei.

If nothing is clear, then a second, clinical definition can be given in simpler terms: Parkinson's disease is a disease that manifests itself in a triad of symptoms: akinesia (movement disorder), muscle rigidity and tremor.

It is important that Parkinson's disease is a particular case of a group of diseases, which is manifested by parkinsonism (akinesia, tremor and rigidity).

The difference between Parkinson’s disease and parkinsonism is only that parkinsonism has a known cause, and Parkinson’s disease occurs without them, and is hereditarily caused. Therefore, when considering the causes of the disease, we will mainly consider secondary parkinsonism.

Causes of Parkinson's Disease and the Hereditary Factor

Causes of Parkinson's Disease In order for parkinsonism to develop, degeneration of neurons containing melanin must occur, and therefore these structures are dyed in a dark color: the substantia nigra and the striatum.

In Parkinson's disease, both right and left structures are affected, and in parkinsonism, one-sided defeat is possible. In this case, the symptoms occur on the opposite side of the body, due to the crossing of the neural pathways. The causes of Parkinson's disease are a number of factors provoking the development of parkinsonism:

  • Encephalitis, especially lethargic and progressive forms of tick - borne encephalitis ;
  • Cerebral atherosclerosis, pronounced in the elderly. Therefore, the individual features of the disease can be found in old people with deep "sclerosis";
  • Tertiary brain syphilis, affecting subcortical structures;
  • Damage to the midbrain tumor;
  • Post-traumatic lesion (formation of contusion focus in the area of ​​subcortical structures);
  • Hemorrhagic or ischemic stroke to the appropriate area. This syndrome is called Benedict's syndrome and is caused by a lesion of the red nucleus, and a tremor occurs on the opposite side of the body;
  • Intoxication with carbon monoxide (carbon monoxide), manganese and its derivatives, organophosphorus compounds.

Young readers do not know, and people at the age of 40 years old will probably remember that their grandmothers in the 70s and 80s of the last century could take such drugs for “pressure” like “Raunatin”, “Rauvazan”. They contained the alkaloid rauwolfia. With prolonged treatment (years) of these drugs, parkinsonism also developed.

As already mentioned, the cause of Parkinson's disease can be hereditary - for the blood relatives of the patient, the risk of becoming ill with Parkinson's disease increases 10 times, compared with ordinary families. In fact, the identification of the cause does not affect the treatment of Parkinson's disease, but this will be discussed below.

The incidence of the disease is, on average, one case per 1000 people, but its incidence increases with age.

Symptoms and signs of Parkinson's disease

Symptoms and signs of Parkinson's disease

The clinical picture of this disease consists of several characteristic symptoms and signs of Parkinson's disease: akinesia, rigidity and tremor. In addition, vegetative disturbances occur in the form of hypersalivation, facial seborrhea, and other symptoms. Consider separately these signs.

  • Akinesia

Slowly but steadily, patient mobility decreases. Mimicry and all manifestations of expression disappear from his face: anger, joy. It is very difficult to start moving. The patient resembles a fingerboard, which is trying to take off after a full dinner with a flat field. The neck makes some awkward jumps, and the patient kneels on tiptoe, and then goes.

Even worse is the end of the movement: it cannot stop suddenly. Additional steps are required again.

Symptoms of Parkinson’s disease such as propulsion, retropulsion (steps back, if thrust into the chest) and laterpulsion (sideways) manifest themselves. All movements become complex, slow and unfinished. The patient has no unnecessary movements. He commits them only when absolutely necessary. Even when walking, the arms do not move, and only the legs make small steps.

The face becomes stiff and masked. On the face "live" eyes, which very rarely blink. With the help of the eye, the patient prefers to communicate, for example, by pointing to the desired object. The speech is quiet, monotonous, dysarthria due to tongue tremor appears.

  • Rigidity

cog in Parkinson's disease

If you take the hand of a patient who suffered a stroke, then when you try to bend it, you will have a distinct resistance at the beginning of movement when you try to bend it (a symptom of a “folding knife”). If you do the same experience with a patient with trembling paralysis, then viscous resistance, like wax, is clearly realized, despite all the requests to relax.

Parkinsonian muscles simply never relax - this leads to some characteristic signs of Parkinson's disease. If the muscles are amenable to passive movement, then only jerks, because their tone changes in steps. This leads to the symptom of "cogwheel", or, as neurologists say, the manifestation of "cog".

If you raise the head of a lying patient, and then abruptly release it, then you can not worry that it will fall. It will slowly go down, like a second hand on the clock, while there are no paralyzes and muscle weakness.

  • Tremor

Most patients have tremor, but some may not have it. This is a low frequency tremor (5-6 movements per second). Its reason is the “game” between opposing muscles - antagonists, which can never come to rest.

An important feature of parkinsonism is the disappearance of tremors during conscious movement, for example, when asked to show the tip of the nose. With essential and cerebellar tremor with an intention, the tremor will only intensify. Also, tremor is absent during sleep.

The type of movements is also characteristic: it looks like a “rolling of a piece of paper”, “a crumb of bread”, or a movement like “a coin count”. Especially pronounced tremor in the hands.

  • Vegetative disturbances

When parkinsonism changes salivation. A large amount of sebum is secreted, the face becomes greasy, often covered in sweat. There are seborrheic phenomena. Patients develop an increase in salivation.

As can be seen, such a vivid clinical picture allowed Parkinson to specially note this disease at the turn of the XVIII-XIX centuries, and dedicate a whole monograph to it.

On the stages of Parkinson's disease

At the time, many classifications and diseases were proposed. One of the most popular was created by doctors Hen and Yar in the 60s of the last century:

  1. In the first stage, unilateral failure;
  2. The second stage - bilateral symptoms appear;
  3. The third stage is characterized by an expanded clinic;
  4. The fourth stage involves outside help;
  5. The fifth stage is a deep disability.

Stages of Parkinson's disease can also be classified according to the degree of predominance of symptoms (for example, there is a “yeast-free form” of trembling paralysis, that is, predominantly manifestations of akinetiko-rigid syndrome).

In the diagnosis of this disease, it is necessary to exclude diseases in which parkinsonism occurs. Thus, progressive supranuclear palsy, strionigral degeneration, Levi's calf-sickness, or Machado-Joseph disease are considered.

Alzheimer's and Parkinson's disease do not get along in the same person. When Alzheimer suffers intellect, memory, disrupted social behavior. It is hard to care for the sick, as they are untidy, and can leave home without finding a way back.

In Parkinson's disease, patient untidiness is not due to the fact that he “doesn’t care”, but because it is difficult for him to move, and he will not leave the house anywhere, the “parkinsonian” intellect does not suffer, despite the fact that it is difficult for them to express their thoughts . Therefore, confusing these diseases is difficult.

Parkinson's disease treatment, drugs

Parkinson's disease treatment, drugs

Treating paralysis therapy is a long and relatively expensive affair. The task of treatment is to maintain a balance between the dopamine and acetylcholine system, because with the disease there is the oppression of the first of them. Therefore, it is necessary either to increase dopaminergic activity, or to reduce cholinergic.

The disease is incurable, and the task of treating Parkinson's disease is to reduce the symptoms. The following drugs that increase dopamine are used:

  • Levodopa - used for disabling forms, reduces hypokinesis and rigidity;
  • Bromocriptine (dopamine agonist);
  • Selegilin ("Yumeks") - dopaminomimetik;
  • Amantadine (dopaminomimetik indirect action).

Holinoblockers are indicated in the initial stages of Parkinson's disease, for example, to reduce tremor: profenamine, benzatropine, trihexyphenidine.

Virtually all drugs for parkinsonism have complex regimens, constant supervision by a specialist is required, and monitoring of side effects that drugs have in abundance.

Therefore, often used combined methods, for example, levodopa in small doses + bromocriptine.

Despite the many drugs, still used cyclodol, which relieves tremor. Its side effect is euphoria and hallucinations, as well as psychosis, so it is limited in use, although it is on the list of essential medicines, primarily because of the cheapness of production.

Severe Parkinson disease can not stop pill treatment. Operative methods are used, as well as minimally invasive neurostimulation.

Forecast

Sometimes you can hear this question: "Parkinson's disease, the last stage - how many live?". When this disease is fatal, it is observed from intercurrent diseases. Let's explain with an example.

There are diseases whose very course leads to death, for example, peritonitis, or hemorrhage in the brainstem. And there are diseases that lead to deep disability, but do not lead to death. With proper care, the patient can live for years, even when switching to tube feeding.

Causes of death are the following conditions:

  • Hypostatic pneumonia with the development of acute respiratory and then cardiovascular insufficiency;
  • The appearance of bedsores with the addition of secondary infection and sepsis ;
  • Habitual constipation, intestinal paresis, autointoxication, vascular collapse.

If the patient is competent to care for, then he can live for years, even when bedridden. Recall the example of Prime Minister Ariel Sharon, who suffered a severe stroke in 2006, and died without regaining consciousness 8 years later, in January 2014.

He was in a coma for 8 years, and treatment was discontinued at the request of his relatives when he turned 86 years old. Therefore, the question of maintaining the life of a patient with parkinsonism is solved simply - this is care and support, since the disease does not lead to the immediate death of the patient.

Parkinson's disease, the symptoms and signs of which we examined, is one of the most vivid and memorable in the course of nervous diseases. It leaves a deep impression on the students, and they remember the disease well. We hope that this article will also leave a trace in your memory, and, having seen a patient with signs of trembling paralysis, you will be able to determine where akinesia is, where rigidity is, and how a tremor is expressed.

This knowledge will not be superfluous - so you will be able to determine the defeat of your relatives and friends, and begin timely treatment.

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