Parkinson's disease

Parkinson's disease is a neurodegenerative brain disease that progresses very slowly in most patients. In short, a patient with Parkinson's disease gradually stops the production of dopamine in the brain. With a decrease in the production of dopamine, the patient becomes less mobile, the movements are constrained, lose their smoothness and grace.

Parkinson's disease itself is not fatal, but the complications that occur during the disease are quite serious.

Parkinson's disease is not currently curable. Your doctor's goal is to treat the symptoms of the disease to maintain a high level of quality of life.

In a healthy person, brain cells (neurons) produce dopamine. These cells are concentrated in a special area of the brain called the black substance. Dopamine is a chemical compound that transmits information between the substantia nigra and other areas of the brain to control the movements of the human body. Dopamine provides smooth and coordinated movements.  When approximately 60-80% of the dopamine-producing cells die, and the production of dopamine does not occur in sufficient quantities, then the first motor symptoms of Parkinson's disease begin to appear. This process of brain cell death is called neurodegeneration.

The main clinical manifestations of Parkinson's disease

 

1. Tremor or tremor of the hands and feet at rest. The movements of the thumb and index finger resemble "rolling pills" or "counting coins". The tremor in the hand disappears during its movement;

 

2. Slowness of all movements - bradykinesia;

 

3. Violation of fine movements of the limbs (when buttoning buttons, threading a needle);

 

4. Stiffness, immobility or rigidity of the muscles in the arms, legs, trunk;

 

5. Disequilibrium up to falls - postural instability. Postural instability appears in the later stages of the disease.

 

The first symptoms of Parkinson's disease are usually trembling, stiffness or awkwardness in one of the limbs, less often the disease is initially manifested by a change in gait or general stiffness. Initially, the symptoms occur only on one side of the body, later the symptoms become bilateral.

 

Also, the symptoms of Parkinson's disease can include:

- small handwriting-micrography;

- no friendly hand movements when walking on the affected side;

- stiffening when walking;

- "masklike" face-hypomimia;

- quiet, muffled speech-hypophonia;

- reduced sense of smell;

- falls on the back-retropulse;

- reduction of blinking and swallowing.

Parkinson's disease can be accompanied by depression, anxiety, hallucinations and psychoses, sleep disorders (vivid dreams, talking and waving hands and feet in a dream); constipation, pain syndromes, urination disorders.

 

Diagnosis of Parkinson's disease

The diagnosis of Parkinson's disease is established clinically.  Special research methods are used mainly to exclude other diseases.  These diseases are characterized by a more extensive involvement of the nervous system, so clinically these diseases manifest other symptoms in combination with parkinsonism, for example, multisystem atrophy and progressive supranuclear paralysis, vascular and drug-induced parkinsonism. You should also make a differential diagnosis with essential tremor.

 

Treatment of Parkinson's disease

There are three ways to treat Parkinson's disease : medication, surgery, and non-medication.

The drug method is aimed at filling the dopamine deficiency and includes the following groups of drugs:

·         Levodopa. The drug was developed in the late 1960s. Levodopa is the first drug that has proven effective in the treatment of a chronic neurodegenerative disease like Parkinson's disease. Levodopa is absorbed into the blood from the small intestine and then converted into dopamine when it enters the brain. Currently, levodopa is the only effective treatment for Parkinson's disease. Modern drugs, such as nakom and madopar, contain a combination of levodopa with an inhibitor of the DOPA – decarboxylase enzyme, which blocks the metabolism of levodopa in peripheral tissues, which reduces the likelihood of side effects. Side effects: nausea, vomiting, loss of appetite, dizziness, decreased blood pressure, dyskinesia (develop with long-term use of levodopa, obsessive movements in the extremities).

* Dopamine receptor agonists (pronoran, mirapex, requip, nieupro) have a structure similar to dopamine, due to which agonists are able to compensate for dopamine deficiency by stimulating its receptors. Agonists are often prescribed as the first drug in the early stages of Parkinson's disease, but it can also be used in the later stages of the disease in combination with levodopa. Side effects: excessive daytime sleepiness, visual hallucinations, swelling of the ankles, confusion, rarely dyskinesia, uncontrolled shopping, gambling, hypersexuality, overeating.

* Amantadines (PC-Merc, midantan) block the reuptake of dopamine and norepinephrine, but their main therapeutic effect may be associated with blocking glutamate receptors.

* MAO-B inhibitors (Yumex) – block the breakdown of dopamine released into synapses and thereby enhance and prolong its effect.

* COMT inhibitors (tasmar, comtan) – inhibit the breakdown in the body of levodopa taken by the patient, prolonging the period of its action. Effective for the treatment of Parkinson's disease only in combination with levodopa.

* Holinolytics (cyclodol, parkopan, akineton, artan) - normalize the relationship between the weakened dopaminergic and increased cholinergic action that is disturbed in the deep structures of the brain. It is most effective in young patients with tremor.

·         Steel-a combination of levodopa, carbidopa, entacapone. It is effective in patients with a late stage of the disease, often used for motor fluctuations. 

Surgical treatment.

 

Indications for neurosurgical treatment: severe fluctuations and dyskinesia, not improved by optimal drug treatment; pronounced tremor, drug-resistant.

 

Surgical treatment currently consists of implanting electrodes in the subcortical structures of the brain: the subthalamic nucleus, the inner segment of the pale ball, the nucleus of the thalamus. After implanting the electrodes in the brain substance, the ends are held under the skin to the neck area, where they are attached to a pulse generator. To control the parameters of stimulation, a manual remote control – programmer is used. During the operation, the patient remains conscious. After the operation, most patients remain on antiparkinsonian therapy, but its dose is reduced.

 

· The duration of the disease is not less than 5 years;

 

·       The stage of the disease according to Hyun-Yar is not lower than the 3rd;

 

·       High efficacy of levodopa in conducting a pharmacological test;

 

·       A high degree of daily activity during the " on " period.

 

·       Severe motor fluctuations or dyskinesia, not corrected by an adequate dose of dopaminergic agents;

 

* Poor tolerability of levodopa drugs, which does not allow increasing its dose to the optimal level;

 

* The presence of a pronounced, disabling rest tremor that cannot be corrected with optimal drug therapy;

Non-drug therapy includes: massage, therapeutic gymnastics, physiotherapy procedures.