Parkinson's disease, manifestation and treatment


  • What are the symptoms of Parkinson's disease
  • How is the diagnosis of Parkinson's disease
  • How is the treatment of Parkinson's disease

  • Parkinson's disease (shaking palsy) - slowly growing
    disease of the central nervous system, characterized by slowness of movements, tremor at rest and in violation of reflexes.

    The basis of Parkinson's disease - loss of nerve cells of the brain stem

    The average age of onset of the disease - 57 years. The 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 this
    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%
    and more neurons.

    What are the symptoms of Parkinson's disease

    • Trembling alone in 50-80% of patients. Tremor in Parkinson's disease - a rhythmic tremor II, III and opposed to them I brush a finger; at
      typically resembles a meat ball rolling fingers (like "skating
      pills "," Coin counting "); early unilateral disease; a maximum
      alone, decreases or disappears during the motion; during sleep is absent; strengthened
      under emotional stress and fatigue; often occurs in the hands, less
      on foot; also observed jitter jaw, tongue, eyelids.
    • Parkinson's disease, manifestation and treatment The progressive slowing of movements, volume controls and speed,
      difficulties in initiating motor act. Movement disorders in Parkinson's disease
      give rise to masklike 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
      patient movement forward when walking or after a light impulse) and retropulsion
      (Involuntary acceleration of the motion back then push in this direction).
    • Muscle tone is changed according to the type of lead pipe.
    • This slow, inexpressive, obscure, silent, stammering. Absent
      tone (monotone speech).
    • Visual disturbances: reduce the number of blinking movements, convulsive
      flashing or reduction of the circular muscles of the eye and the century, eye spasm (involuntary
      eyes turn up with a long (up to several minutes) by holding them
      in this position); symptom puppet eyes - when you lean forward eye head
      apples are moving up, eyeballs fall when tilting the head.
    • Seborrhea - strengthening the functions of the sebaceous glands, resulting in excess secretion
    • Autonomic disorders: constipation, lower blood pressure, incontinence,
      sexual dysfunction.
    • Dementia occurs in 50% of patients, usually at the beginning of the disease with bilateral

    How is the diagnosis of Parkinson's disease

    • computer or magnetic imaging rezonanskaya
    • Positron emission tomography.

    How is the treatment of Parkinson's disease

    • Therapy was carried out for the entire life of the patient.
    • The sharp deterioration of the 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
      a program of regular exercise.
    • Parkinson's disease, manifestation and treatmentLevodopa + Carbidopa tablet at I (25/250 mg) I-2 p / day after a meal (with good
      tolerance to gradually increase the dose of 1 tablet every 4-7 days until
      achieve a stable, but no more than 8 tablets / day) or levodopa + carbidopa. Side
      effects: nausea, vomiting, psychosis, dyskinesia of the mouth, face, limbs, dystonia.
      After 2-5 years of treatment, 50% of patients due to the reception of preparations containing
      levodopa, there is the phenomenon of on-off: stiffness is quickly replaced
      uncontrolled hyperactivity disorder (grimacing). To mitigate this side
      the effect of the transition to recommend frequent receptions (1-2 hours), low-dose preparations
      levodopa, dopamine or additional purpose selegilina.Piridoksin agonists
      those receiving levodopa medications is contraindicated.
    • Bromocriptine at 5-60 mg / day, mainly in combination with low doses of drugs
      levodopa later on (with a decrease of efficiency or the development of side effects
      levodopa) and the early stages of the disease. Side effects: nausea, mental
      disorder, lower blood pressure, headache. Tolerability worsens
    • M-holinoblokatory - in the early stages, and as an adjunct to levodopa
      in later stages; most effective for removing jitter. Treatment
      start with small doses, gradually increasing them. Biperiden 1-2 mg 3 / day. Trihexyphenidyl on 1-5 mg 3 / day. Difeniltropin 10-12.5 mg for 1-2 p / day.
      Side effects: dry mouth, decrease in urinary volume, constipation, blurred vision,
      confusion, disturbance of thermoregulation. Contraindicated in closure
      glaucoma, urinary retention, atrial fibrillation. observe
      caution with hypertension, atherosclerosis, diseases
      heart, liver and kidneys.
    • Selegiline at 5-10 mg / day, can be combined with levodopa + benserazide or carbidopa + levodopa;
      sometimes potentiate the side effects of levodopa.
    • Diphenhydramine by 25-100 mg / day, with tremors.
    • 25-50 mg of amitriptyline at bedtime) in combination with levodopa - depression, anxiety, insomnia.
    • Propranolol 10-40 mg 2-4 p / day is sometimes effective in enhancing the jitter
      during physical activity.
    • Surgical treatment: the rough-sided tremor and the absence of effective
      of drug therapy.
    • The method of treatment of Parkinson's disease by transplanting cells secreting
      dopamine (embryonic or obtained by genetic engineering) to
      basal ganglia to date remains the only experimental.

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