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.
- 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,
- 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
- 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.
- Levodopa + 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.