Parkinson's disease

Description:

Parkinson's disease - the chronic progressing degenerative disease of the central nervous system, clinically about being disturbance of autokinesias.
BP belongs to primary, or idiopathic, to parkinsonism. Distinguish also secondary parkinsonism which can be caused by various reasons, for example encephalitis, excess reception of medicines, atherosclerosis of vessels of a brain. The concept "parkinsonism" is applied to any syndrome at which neurologic disturbances, characteristic of BP, are observed.

Symptoms of the Disease of Parkinson:

The hypokinesia (bradykinesia) is shown by delay and reduction of quantity of movements. Usually patients describe a bradigipokineziya as feeling of weakness and bystry fatigue while detached onlookers first of all note considerable depletion of a mimicry and gesticulation at communication with the patient. Especially difficult for the patient a start of motion, and also coordinate implementation of the motive act. At later stages of a disease patients note difficulties when changing position of a body during sleep which owing to the arising pains can be broken. When awakening by such patient it is very difficult to get up without others help.
The hypokinesia is most often shown in a trunk, extremities, face muscles and an eye.

Rigidity is clinically shown by increase in a muscle tone. At a research of passive movements at the patient the characteristic resistance in muscles of extremities which received the name of a phenomenon of "cogwheel" is felt. The raised tone of skeletal muscles causes also a characteristic round-shouldered pose of patients with Parkinson's disease (a so-called pose of "applicant"). Rigidity can cause pain, and in certain cases pain can become that first symptom which forces patients to ask for medical care. Because of active complaints to pain the incorrect diagnosis of rheumatism can be originally made to such patients.

The tremor not necessarily accompanies parkinsonism. It arises because of rhythmic reduction of antagonistic muscles with a frequency of 5 fluctuations a minute and represents a rest tremor. Trembling is most of all noticeable in hands, reminds "rolling pills" or "the account of coins" and becomes less expressed or disappears when performing of the directed movement. Unlike parkinsonichesky trembling, the essential or family tremor is present always, without decreasing at the movement.

Postural instability. Changes of postural reflexes are considered as one of the main clinical displays of a disease of Parkinson along with a tremor, rigidity and a hypokinesia now. Postural reflexes participate in regulation of standing and walking and all other reflexes are involuntary, as well as. At Parkinson's disease these reflexes are broken, they or are weakened, or at all are absent. Correction of a pose is insufficient or at all is inefficient. Disturbance of postural reflexes explains frequent falling of patients with parkinsonism.
For diagnosis of BP there have to be at least two of four manifestations called above.

Symptoms and diagnosis of parkinsonism.
Diagnosis completely is based on clinical observations since at this disease there are no specific diagnostic tests.
The beginning of a disease at early age (up to 40 years) quite often complicates diagnosis since Parkinson's disease - "privilege" of elderly people. At an early stage patients can note only some rigidity in extremities, reduction of flexibility of joints, pain or the general difficulties when walking and the active movements therefore the incorrect interpretation of symptoms in a debut of a disease is not a rarity.

Here is how the list of symptoms of a disease of Parkinson looks:

    * hypokinesia;
    * crooked pose;
    * the slowed-down gait;
    * an acheirokynesis (reduction of a swinging hands when walking);
    * difficulties in balance maintenance (postural instability);
    * episodes of "hardening";
    * rigidity as "cogwheel";
    * rest tremor (tremor of "rolling pills");
    * micrography;
    * rare blinking;
    * gipomimiya (mask-like face);
    * plateau speech;
    * swallowing disturbances;
    * hypersalivation;
    * dysfunction of a bladder;
    * vegetative frustration;
    * depression.

In addition to the listed symptoms, many patients complain of difficulties at a rising from a bed and at turns to beds during a night dream that significantly breaks not only quality of a night dream, but also, as a result, full value of day wakefulness.
Further the short description of the displays of parkinsonism which are not considered above follows.

Crooked pose. Reflects rigidity in flexor muscles of a trunk that is shown by stoop when walking.

The slowed-down gait. The patient goes the small shuffling short steps which sometimes force it to quicken the pace for maintenance of a vertical pose and sometimes even to pass to run (so-called "propulsion").

Acheirokynesis. Reduction of a swinging hands when walking.

"Hardening". Confusion in a start of motion or before overcoming an obstacle (for example, a doorway). It can be shown also in the letter and the speech.

Micrography. The lack of coordination in a wrist and a brush generates small indistinct handwriting.

Rare blinking. There is owing to a hypokinesia in muscles a century. The look of the patient is perceived as "unblinking".

Plateau speech. Loss of coordination in the muscles participating in an articulation leads to the fact that the speech of the patient becomes uniform, loses accents and intonations (disprosodiya).

Swallowing disturbances. For suffering Parkinson's disease is uncharacteristic hypersalivation, but difficulties of swallowing prevent patients to exempt an oral cavity from normally produced saliva.

Disturbances of an urination. Decrease in force of reduction of a bladder and frequent desires on an urination (a so-called "neurogenic bladder") is observed.

Vegetative disturbances. Include the frequent locks caused by sluggish sokratitelny ability of intestines, the increased greasiness of skin (fat seborrhea), sometimes orthostatic hypotonia.

Depression. Approximately at a half of patients with Parkinson's disease (on different these from 30 to 90% of cases) displays of a depression are noted. There is no consensus about the nature of a depression. There are data that the depression is actually one of symptoms of a disease of Parkinson. Perhaps the depression, on the contrary, has reactive character and develops at the person having a heavy motor illness. However the depression can remain, despite successful correction of motor defect by means of antiparkinsonichesky drugs. In this case prescription of antidepressants is required.

Etiologies of Parkinson:

The origin of a disease of Parkinson remains up to the end not studied, nevertheless as a cause of illness the combination of several factors is considered:
• aging;
• heredity;
• some toxins and substances.

Aging
The fact that some manifestations of BP arise also at normal aging forces to assume that age decrease in amount of brain neurons can be one of causative factors of parkinsonism. Actually about 8% of neurons lose each 10 years of life of people. Compensatory opportunities of a brain are so big that symptoms of parkinsonism appear only at loss of 80% of neural weight.

Heredity
The possibility of genetic predisposition to BP is already for many years discussed. The genetic mutation as assume, can be caused by influence of some toxins in the environment.

Toxins and other substances
In 1977 several cases of heavy parkinsonism at the young addicts accepting synthetic heroin were described. This fact demonstrates that various chemicals can "start" pathological process in neurons of a brain and cause displays of parkinsonism.

Other reasons include:
the viral infections leading to postencephalitic parkinsonism;
atherosclerosis of vessels of a brain;
severe and repeated craniocereberal injuries.

Long reception of some drugs blocking release or transfer of dopamine (for example neuroleptics, the rezerpinso-holding means), can lead to emergence of symptoms of parkinsonism therefore it is always necessary to specify what therapy was received by the patient before establishment of the diagnosis of a disease of Parkinson also.

Treatment of the Disease of Parkinson:

The levodopa is considered "The gold standard" of treatment of a disease of Parkinson. But at prolonged treatment a levodopa there can be side effects. Doctors, considering it, often at first appoint dopamine agonists, for example, прамипексол and ропинирол. Other not dopamine medicines can be used for treatment of symptoms at an early stage of a disease. Monoamine, oxidase inhibitors (for example, селегилин) and anticholinergics belong to such medicines амантадин (for example, trigeksifenidit). Over time with progressing of a disease most likely it is necessary to add a levodopa.
Apomorphinum (Apokin) - the high-speed agonist of a dopamine applied to treatment of the accidental episodes of loss of mobility caused by Parkinson's disease. Apomorphinum can be entered under skin injektsionno at episodes "jammings or hardenings" muscles, inability to rise from a chair or to perform daily work. Treatment by Apokin's injections can reduce the need for regular reception of other medicines which are applied to treatment of symptoms of a disease of Parkinson. Owing to what the risk of emergence of side effects, for example, twitching and other uncontrollable movements decreases. Apokin can be applied together with antiemetic medicines to prevent emergence of such side effects as severe nausea and vomiting.