Akinetic crisis
Contents:
Description:
Akinetic crisis — sudden permanent strengthening of a hypokinesia and rigidity with development of an obezdvizhennost and disturbance of bulbar functions (a dysarthtia and a dysphagy).
Symptoms of Akinetic crisis:
Akinetic crisis is characterized by sharply expressed akineziya, rigidity, a tremor in extremities confining the patient of to a bed, a rough dysarthtia and a dysphagy.
Reasons of Akinetic crisis:
Akinetic crisis arises spontaneously or can be connected with the reception termination, a dose decline of the means containing a levodopa, disturbance of their absorption in digestive tract, development of an intercurrent infection.
Treatment of Akinetic crisis:
Treatment is performed in the conditions of a hospital. The research of the reasons of akinetic crisis (the termination of reception or a dose decline of protivoparkinsonichesky means, the digestive tract disease causing disturbance of absorption of drugs of a levodopa, an intercurrent infection, a cerebrovascular disease, a somatopathy decompensation) is conducted.
Medicinal therapy is appointed individually on the basis of data of the anamnesis and daily survey of the patient. At a dysphagy introduction of the nazogastralny probe is necessary for feeding and introduction of drugs. The package of measures for the prevention of decubituses, first of all turns in a bed each 2 h, regular processing of places of bone ledges by camphoric alcohol, use of antidecubital mattresses is shown.
If akinetic crisis resulted from the sudden termination of reception of the means containing a levodopa, then it should be reappointed in lower dose (50–100 mg 3–4 times a day), then to gradually increase a dose each 3 days before obtaining effect (but no more than to 700–800 mg of a levodopa a day) (level C).
If akinetic crisis arose owing to a dose decline, then it it is necessary to increase by 100 mg each 3 days before achievement of effect (but no more than to 700–800 mg of a levodopa a day) (level C).
At a dysphagy (but at normal function of digestive tract) the drugs of a levodopa are administered in a rastyovorenny look via the probe.
As an additional sredyostvo, especially at disturbance of swallowing and absorption of drugs in digestive tract, appoint an amantadin sulfate — 200 mg / 500 by ml in/in kapelno with a speed of 60 thaws of 1 min. of 1-2 times a day within 5–10 days (level C) with the subsequent obligatory transition to reception of an amantadin in (100–200 mg 3 times a day).
At dehydration for the purpose of achievement of an euvolemiya enter normal saline solution, Ringer's solution, 0,45% solution of sodium chloride and 5% glucose solution, albumine solution, Reopoliglyukin (level C).
For prevention of a deep vein thrombosis of a shin and tromboembolic episodes purpose of direct anticoagulants (Heparin, 2,5–5 thousand units subcutaneously 2 times a day or Fraksiparin of 0,3 ml subcutaneously 2 times a day) to permission of akinetic crisis is shown (level C).
Before swallowing recovery food is carried out via the nazogastralny probe. At dysfunction of digestive tract parenteral food is carried out.
At emergence of the respiratory insufficiency, an acute heart failure and a heavy dysphagy creating threat of aspiration, the patient is transferred to intensive care unit where the intubation, and if necessary and artificial ventilation of the lungs is carried out. The rehabilitation including remedial gymnastics and massage is carried out after stopping of crisis and stabilization of a state.