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Parkinson's disease is a chronic degenerative disease of the nervous system in which a person loses the ability to control their movements. The disease develops relatively slowly, but has a tendency to progress. It is a fairly common problem - 4% of the elderly population suffer from manifestations of parkinsonism.

The development of the disease is based on changes that occur in the substantia nigra of the brain. The cells in this area are responsible for producing the chemical dopamine. It mediates signal transmission between neurons in the substantia nigra and striatum in the brain. Violation of this mechanism leads to the fact that a person loses the ability to coordinate his movements.

What it is?

Parkinson's disease is a degenerative change that occurs in the central nervous system and tends to progress at a slow rate. The symptoms of the disease were first described by the doctor D. Parkinson in 1877. At that time, he defined the disease as shaking palsy. This is due to the fact that the main signs of central nervous system damage are manifested in limb tremors, muscle rigidity and slowness of movements.

Epidemiology

Parkinson's disease accounts for 70-80% of cases of parkinsonism syndrome. It is the most common neurodegenerative disease after Alzheimer's disease.

The disease occurs everywhere. Its frequency ranges from 60 to 140 people per 100 thousand population, the number of patients increases significantly among representatives of the older age group. The proportion of people with Parkinson's disease in the age group over 60 years old is 1%, and over 85 years old - from 2.6% to 4%. Most often, the first symptoms of the disease appear at 55-60 years of age. However, in some cases, the disease can develop before the age of 40 (early-onset Parkinson's disease) or before 20 years of age (juvenile form of the disease).

Men get sick slightly more often than women. There were no significant racial differences in the incidence pattern.

Parkinson's disease - causes

The exact causes of Parkinson's disease remain a mystery to this day, however, some factors, coming to the fore, still take on the leading function, and therefore are considered to be the culprits of this pathology.

These include:

1. Aging of the body, when the number of neurons naturally decreases, and, therefore, the production of dopamine decreases;
2. Some medications used to treat various diseases and, as a side effect, have an effect on the extrapyramidal structures of the brain (aminazine, rauwolfia preparations);
3. Environmental factors: permanent residence in rural areas (treatment of plants with substances intended to destroy agricultural pests), near railways, highways (transportation of environmentally hazardous goods) and industrial enterprises (harmful production);
4. Hereditary predisposition (the gene for the disease has not been identified, but the family pattern is indicated - 15% of patients have relatives suffering from parkinsonism);
5. Acute and chronic neuroinfections (for example, tick-borne encephalitis);
6. Vascular cerebral pathology;
7. Poisoning with carbon monoxide and heavy metal salts;
8. Brain tumors and injuries.

At the same time, when considering the causes of Parkinson’s disease, it is worth noting an interesting fact that pleases smokers and coffee lovers. For those who smoke, the “chance” of getting sick is reduced by 3 times. It is said that tobacco smoke has such a “beneficial” effect because it contains substances resembling MAOIs (monoamine oxidase inhibitors), and nicotine stimulates the production of dopamine. As for caffeine, its positive effect lies in its ability to increase the production of dopamine and other neurotransmitters.

Forms and stages of the disease

There are several forms of the disease:

The generally accepted gradation of stages of the disease, reflecting the degree of severity, is as follows:

• stage 0 – absence of motor disorders;
• stage 1 – unilateral nature of the manifestations of the disease;
• stage 2 – bilateral manifestations of the disease, the ability to maintain balance is not affected;
• stage 3 – moderately severe postural instability, the patient is able to move independently;
• stage 4 – severe loss of motor activity, the ability to move is preserved;
• stage 5 - the patient is bedridden or wheelchair-bound, and movement without assistance is impossible.

The modified Hoehn and Yarh scale (Hoehn and Yarh, 1967) suggests the following division into stages:

• stage 0.0 – no signs of parkinsonism;
• stage 1.0 – unilateral manifestations;
• stage 1.5 – unilateral manifestations involving the axial muscles (neck muscles and muscles located along the spine);
• stage 2.0 – bilateral manifestations without signs of imbalance;
• stage 2.5 – mild bilateral manifestations, the patient is able to overcome the caused retropulsion (the patient accelerates backward when pushed from the front);
• stage 3.0 – moderate or moderate bilateral manifestations, slight postural instability, the patient does not need outside assistance;
• stage 4.0 – severe immobility, the patient’s ability to walk or stand without support is preserved;
• stage 5.0 – the patient is confined to a chair or bed without assistance.

Symptoms of Parkinson's disease

In the early stages of development, Parkinson's disease is difficult to diagnose due to the slow development of clinical symptoms (see photo). It can manifest as pain in the extremities, which can be mistakenly associated with diseases of the spine. Depressive states can often occur.

The main manifestation of parkinsonism is akinetic-rigid syndrome, which is characterized by the following symptoms:

1. Tremor. It is a rather dynamic symptom. Its appearance can be associated both with the emotional state of the patient and with his movements. For example, a tremor in the hand may decrease during conscious movements, and increase when walking or moving the other hand. Sometimes it may not exist. The frequency of oscillatory movements is small - 4-7 Hz. They can be observed in the arm, leg, and individual fingers. In addition to the extremities, trembling may occur in the lower jaw, lips and tongue. The characteristic parkinsonian tremor in the thumb and index finger resembles “pill rolling” or “coin counting.” In some patients, it may occur not only at rest, but also during movement, causing additional difficulties when eating or writing.
2. Rigidity. Movement disorders caused by akinesia are aggravated by rigidity - increased muscle tone. Upon external examination of the patient, it is manifested by increased resistance to passive movements. Most often, it is uneven, which causes the appearance of the “gear wheel” phenomenon (there is a feeling that the joint consists of gear wheels). Normally, the tone of the flexor muscles prevails over the tone of the extensor muscles, so rigidity in them is more pronounced. As a result, characteristic changes in posture and gait are noted: the torso and head of such patients are tilted forward, the arms are bent at the elbows and brought to the body, the legs are slightly bent at the knees (“supplicant pose”).
3. Bradykinesia. It represents a significant slowdown and impoverishment of motor activity, and is the main symptom of Parkinson's disease. It manifests itself in all muscle groups, but is most noticeable on the face due to the weakening of facial muscle activity (hypomimia). Due to the rare blinking of the eyes, the gaze seems heavy and piercing. With bradykinesia, speech becomes monotonous and muffled. Due to impaired swallowing movements, drooling may occur. Fine motor skills of the fingers are also depleted: patients have difficulty making familiar movements, such as fastening buttons. When writing, transient micrographia is observed: towards the end of the line, the letters become small and illegible.
4. Postural instability. It is a special disorder of coordination of movements when walking, caused by the loss of postural reflexes involved in maintaining balance. This symptom appears at a late stage of the disease. Such patients experience some difficulty in changing posture, changing direction of movement, and starting to walk. If you push the patient out of balance with a small push, he will be forced to take several quick short steps forward or backward (propulsion or retropulsion) in order to “catch up” with the center of gravity of the body and not lose balance. The gait becomes mincing, “shuffling.” The consequence of these changes is frequent falls. Postural instability is difficult to treat and is often the reason why a patient with Parkinson's disease becomes bedridden. Movement disorders in parkinsonism are often combined with other disorders.

Mental disorders:

1. Cognitive disorders (dementia) - memory is impaired, slow vision appears. With a severe course of the disease, serious cognitive problems arise - dementia, decreased cognitive activity, the ability to reason sensibly, and express thoughts. There is no effective way to slow the development of dementia, but clinical studies show that the use of Rivastigmine and Donepezil somewhat reduces such symptoms.
2. Emotional changes - depression, it is the very first symptom of Parkenson's disease. Patients lose self-confidence, are afraid of new situations, avoid communication even with friends, pessimism and irritability appear. You experience increased sleepiness during the day, disturbed sleep at night, nightmares, and overly emotional dreams. It is unacceptable to use any medications to improve sleep without a doctor's recommendation.

Autonomic disorders:

1. Orthostatic hypotension is a decrease in blood pressure when changing body position (when a person stands up suddenly), this leads to a decrease in blood supply to the brain, dizziness and sometimes fainting.
2. Gastrointestinal disorders are associated with impaired intestinal motility - constipation associated with inertia, poor nutrition, and limited drinking. Constipation is also caused by taking anti-parkinsonism medications.
3. Decreased sweating and increased skin greasiness - the skin on the face becomes oily, especially in the area of ​​the nose, forehead, and head (provokes the occurrence of dandruff). In some cases, it may be the other way around, the skin becomes too dry. Conventional dermatological treatment improves skin condition.
4. Increased urination or, conversely, difficulty emptying the bladder.

Other characteristic symptoms:

1. Difficulty eating - this is due to limited motor activity of the muscles responsible for chewing and swallowing, and increased salivation occurs. Retention of saliva in the mouth can lead to choking.
2. Problems with speech - difficulty starting a conversation, monotony of speech, repetition of words, too fast or slurred speech is observed in 50% of patients.
3. Sexual dysfunction - depression, taking antidepressants, poor circulation lead to erectile dysfunction and decreased sexual desire.
4. Muscle pain - aches in the joints and muscles are caused by poor posture and muscle stiffness, the use of levodopa reduces such pain, and certain types of exercise also help.
5. Muscle spasms - due to lack of movement in patients (muscle stiffness), muscle spasms occur, more often in the lower extremities; massage, warming, and stretching help to reduce the frequency of cramps.
6. Fatigue, weakness - increased fatigue usually worsens in the evening and is associated with problems starting and ending movements; it can also be associated with depression and insomnia. Establishing a clear sleep and rest schedule, and reducing physical activity helps reduce fatigue.

It is worth noting that the course of the disease is individual for each person. Therefore, some symptoms may predominate, while others may be mild. Signs of the disease are amenable to drug therapy. In some cases, surgery can effectively combat the disease.

Diagnostics

Comprehensive diagnosis of the disease is based on the study of the neurological status, patient complaints and a combination of a number of criteria.

Among the instrumental research methods, the most reliable is positron emission tomography (PET), in which radioactive fluorodopa is injected intravenously and the degree of its accumulation in specific areas of the brain is assessed. The disadvantage of the method is its high cost and low prevalence. Other laboratory and instrumental methods do not reliably identify the causes of the disease and prescribe its treatment, therefore they are used to exclude other diseases with similar symptoms.

To make a diagnosis, a combination of hypokinesia with one or more signs (rest tremor (frequency 4-6 Hz), muscle rigidity, postural disturbances) is necessary.

Treatment of Parkinson's disease

This disease is incurable; all modern drugs for therapy only alleviate the symptoms of Parkinson's disease. Symptomatic treatment is aimed at eliminating movement disorders.

How to treat Parkinson's disease? In the early stages of the disease, feasible physical activity and physical therapy are indicated. Treatment with drugs should be started as late as possible, since with long-term use of medications, the patient develops addiction, a forced increase in dosage and, as a result, increased side effects.

• For severe clinical manifestations of parkinsonism, levodopa is currently the basic drug, usually in combination with a decarboxylase inhibitor. Doses are increased slowly over several weeks until clinical effect is achieved. Side effects of the drug are dystonic disorders and psychosis. Levodopa, entering the central nervous system, is decarboxylated into dopamine, which is necessary for the normal function of the basal ganglia. The drug affects primarily akinesia and, to a lesser extent, other symptoms. When combining levodopa with a decarboxylase inhibitor, the dose of levodopa can be reduced and thereby reduce the risk of side effects.
• In the arsenal of symptomatic antiparkinsonian drugs, a large place is occupied by anticholinergic drugs, which, by blocking m- and n-cholinergic receptors, promote relaxation of striated and smooth muscles, reduce violent movements and the phenomena of bradykinesia. These are natural and synthetic atropine-like drugs: bellazone (romparkin), norakin, combipark. Phenothiazine drugs are also used: dynesin, deparkol, parsidol, diprazine. The main reason for the variety of medications used to treat parkinsonism is their insufficient therapeutic effectiveness, the presence of side effects, individual intolerance and rapid addiction to them.
• The morphological and biochemical changes in Parkinson's disease are so complex, and the course of the disease and its consequences are so severe, and are also aggravated by the effects of replacement therapy - levodopa, that the treatment of such patients is considered the height of medical skill and is subject to virtuosos - neurologists. Therefore, special centers for the treatment of parkinsonism are open and operating, where the diagnosis is clarified, observation is carried out, and doses of necessary drugs and treatment regimens are selected. You cannot prescribe or take medications on your own.

For replacement therapy, levodopa, carbidopa, and nacom are used. Adamantine, memantine, bromocriptine stimulate the release of dopamine, inhibit the process of dopamine reuptake - anticholinesterase drugs and tricyclic antidepressants (amitriptyline), inhibit the breakdown of dopamine selegiline, antioxidants are used as neuroprotectors of DA neurons - selegiline, tocopherol, calcium channel blockers - nifidipine.

In the early stages, the use of pramipexole (Mirapex) has been proven to preserve quality of life. It is a first-line drug for the treatment of Parkinson's disease with a high level of efficacy and safety. The treatment uses umex, neomidantan, neuroprotectors, and antioxidants. Patients need therapeutic exercises according to an individual program - to move as much as possible and stay active longer.

Neurostimulation

Neurostimulation is a modern treatment method that is a minimally invasive neurosurgical operation.

This method is used in the following cases:

1. Despite correctly selected drug therapy, the patient is unable to achieve a significant reduction in symptoms.
2. The patient is socially active and is afraid of losing his job due to the disease.
3. Progression of the disease leads to the need to increase doses of medications, and the side effects of the drugs become intolerable.
4. The patient loses the ability to care for himself and becomes dependent on his family to perform daily activities.

Results of the operation:

1. Allows non-invasive adjustment of stimulation settings as the disease progresses;
2. Unlike palidotomy and thalamotomy, it is reversible;
3. The period of effective control over the symptoms of the disease increases;
4. The need for antiparkinsonian medications is significantly reduced;
5. Can be bilateral (that is, effective for symptoms on both sides of the body);
6. It is easily tolerated and is a safe method.

Disadvantages of neurostimulation:

1. Relatively high cost;
2. Possibility of electrodes moving or breaking; in these cases (15%) repeat surgery is needed;
3. The need to replace the generator (after 3-7 years);
4. Some risk of infectious complications (3-5%).

The essence of the method: the therapeutic effect is achieved by stimulating certain brain structures responsible for controlling body movements with a precisely calculated small amplitude electric current. To do this, thin electrodes are inserted into the patient's brain and connected to a neurostimulator (similar to a pacemaker) implanted subcutaneously in the chest area under the collarbone.

Treatment using stem cells.

The results of the first trials on the use of stem cells in Parkinson's disease were published in 2009. According to the data obtained, 36 months after the introduction of stem cells, a positive effect was observed in 80% of patients. The treatment involves transplanting neurons obtained from differentiated stem cells into the brain. Theoretically, they should replace dead dopamine-secreting cells. As of the second half of 2011, the method has not been sufficiently studied and does not have widespread clinical use.

In 2003, for the first time, genetic vectors containing the gene responsible for the synthesis of glutamate decarboxylase were introduced into the subthalamic nucleus of a person with Parkinson's disease. This enzyme reduces the activity of the subthalamic nucleus. As a result, it has a positive therapeutic effect. Despite the good treatment results obtained, as of the first half of 2011, the technique is practically not used and is in the stage of clinical trials.

Physiotherapy

Patients may develop joint contractures as a result of impaired tone and hypokinesia, for example, shoulder-scapular periarthrosis. Patients are recommended to follow a low-cholesterol diet and a low-protein diet. For normal absorption of levodopa, protein products should be taken no earlier than an hour after taking the medicine. Psychotherapy and reflexology are indicated.

Maintaining physical activity stimulates the production of internal (endogenous) neurotransmitters. Scientific research is being conducted on the treatment of parkinsonism: these include stem and dopamine-producing cells, a vaccine against Parkinson’s disease, surgical treatment - thalamotomy, pallidotomy, high-frequency deep stimulation of the subthalamic nucleus or the internal segment of the globus pallidus and new pharmacological drugs.

Folk remedies

The patient will not be able to cope without drug treatment. Traditional medicine methods for Parkinson's disease will only slightly alleviate his condition.

• Patients often suffer from sleep disturbances; they may wake up repeatedly during the night and walk around the room in a half-asleep state. In doing so, they bump into furniture and can seriously injure themselves. Therefore, a patient suffering from parkinsonism should create an extremely comfortable environment for night rest.
• The patient will benefit from foot baths with fern decoction. To prepare the decoction you need to take 5 tbsp. l. dry rhizomes, add 5 liters of water and boil for at least 2 hours. Cool the broth and prepare a foot bath.
• A mixture of freshly squeezed juices of plantain leaves, nettle and celery will help reduce clinical manifestations.
• Herbal teas are prepared from linden blossom, chamomile, sage or thyme. It is better to take plants separately, adding to 1 tbsp. l. substrate 1 tsp. dry motherwort herb for a sedative effect. At 2 tbsp. l. of the medicinal plant, take 500 ml of boiling water and infuse it in a bowl covered with a towel.

Before using any products from this category, you should consult your doctor!

Forecast for life

The prognosis is conditionally unfavorable - Parkinson's disease is steadily progressing. Symptoms of movement disorders develop most quickly. Patients who do not receive treatment, on average, lose the ability to care for themselves after 8 years from the onset of the disease, and after 10 years they become bedridden.

• As of the second half of 2011, the vast majority of patients are receiving appropriate treatment. The prognosis in this group is better compared to patients who do not receive adequate therapy. Individuals taking levodopa become dependent on their caregivers after an average of 15 years. However, in each specific case the rate of progression of the disease is different. It has been noted that with the relatively early development of Parkinson's disease, symptoms of impaired motor activity progress most quickly, and when the first symptoms of the disease appear in people 70 years of age and older, mental disorders come to the fore.
• Adequate therapy slows down the development of a number of symptoms leading to disability in patients (muscle rigidity, hypokinesia, postural instability, etc.). However, 10 years after the onset of the disease, the working capacity of most patients is significantly reduced.

The life expectancy of patients is reduced. The ability to work in these patients is permanently and irreversibly lost; depending on the severity of neurological disorders, patients are assigned a disability group.

Prevention

In order to reduce the risk of Parkinson's disease, you should adhere to the following preventive measures:

1. Timely diagnose and treat vascular pathologies of the brain associated with injuries or infections. In this way, dysfunction of dopamine production will be avoided.
2. Follow the timing of taking neurolipeptic drugs. They can be used for no more than 1 month without interruption.
3. Consult a doctor if you notice the slightest signs of Parkinson's disease.
4. Substances that are really able to protect neurons are flavonoids and anthocyanins. They can be found in apples and citrus fruits.
5. It is worth protecting the nervous system by avoiding stress, leading a healthy lifestyle, and exercising.
6. Increasing scientific evidence indicates that smokers and coffee drinkers have virtually no incidence of Parkinson's disease. But this is a rather specific preventive measure that should not be considered as a recommendation. Moreover, when a disease is detected, there is no point in starting to smoke or drink coffee, since this does not in any way affect the course of pathological processes. However, in the absence of contraindications, you can consume minimal doses of natural coffee on a regular basis.
7. It is beneficial to eat a diet that is rich in B vitamins and fiber.
8. Avoid contact with harmful substances that affect the development of the disease, such as manganese, carbon monoxide, opiates, pesticides.

New research shows that berries can have an impact on the risk of disease.

Parkinson's disease is a neurological pathology with slow progression, which most often occurs in older people. Parkinson's disease is also referred to in medical literature as idiopathic parkinsonism syndrome, or “shaking palsy.” This is a degenerative disease of the extrapyramidal motor system, caused by the death of brain neurons that produce the neurotransmitter dopamine, which leads to increased influence of the basal ganglia on the cerebral cortex.

Classification of the disease

Parkinson's disease is a pathology that doctors can identify in patients all over the world. The disease can be classified according to many criteria - the age when the first signs of the disease began to appear, manifestations, stages of progression, etc. Knowledge of the basics of the classification of parkinsonism helps to develop the correct treatment tactics for the disease in the early stages.

By age of onset of illness

Many older people suffer from Parkinson's disease; after 65 years, 1% of the entire population of the planet hears this diagnosis, and after 85 – more than 2.5% of people. On average, the disease begins in patients after 55 years of age, but there are cases of parkinsonism with an early onset - in 10% of all cases known to science, the disease occurred before the age of 40 years, or even before the age of 20 years, which indicates juvenile parkinsonism.

Juvenile parkinsonism should be understood as early genetically determined parkinsonism that occurs before the age of 20-25 years. The clinical manifestations of this pathology include symmetrical static and kinetic tremors, dyskinesia, pyramidal signs, and intellectual impairment. Juvenile pathology is a hereditary disease of the central nervous system, which is transmitted genetically through autosomal recessive mechanisms. The hereditary nature is the main difference between juvenile pathology and standard Parkinson's disease, which is caused by a multifactorial etiology. After the discovery of the Parkinson gene in 1998, the introduction of DNA diagnostic techniques for defects in this gene into medicine allowed specialists to identify cases of juvenile parkinsonism much more often. The prevalence of this pathology has no territorial restrictions, in terms of gender - it is more common in women.

Early-onset parkinsonism is a disease that occurs in people under 45 years of age and is most often caused by genetic factors. An association of Parkinson's disease with certain gene polymorphisms in the detoxification of xenobiotics, in the antioxidant cellular defense system, in dopamine metabolism, and in the process of lipid metabolism has been established. When carriers of allelic genes are detected, the risk of developing Parkinson's disease in the body increases, and a hereditary predisposition to the pathology arises. The combination of unfavorable polymorphisms provokes early manifestation of the disease. It is important to understand that it is at a young age that the causes of Parkinson’s disease most often become genetic predispositions, while in the elderly this pathology is more often provoked by environmental and other factors.

According to the manifestations of the disease

Depending on the manifestations and symptoms of the disease, the pathology in question can be divided into:

• tremulous form, which is very characteristic of the head, limbs, lower jaw with high or medium amplitude, as well as increased (sometimes normal) muscle tone;
• trembling-rigid form, in which tremor occurs in the distal parts of the limbs and, as the disease progresses, stiffness during voluntary movements is added;
• akinetic-rigid form (the most unfavorable of all), in which the patient’s activity of movement drops sharply, often reaching the point of immobility, and muscle tone sharply increases, which threatens the occurrence of muscle contracture;
• a mixed form, in which all of the above forms can appear both together and flow into one another;
• an atypical form, which is characterized by synucleinopathy (with Lewy bodies, idiopathic parkinsonism, etc.) or tauopathy (corticobasal dementia, supranuclear gaze paresis, etc.).

Each form of Parkinson's disease, in addition to differences in manifestations, may require specific therapy and patient care.

Causes and mechanism of development

The causes of Parkinson's disease do not always provoke the disease directly; more often, under their influence, the syndrome of parkinsonism is formed, which responds well to treatment, in contrast to the main form of the disease. Among the main causes of Parkinson's disease are:

• damage by high doses of free radicals of the black substance;
• highly toxic damage to the meninges, which can occur during periods of poisoning, with internal intoxication due to the release of toxins from the liver;
• heredity, which manifests itself in approximately 20% of cases of all diagnosed pathologies of this kind and has an indirect effect on the occurrence of the disease;
• genetic factor, in which the presence of modified genes in the genetic code provokes parkinsonism at a young age;
• deficiency, which is responsible for building protective barriers that prevent free radicals and toxic substances from entering the body, the deficiency of which becomes especially noticeable in old age;
• inflammations caused by bacterial or viral infection, such as encephalitis and others;
• brain injuries of varying degrees of severity;
• high, provoking atherosclerotic changes;
• degenerative brain processes due to impaired blood circulation.

All of the above factors can shape the etiology of the disease, but they are not stable in this matter and do not always provoke such processes.

The mechanism of development of the disease at the initial stage is characterized by a decrease in the production of dopamine, which provokes changes in the brain. Degeneratively changed areas of the brain begin to die, which leads to the characteristic symptoms of the disease. When the disease begins at a young age, it is worth understanding that the processes are caused by hereditary factors, and with a late onset of the disease, in the vast majority of cases, it is worth keeping in mind the mechanism of development of the pathology due to various external influences on the patient’s body.

Despite the fact that the obvious causes of Parkinson's disease have not yet been identified, the ways of diagnosing and treating the pathology have long been known, they are determined in each specific case individually and often help to maintain the patient's condition at the proper level.

Main manifestations

The main manifestations of Parkinson's disease are considered to be tremor, hypokinesia, muscle rigidity and postural instability, as well as mental and autonomic disorders.

Tremor or shaking is the most obvious and pronounced symptom of the disease, which most often bothers a person at rest, but can also occur as a postural or intentional manifestation. The frequency of tremor in parkinsonism reaches 4-6 movements per second. The tremor usually begins from the distal part of either arm, and as it progresses, it spreads to the second arm and both legs. The movement of the patient's fingers with tremor may superficially resemble counting coins. Head tremors may also occur, manifested by “yes-yes” or “no-no” movements, trembling of the eyelids, jaw or tongue. Very rarely, tremor in parkinsonism covers the entire body. Most often, it intensifies in stressful situations; it can usually be noticed in the patient at rest, and when moving, the trembling subsides or disappears completely.

Hypokinesia is understood as a decrease in the level of spontaneous activity of movements, which results in many hours of immobility of the patient.

There is stiffness in the human body; he can move actively only after some delay, and then at a slow pace (characterizes the resulting bradykinesia). A person’s steps become small, the gait is like a doll’s, and the feet are positioned clearly parallel to each other. At the same time, the patient’s facial expression and gaze are frozen, there is pronounced facial expression, a smile, and a crying grimace appears on the face very slowly, inhibited.

A person often freezes in a mannequin pose. His speech is monotonous and gradually fades away. Handwriting becomes choppy and small, which characterizes the development of micrography. Also, as a manifestation of hypokinesia, oligokinesia and synkinesia may occur, that is, a reduction in the total number of movements and the disappearance of friendly movements in the patient, such as sweeping arm movements when walking, wrinkling of the forehead when looking up, and so on. The patient can no longer perform parallel actions; all his movements become automatic.

Rigidity of muscle tissue is manifested by a uniform increase in muscle tone of the plastic plane. In this case, the limbs freeze in a bent position or in a fully extended state, which is a manifestation of plastic wax flexibility. If rigidity begins to predominate in some muscle groups, then a mannequin or supplicant pose arises, in which there is a stoop, the head is tilted forward, the arms are half-bent at the elbows and pressed against the body, and the legs are half-bent at the hip and knee joints. If you try to passively bend and straighten the wrist joints and forearms, you can feel a stepwise pattern of muscle tension or a “gear wheel” symptom.

When muscle tone changes, the limbs can no longer spontaneously return to their original position after any action performed. This characterizes the occurrence of the Westphal phenomenon, when, with a sharp dorsiflexion of the foot, it remains in this position for some time and does not straighten on its own.

In the later stages of the disease, postural instability occurs. The patient cannot spontaneously overcome either the inertia of rest or the inertia of movement; can hardly begin to move, and once it starts, it can no longer stop. When moving forward, the body begins to get ahead of the legs, the center of gravity in the body is disturbed, a loss of stability occurs and the person falls. This symptom may go away on its own after sleep or under the influence of other factors, but after some time it returns again.

In addition to impaired motor activity, patients with Parkinson's disease usually have pronounced mental and autonomic disorders and metabolic disorders. As a result, the patient may experience obesity, exhaustion, and increased secretory activity of the sebaceous, sweat and salivary glands.

Progression of the disease and its severity

Parkinson's disease tends to progress, and the overall prognosis of the disease largely depends on the degree of such progression. The pathology can have a rapid rate of progression, when the stages of the disease replace each other over 2 years, a moderate type of progression, if the change of stages occurs over 5 years, and a slow rate, in which the change of stages of Parkinson's disease occurs no more than once every 5 years or less often.

The inevitability of the progression of pathology has necessitated a detailed study of its stages, each of which has its own symptoms and signs and requires specific therapy. The classification of the stages of parkinsonism was adopted in medicine back in 1967 and since then it has only been slightly adjusted. Today, the classification of the disease includes 6 main stages:

1. Level zero Parkinson's disease has no obvious signs. Asymptomatic progression provokes its worsening due to lack of timely treatment. At the same time, many do not pay attention to such signs of the zero stage as forgetfulness, obsession and other signs that, in the understanding of an ordinary person, are not symptoms of the disease. However, if you pay due attention to them and start timely treatment, the progression of the disease can be stopped, preventing its development.
2. In the first degree of the disease, unilateral damage to the body or limbs may occur in a mild form, due to which patients and their environment also rarely pay attention to these pathological changes and do not begin treatment.
3. The second degree of parkinsonism is characterized by the gradual addition of pathological processes in the second half of the body or limbs. Again, the second degree occurs in a mild form, so rarely do any patients, even at this stage, pay attention to their own health and consult a doctor. In the second degree of parkinsonism, balance is completely preserved and there are no postural symptoms.
4. When the disease moves to the third stage, patients may begin to complain of some restrictions when performing work or movements, but these restrictions do not affect everyday life in any way, therefore, in the vast majority of cases, this stage remains practically unnoticed and untreated.
5. At the fourth stage of the disease, all the symptoms that previously appeared in a mild form sharply intensify, which leads to the patient losing independence in actions and movements. At the fourth stage of parkinsonism, people do not have problems with standing, but already have problems with movement.
6. The fifth degree of Parkinson's disease is the most severe and difficult to treat, since a person without outside help becomes literally bedridden, he is completely unable to cope without outside support, his body ceases to obey him.

Diagnosis of the disease

Parkinson's disease is more common in older people and is irreversible, but diagnosis is necessary to maintain the patient's normal level of functioning and timely selection of appropriate treatment. Early diagnosis plays a key role in this aspect.

The diagnosis of Parkinson's disease is easily made even based on the external symptomatic manifestations of the disease. The difficulty is that other neurological pathologies may have similar symptoms, so doctors are in no hurry to make a diagnosis without examinations. The more complete the picture of the course of the disease, the more effective the therapy will be selected and the longer the patient will live , maintaining quality of life.

Nevertheless, the main method for diagnosing parkinsonism is the clinical picture of the disease. The specialist takes into account and considers all data indicating the occurrence of this pathology in a comprehensive manner. Topical diagnosis of Parkinson's disease is also often carried out, which is a comprehensive diagnosis with which the localization is easily determined pathological a lesion in the patient’s brain or a complex of such lesions. The basis for topical diagnosis is often the clinical picture of the disease. In addition, there are other methods for diagnosing parkinsonism, among which differential diagnosis occupies an important place.

Differential diagnosis

The differential diagnosis of Parkinson's disease implies a very careful consideration of clinical data and their study. The fact is that if the patient’s history does not have pronounced symptoms of parkinsonism, then making a diagnosis can become a whole problem for the doctor.

It is very important to differentiate the symptoms observed in the patient from the symptoms of prolonged depression, post-stroke condition and other pathological conditions.

It is important to understand that in medicine today there are no special tests that can be used to determine Parkinson’s disease. The importance of differential diagnosis is determined by the fact that it must be carried out regularly between courses of treatment in order to understand their effectiveness and promptly make competent adjustments to them.

Diagnosis of disease using MRI

To confirm the diagnosis of parkinsonism at any stage of the disease, the patient can be tested, since the death of nerve cells during degenerative changes reflected by changes in visualization in the form of characteristic radiological signs.

In addition, MRI does not use X-rays, which may have a negative impact, This examination is non-invasive because no parts are damaged during the process. fabrics and structures person. Magnetic resonance imaging is performed completely painlessly for people. To make the MRI result more informative, sometimes special contrast agents are used during diagnosis, which are introduced into the body through intravenous injections. Contrast enhances the information content of an MRI and, based on such data, a diagnosis can be made more accurately and effective treatment can be prescribed.

Principles of treatment

For effective treatment of Parkinson's disease, it is necessary to diagnose the disease in a timely manner and prescribe appropriate therapy. Complex treatment of this pathology involves a whole range of measures:

• the use of drug therapy, which, in addition to symptomatic medications, must necessarily include the use of neuroprotectors;
• the use of various folk remedies and treatment methods;
• rehabilitation procedures, including medical and social means;
• neurosurgical methods of intervention.

Modern medicine in the treatment of Parkinson's disease adheres to two main principles - to prevent the development of the disease by stopping the process of degeneration of brain tissue and to eliminate the symptoms of the disease so that the patient begins to feel much better. Both of these goals must be achieved taking into account the degree of progression of the disease in the patient.

How to avoid pathology

The mechanism for the development of the disease is the process of death of brain cells in those parts of the brain where dopamine is produced. Most often, according to experts, the process is caused by age-related changes, and the occurrence of pathology due to other diseases is detected quite rarely. This suggests that at any age it is necessary to monitor your body, maintaining all its functions in working order. These actions will act as a prevention of parkinsonism.

The most important aspect of disease prevention is proper human nutrition.

With the help of food, you can maintain normal health of the cardiovascular system, prevent atherosclerotic changes, and fully nourish the brain cells in which dopamine and other substances essential for the functioning of the body are produced.

A diet to prevent Parkinson's disease includes the following aspects:

• It is necessary to constantly consume a lot of fresh vegetables and fruits, whole grains, which accelerate the process of peristalsis and prevent;
• when using the drug Levodopa, you should not eat a lot of protein foods, as they reduce the effectiveness of such treatment;
• You should monitor your own weight, for which it is necessary to exclude from food, if possible, simple and excessive amounts.

If you eat according to these principles, you can not only I will prevent the development of the disease, but also to preserve the beauty and youth of all body systems for a long time, to enhance performance at any age.

In order to prevent parkinsonism, doctors recommend not to forget about physical activity. It is important to frequently be in the fresh air, lead an active lifestyle, do gymnastics or engage in any sport to improve oxygen supply to all tissues. At the same time, the blood circulation process is stabilized and the performance of brain structures improves.

Throughout life, and especially at retirement age, it is important regularly and continuously keep your brain busy. And if in youth people often work, and there is no need for additional brain training, then after retirement many stop paying attention to this, but in vain. It is important to solve crosswords, learn something new, and create something with your own hands.

Preventive procedures regarding the occurrence of parkinsonism must necessarily include measures that strengthen the immune system. With a weakened immune system, many viral diseases weaken the body, and after this all sorts of complications often arise, as a result of which the meninges can be affected. This process can often be irreversible, so stimulation of the immune system should also be given sufficient attention.

If you are diagnosed with Parkinson's disease, you should eat right. The diet should largely correspond to the one that was named as the prevention of the disease. First of all, you should not eat foods that cause constipation. It is better to enrich the diet to help improve the functioning of the digestive system. It is also very important to maintain a drinking regime and consume enough fluids for the full viability of the whole organism.

Blood thickening due to lack of fluid provokes thrombus formation, which, in turn, leads to disruption of the normal functioning of the vascular system and, as a consequence, in some cases, to the death of brain cells.

The menu for Parkinson's disease should be varied, products should contain a full range of vitamins and minerals. Alcohol and tobacco are strictly contraindicated, especially in case of parkinsonism in old age with a history of concomitant pathologies.

Other contraindications

Among the main contraindications for Parkinson's disease is the use of medications without a doctor's prescription. For this pathology, before prescribing medications, the specialist must conduct a comprehensive examination of the patient’s body, identify associated problems and prescribe medications, the use of which will not contribute to the intensification or occurrence of other diseases. Certain antiparkinsonian medications are used to treat Parkinson's disease. These include dopamine activators, which inhibit the process of brain cell death. However, it must be remembered that some other medications can block the production of dopamine or inhibit the activity of the brain receptors responsible for its functioning in the body.

Among these drugs, experts identify:

• vasoactive drugs (cinnarizine);
• neuroleptics (torecan, haloperidol);
• antihypertensive drugs (adelfan).

In addition to not taking the above-mentioned remedies, you should remember that taking any treatment, even non-drug (folk) treatment, must be agreed with your doctor. It is also strictly forbidden to cancel medications prescribed by a specialist without permission.

Any intervention in the treatment regimen for Parkinson's disease is a contraindication. All patients should remember that they should not perform physical exercises that require sudden movements, or perform gymnastics where physical inactivity will prevail. Any physical activity for parkinsonism should prevent the process of tissue atrophy in the patient’s body.

Complications and consequences

As a result of Parkinson's disease, the patient may face a whole range of consequences. All of them are provoked directly by the disease and lead to various pathologies, or to progression parkinsonism itself.

The presence of tremor in patients changes the appearance of patients and their behavioral reactions. With muscle disorders, a person loses a significant amount of facial expressions, his appearance takes on the features of indifference. Stiffness and rigidity of muscle tissue contribute to awkward postures of a person, in which he is comfortable, but which look rather strange. Disturbances in the functioning of the nervous system provoke the occurrence of insomnia, constipation, hallucinations and even.

The consequences of Parkinson's disease are largely determined by the stage of its progression. Some forms of the disease are not so dangerous, others often lead to the rapid development of pathology.

With competent support for the patient, it is possible to ensure his life with a minimum of changes due to the disease. People do not die from Parkinson's disease; deaths are caused by complications of the disease. Even a simple cold in the last stage of parkinsonism can lead to bronchitis and pneumonia, from which a person can die.

How long do patients live?

Parkinson's disease itself does not cause death to the patient, but it greatly impairs the quality of life and can lead to disability. Among the main causes of death in patients with parkinsonism are processes such as:

• pneumonia;
• dysphagia or;
• infectious diseases with complications;
• cardiovascular pathologies;
• injuries;
• somatic changes;
• neuroleptic syndrome due to constant use of Levodopa.

At the same time, regarding Levodopa, it is worth noting that in general, the life expectancy of patients who use such treatment is several times higher than that observed in persons without such therapy.

The basis for predicting life expectancy when parkinsonism is detected is the degree of progress and stage of the patient’s disease, as well as the age at which the disease made itself felt. Symptoms of the disease can increase over many years, gradually leading to disability. However, everything is individual and is largely determined by the effectiveness and timeliness of the treatment started. Many patients with Parkinson's disease live more than 20 years, and death occurs not from the disease or its complications, but due to the natural aging of the body.

The prognosis regarding the issue of complete recovery is unfavorable, since today Parkinson's disease cannot be completely eliminated. All therapy for this pathology is not aimed at overcoming it, but at delaying the progress of the clinical picture and inhibiting the process of death of neurons in the patient’s brain.

Disability in Parkinson's disease

Disability in Parkinson's disease occurs when a person's movements become noticeably limited due to pathology. Due to the development of this pathology, the patient loses not only his ability to work, but also the ability to self-care. However, in the early stages of parkinsonism, patients are not considered disabled. If their physical work becomes no longer possible, they are offered to change their activity profile and choose a more suitable job, taking into account the development of the disease.

However, in some cases, assigning a disability group for Parkinson's disease is extremely necessary. This is necessary if a person’s motor impairment progresses and he is no longer able to perform his work, as well as in the case of a very sharp progression of the disease, the need for social protection, ineffectiveness of the therapy.

To register a disability group for Parkinson's disease, it is necessary to collect documents such as MRI results, a written report, etc. It is also necessary to undergo a special study to assess the autonomic system and its functionality and provide documentary evidence of this study. Sometimes the commission may require other documents that will characterize other diseases in the patient’s history.

In case of parkinsonism, 3 disability groups can be assigned to MSE. The first group is given to patients with a severe form of the disease, severe restrictions in movement, and also if it is necessary to undergo psychiatric treatment in a hospital. The second group is assigned to those patients who have been diagnosed with a moderate form of parkinsonism, but restrictions on motor activity do not allow the patient to fully work and provide and serve themselves independently. The third disability group is given to those patients who have been diagnosed with moderate parkinsonism, but motor restrictions only allow them to partially perform usual activities.

It is important to understand that disability for Parkinson's disease is most often prescribed if the patient has suffered from the disease for at least 5 years.

2. In 2017, by the decision of the examination commission at the private institution of additional professional education “Institute for Advanced Training of Medical Personnel”, she was admitted to carry out medical or pharmaceutical activities in the specialty of radiology.

Experience: general practitioner – 18 years, radiologist – 2 years.

Neurologist, Candidate of Medical Sciences, parkinologist at the Yusupov Hospital Georgy Romanovich Popov told Zozhnik about Parkinson’s disease - common and so far incurable.

Parkinson's disease is the most common neurodegenerative disease after Alzheimer's disease.

Per 100 thousand people – from 120 to 180 cases, and the older the age group, the more common the disease. After 60 years of age, 1% of people suffer from the disease; among people over 85 years old - from 2.6 to 4%. But sometimes the disease can develop up to 40 or even 20 years of age.

Many famous people have been diagnosed with Parkinson's disease. Among them: John Paul II, Mao Zedong, Yasser Arafat, Spanish leader Franco, artist Salvador Dali, poet Andrei Voznesensky, boxer Mohammed Ali, actors Robin Williams and Michael J. Fox (he underwent a thalamotomy, but more on that below).

Muhammad Ali and Michael J. Fox are victims of Parkinson's disease.

Parkinson's disease: cause unknown to science

Parkinson's disease is also called idiopathic parkinsonism ("idiopathic" - occurring for an unknown reason). Actually, modern science still finds it difficult to name the exact causes of the disease.

Currently, the causes are sought mainly by genetic factors (gene mutations) and among little-studied internal and external environmental factors, the interaction of which leads to Parkinson's disease.

However, experts doubt the significant contribution of ecology specifically to the development of Parkinson’s disease. The first descriptions of the disease were from Hippocrates and in Ayurveda, then the environment was good, but people still got sick. Another argument against the environment is that rural residents get sick more often, where the environment is better than in the city.

Pathological genes are more often blamed when the onset of the disease occurs in the 4th decade of life and earlier - when parkinsonism manifests itself in the 2nd decade of life.

Little-studied environmental factors are more important when Parkinson's disease occurs in old age, and genetic factors, on the contrary, fade into the background.

There are other, more rare causes of parkinsonism and their corresponding types of parkinsonism:

• neuroleptic parkinsonism,
• posthypoxic,
• infectious (Economo's encephalitis),
• post-traumatic,
• intoxication (manganese, gasoline, carbon disulfide, carbon monoxide, etc.),
• parkinsonism due to hydrocephalus or brain tumor
• vascular parkinsonism

and other options for the origin of this syndrome - due to the occurrence of the disease.

Is Parkinson's disease inherited?

Scientists studied identical twins who carry exactly the same genotype, but only one of the twins gets sick, while the other is spared the disease.

A genetic connection can be traced, but cases of inheritance of Parkinson's disease from parents to children do not exceed 10%, and even this figure, as practice shows, is clearly overestimated.

Some symptoms of Parkinson's disease.

How does Parkinson's disease manifest?

The motor symptoms of Parkinson's disease actually form the parkinsonism syndrome, which includes at least the first and one more of the following three signs:

• Increased muscle tone according to the plastic type(when there is muscle resistance at all stages of passive movement, both during flexion and extension - that is, both antagonist and agonist muscles resist and are tense)
• Rest tremor,
• Postural instability(impaired ability to maintain balance).

Parkinsonism in the early stages: how to identify and start treatment on time

The early stages of the disease are the golden time when you can really stop the progression of the disease by taking antiparkinsonian drugs in a timely manner. According to the bitter experience of domestic doctors, patients most often present at advanced stages; they simply do not know how to recognize the first symptoms of the disease.

The disease always starts on one side: slight dragging of one leg appears, arms do not move cooperatively when walking. You need to pay attention to changes in handwriting (it may become smaller), a very significant symptom is trembling in a resting limb, some patients notice awkwardness in small-point movements: lacing, fastening buttons.

Constipation very often develops, and people who smoke easily quit smoking; patients often experience pain of unknown origin in the muscles or in the shoulder area, and melancholy and anxiety develop for no reason.

If you notice these symptoms, you should immediately contact a specialist. on Parkinson's disease and movement disorders. The doctor will make a diagnosis, since many conditions mimic parkinsonism.

If you find the listed symptoms in yourself, check with a specialist. Firstly, it may not be Parkinson’s disease, and secondly, if it is, the sooner you start treatment, the longer you will be on your feet.

Treatment will include the mandatory use of medications; physical education is no less important: stretching exercises, fine motor skills, long walking and swimming are very useful, which contribute to the production of endogenous neurotrophic factors.

Many patients note that they do not feel symptoms of the disease when running. All in all, The main rule is to strictly take prescribed medications and exercise.

Adynamia is extremely harmful for the course of Parkinson's disease. Other medical measures such as massage, physiotherapy, acupuncture are also important, but still fade into the background.

Stages of development of Parkinson's disease: symptoms appear already in the middle of the development of the disease.

Diseases associated with parkinsonism

Parkinsonism syndrome is a companion to other diseases. Parkinsonism occurs in a group of neurodegenerative diseases, also with an unknown cause of origin, like Parkinson's disease, for example, multiple system atrophy, progressive supranuclear palsy, diffuse Lewy body disease, Alzheimer's disease, corticobasal deneration, but in these cases the parkinsonism syndrome is not dominant in the clinical picture.

What types of parkinsonism are curable?

In the vast majority of cases, parkinsonism progresses and is difficult to treat, with the exception of:

• drug-induced parkinsonism (most often neuroleptic) – when the cause is the use of certain medications,
• parkinsonism due to tumors or other intracranial space-occupying formations, hydrocephalus,
• parkinsonism in a rare dysmetabolic disease associated with copper accumulation - Wilson's disease.

In these cases, eliminating the cause: discontinuation of the neuroleptic, removal of the tumor and timely initiation of therapy for Wilson-Konovalov disease with D-penicillamine leads to a gradual regression of parkinsonism.

How is Parkinson's disease treated?

So far, the most effective and common methods of treating parkinsonism are conservative.

A dramatic breakthrough in the treatment of Parkinson's disease occurred with the invention of levodopa half a century ago, and the effectiveness of levodopa has not yet been surpassed.

No drugs have yet surpassed the effectiveness of levodopa in the treatment of parkinsonism.

Of the 6 classes of antiparkinsonian drugs, levodopa remains the gold standard for the treatment of Parkinson's disease.

At first, at the dawn of its use, the maximum tolerated doses were prescribed, but temporary euphoria gave way to disappointment: almost all patients began to experience a shortening of the effect of the dose taken, and over time this phenomenon progressed, unclear violent movements appeared and these conditions only worsened.

A few years later, levodopa was modernized. The addition of peripheral dopadecarboxylase inhibitors (carbidopa or benserazide) to levodopa, which do not penetrate the brain, effectively prevented the side effects of dopamine and its metabolites in the periphery, increased the bioavailability of levodopa, but did not solve the problem of late motor complications - the main problem treatment of parkinsonism with levodopa.

The entire subsequent evolution of drug treatment for Parkinson's disease was generally aimed at the prevention and correction of these motor complications.

Over time, prolonged forms of levodopa appeared, so-called dopamine receptor agonists appeared, amantadine drugs, which were found to have an anti-dyskinetic effect, began to be more actively used, drugs gradually began to appear that block the breakdown of levodopa and its main active metabolite - dopamine (COMT and MAO-B inhibitors ).

But nevertheless: over time, motor complications of levodopa treatment increase and, in extreme cases, surgical intervention is used.

Surgeries are used for dyskinesias and tremor that are resistant to drug therapy.

Surgical methods for treating parkinsonism

The earliest are the so-called destructive operations: destruction of certain nuclei on one side of the brain led to the disappearance of dyskinesia and tremor on the opposite side, attempts at bilateral destruction led to extremely unpleasant consequences - impaired swallowing, loss of voice and often severe depression; subsequently, the techniques of destructive operations were improved , a non-invasive method of operations has appeared - the gamma knife, based on the radiological focus of the target point in the brain.

A less dangerous and more effective surgical method is deep brain stimulation (DBS). But this expensive intervention can also lead to a number of side effects.

It should be added that any surgical intervention does not allow the abolition of antiparkinsonian drugs and has its own strict indications and contraindications.

Invasive treatments for parkinsonism

Alternative and relatively new treatment methods are invasive methods.

One method is parenteral administration of duodopa (levodopa/carbidopa in gel form) directly into the duodenum. Until this moment, a trial period passes (from a day to 3), when the optimal dose is selected through an installed nasogastric tube, after which an operation is performed to insert a cannula into the duodenum through the stomach, which is fixed on the skin. A cartridge with duodopa is connected to it, ensuring a continuous supply of duodopa to the intestines; the cartridge is changed daily. The method is unique, in many respects there is no alternative, but it has some disadvantages associated, as a rule, with very strict adherence to instructions for use by patients; moreover, over time, patients may develop polyneuropathy associated with a deficiency of vitamins B6 and B12.

The latest type of levodopa-containing drugs is a form that is released extremely slowly and evenly, requiring three doses at certain times. But the drug is not registered in our country, and although in the USA and some countries it appeared on the market under the trade name Rytary, while its clinical trials are still ongoing. (according to drugs.com, the drug costs $280-350 per 100 capsules, depending on the dosage of the active drugs)

Another modern remedy similar in structure to levodopa is its methyl ester ( L-DOPA methylester hydrochloride), which easily penetrates the mucous membranes and the blood-brain barrier and causes a rapid “on” in patients with motor fluctuations. The drug is undergoing the final stages of clinical trials, but it is not yet known when it will appear on the Russian market.

Another modern invasive method (conditionally invasive, since the drug is administered subcutaneously) is the use of apomorphine pumps, which automatically administer the drug at certain intervals. Apomorphine– one of the long-discovered drugs from the group of dopamine receptor agonists, its effect occurs much faster than that of standard and fast-acting forms of levodopa, and almost surpasses levodopa in its antiparkinsonian effect. But the drug causes a lot of undesirable effects, the prevention of which requires the use of other medications.

The experience of Western colleagues suggests that it is better to replace pumps with occasional injections of the drug by patients themselves to quickly exit the “off” state, i.e. immobility. Apomorphine has not yet been registered in our country as an antiparkinsonian drug.

Treating parkinsonism with placebo

In many early clinical studies, placebo was effective in about 4% of patients, so this effect was completely lost, which is generally typical for all organic brain lesions.

Therapy for Parkinson's disease - symptomatic

Almost all of the above-described methods of treating parkinsonism are essentially symptomatic, but timely and adequate therapy helps maintain patient mobility and has a positive effect in the long term.

Views on the prescription of levodopa drugs have changed: from immediate prescription from the moment of diagnosis to maximum delay of its prescription.

It is now accepted that levodopa should be prescribed neither too early nor too late, only when other antiparkinsonian drugs become insufficiently effective.

This rule does not apply to patients over 70 years of age, since, paradoxically, motor complications in this age category, if they develop, are milder and, moreover, the higher the age, the more chronic diseases, the higher the risk of iatrogenic psychoses, and levodopa drugs are most tolerated, in addition to being most effective.

Ineffective treatments for Parkinson's disease

There have been attempts in the past Antioxidant therapy for Parkinson's disease, but studies have shown them to be ineffective.

The same can be said about the introduction of stem cells into the body, when the effect was short-lived and a massive deterioration in the condition occurred. However, genetically engineered stem cells have not yet completely discredited themselves, but a lot of effort is still required to bring this method to a reliable and effective level.

Current methods with stem cells can also be considered unethical, since so-called “abortive material” is often used for this method.

Parkinson's disease: treatment prospects

Alas, predictions for curing a disease are usually given by charlatans, of whom there are many on the Internet. Serious researchers, in general, are not yet filled with optimism.

Nevertheless - any disease is potentially curable, and if a way to cure Parkinson's disease is found, it will be the greatest breakthrough in neurology, comparable to the invention of antibiotics. Perhaps the cure for Parkinson's disease will be universal for all neurodegenerative diseases, and this will be a new era in medicine.

Currently, the effectiveness of certain antibiotics in preventing aggregation of the protein ᾱ-synuclein, the conglomerates of which have a cytotoxic effect, is being studied at the test tube level.

Attempts to introduce neurotrophic factors into the body to restore partially damaged cells have not yet been successful, since neurotrophic factors exert their effect not in the affected brain cells, but in neighboring glial cells. The targeted delivery method is still being developed.

As a potential treatment for Parkinson's disease, drugs are also being developed that promote the production of endogenous proteins - chaperones, which contribute to the correct folding of synthesized proteins in neurons.

Parkinson's disease- symptoms and treatment

What is Parkinson's disease? We will discuss the causes, diagnosis and treatment methods in the article by Dr. T. A. Polyakov, a neurologist with 11 years of experience.

Definition of disease. Causes of the disease

Parkinson's disease is one of the most common neurodegenerative diseases, affecting predominantly dopamine-producing (dopaminergic) neurons in a certain area of ​​the brain called the substantia nigra with the accumulation of alpha-synuclein protein and special intracellular inclusions (Lewy bodies) in the cells. This disease is the most common cause of parkinsonism syndrome (80% of all cases). The prevalence of Parkinson's disease is approximately 140 (120-180) cases per 100,000 population. The disease most often manifests itself after 50 years of age, but cases of the onset of the disease at an earlier age (from 16 years of age) are not uncommon. Men are affected slightly more often than women.

The cause remains largely unknown. It is assumed that the occurrence of the disease is influenced by genetic factors, the external environment (possible exposure to various toxins), and the aging process. Genetic factors play a dominant role in the early development of Parkinson's disease. Young patients with the disease and with a family history of the disease are more likely to carry genes associated with Parkinson's disease, such as SNCA, PARK2, PINK1 and LRRK2. One recent study found that 65% of people with early-onset Parkinson's disease before age 20 and 32% of people with onset between 20 and 30 years of age had a genetic mutation that is thought to increase the risk of developing Parkinson's disease.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of Parkinson's disease

Many symptoms of Parkinson's disease are not related to movement. Non-motor (“invisible symptoms”) of Parkinson's disease are common and can affect daily life more than more obvious difficulties with movement. These may include:

At the onset of the disease, an incorrect diagnosis is often made - glenohumeral periarthritis, manifested by pain and tension in the muscles of the arm and back.

Parkinsonism syndrome is the main clinical manifestation of Parkinson's disease, its symptoms:

• slowness of all movements;
• exhaustion of rapid repetitive movements in the arms and legs;
• muscle stiffness (muscle rigidity);
• trembling of the arms and legs (but almost never of the head), most pronounced at rest;
• unsteadiness when walking;
• shortening of the step length and shuffling when walking, treading in place, freezing when walking, lack of cooperative movements of the arms when walking.

At first, symptoms occur on only one side of the body, but gradually become bilateral. Symptoms remain pronounced on the side where they appeared at the beginning of the disease. Symptoms on the other side of the body often do not become as severe as symptoms on the original side. Movements become increasingly slow (the main symptom of parkinsonism). Symptoms of the disease fluctuate throughout the day and depend on many factors.

Pathogenesis of Parkinson's disease

Parkinson's disease belongs to the group of synucleinopathies, since excessive accumulation of alpha-synuclein in neurons leads to their death. Elevated levels of alpha-synuclein may be a consequence of disruption of the intracellular protein clearance system carried out by lysosomes and proteasomes. Patients were found to have a dysfunction of this system, the causes of which include aging, oxidative stress, inflammation, and environmental toxins. Cells die presumably due to the activation of a genetically programmed mechanism (apoptosis).

Classification and stages of development of Parkinson's disease

Parkinson's disease is classified according to the form, stage and rate of progression of the disease.

Depending on the predominance of a particular symptom in the clinical picture, the following forms are distinguished:

1. Mixed (akinetic-rigid-tremor) the form is characterized by the presence of all three main symptoms in different proportions.

2. Akinetic-rigid the form is characterized by pronounced signs of hypokinesia and rigidity, which are usually accompanied early by gait disturbances and postural instability, while rest tremor is absent or minimally expressed.

3. Trembling the form is characterized by the dominance of rest tremor in the clinical picture, signs of hypokinesia fade into the background.

For characteristics stages of Parkinson's disease used Hoehn–Yahr scale, 1967:

• at stage 1 akinesia, rigidity and tremor are detected in the limbs on one side (hemiparkinsonism);
• at stage 2 symptoms become bilateral;
• at stage 3 postural instability occurs, but the ability to move independently is preserved;
• at stage 4 symptoms of parkinsonism sharply limit motor activity;
• at stage 5 as a result of further progression of the disease, the patient becomes bedridden.

There are three options for the rate of progression of the disease:

1. With fast changing stages of the disease from the first to the third takes 2 years or less.
2. With moderate- from 2 to 5 years.
3. At slow- more than 5 years.

Complications of Parkinson's disease

Parkinson's disease is not a fatal disease. A person dies with it, not from it. However, as symptoms worsen, they can cause incidents that lead to death. For example, in severe cases, difficulty swallowing can cause patients to aspirate food into the lungs, leading to pneumonia or other pulmonary complications. Loss of balance can result in a fall, which in turn can result in serious injury or death. The severity of these incidents largely depends on the patient's age, general health, and stage of the disease.

In later stages of the disease, more severe symptoms of Parkinson's disease appear: dyskinesia (involuntary movements or jerking of parts of the body that can result from long-term use of levodopa, freezing (sudden inability to move) or a mincing gait (short, almost running steps that seem to accelerate on their own).

It should be remembered that Parkinson's disease is very individual in its course and each person has its own scenario.

Diagnosis of Parkinson's disease

Parkinsonism is one of those disorders that can be diagnosed at a distance, especially with a detailed picture of the disease. However, diagnosing Parkinson's disease at an early stage is difficult. Early and accurate diagnosis of the disease is very important to develop the best treatment strategies and maintain a high quality of life for as long as possible. In practice, it is possible to underestimate or overestimate Parkinson's disease. A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. The initial assessment is based on medical history, neurological examination using special tests to assess symptoms of the disease. Neurological examination includes assessment of coordination, walking and fine motor tasks, assessment of neuropsychological status.

The practice of obtaining a second opinion largely depends on the patient's personal choice. But keep in mind that Parkinson's disease is often difficult to diagnose accurately, especially when symptoms are mild. There is no simple diagnostic test, and approximately 25% of Parkinson's disease diagnoses are incorrect. Parkinson's disease begins with few visible symptoms, so many doctors who are not trained in movement disorders are unable to make an accurate diagnosis. In fact, even the best neurologists can make mistakes. If the doctor does not have specific experience in this area, then a specialist in movement disorders should be consulted. A good neurologist will understand your desire to confirm the diagnosis. A second opinion can help make timely and correct decisions regarding diagnosis and therapy.

Treatment of Parkinson's disease

Although there is no cure for Parkinson's disease, there are many treatments that can help you live a full and productive life for many years to come. Many symptoms can be relieved by medications, although over time they may become less effective and cause unwanted side effects (such as involuntary movements known as dyskinesia).

There are several treatments available to slow the onset of motor symptoms and improve motor function. All of these treatments are designed to increase the amount of dopamine in the brain, either by replacing it or prolonging the effects of dopamine by inhibiting its breakdown. Research has shown that early treatment can delay the development of motor symptoms, thereby improving quality of life.

The nature and effectiveness of treatment is influenced by a number of factors:

1. severity of functional deficit;
2. patient's age;
3. cognitive and other non-motor impairments;
4. individual sensitivity to drugs;
5. pharmacoeconomic considerations.

The goal of therapy for Parkinson's disease is to restore impaired motor functions and maintain optimal mobility for the longest possible period of time, minimizing the risk of side effects of drugs.

There are also surgical interventions such as deep brain stimulation, which involves implanting electrodes into the brain. Because of the risks inherent in this type of treatment, most patients forego this treatment until the medications they are taking no longer provide them with meaningful relief. Typically, this treatment is reserved for patients with a disease duration of four years or more who are benefiting from medications but have motor complications such as significant “off” (periods when the medication does not work well and symptoms return) and/or dyskinesias (uncontrollable, involuntary movements). Deep brain stimulation works best for symptoms such as stiffness, slowness, and tremors, but does not work for stability, stiffness in walking, and non-motor symptoms. This treatment may even make memory problems worse, so surgery is not recommended for people with cognitive impairment.

Various new routes of administration of levodopa offer additional therapeutic options. Today, intestinal (intestinal) duodopa gel is used, which reduces daily “off” periods and dyskinesia in patients with progressive Parkinson’s disease thanks to a constant non-pulse regimen of drug administration.

An alternative approach, the use of dopamine-producing cells derived from stem cells, is being explored. Although stem cell therapy has great potential, more research is needed before such cells can become a tool in the treatment of Parkinson's disease.

As Parkinson's disease progresses, the brain's dopamine storage and buffering capabilities become increasingly compromised, narrowing the therapeutic window for therapy and resulting in fluctuations in the individual's motor system. Apomorphine pump is delivered by subcutaneous infusion throughout the day to treat fluctuations (ON-OFF phenomena) in patients with Parkinson's disease that are not adequately controlled with oral antiparkinsonian medications. This system is used continuously to provide the brain with continuous stimulation.

Forecast. Prevention

Parkinson's disease is unique to each person; no one can predict what symptoms will appear and when exactly. There are general similarities in the pattern of disease progression, but there is no guarantee that what is observed in one person will be observed in everyone with a similar diagnosis. Some people end up in wheelchairs; others still compete in marathons. Some people cannot clasp a necklace while others make their necklaces by hand.

There is everything a patient can do to actively influence the course of Parkinson's disease, and for at least one very good reason: the deterioration of symptoms is often much slower in those who take a positive and proactive attitude towards their condition than in those who do not. does. The first step is to find a physician the patient trusts and who will collaborate on the evolving treatment plan. Reducing stress is a must—stress worsens every symptom of Parkinson's disease. Educational activities are recommended: drawing, singing, reading poetry, handicrafts, learning languages, traveling, working in a team, engaging in social activities.

Unfortunately, even if drug therapy is adequately selected, this does not guarantee that cells will stop dying in Parkinson’s disease. Therapy should be aimed at creating favorable conditions for physical activity, taking into account the individual characteristics of the clinical picture of the disease. As the results of numerous studies show, professional motor rehabilitation is a necessary condition for slowing the progression of the disease and improving its prognosis. To date, clinical studies have shown the effectiveness of the rehabilitation program according to the LSVT LOUD, LSVT BIG protocols, the theoretical basis of which is the development of neuroplasticity of the brain substance. It is aimed at correcting tremors, walking, posture, balance, muscle tone and speech.

Rehabilitation methods should be aimed not only at maintaining preserved motor abilities, but also at developing new skills that would help a person with Parkinson’s disease overcome the limitations of his physical capabilities, which is facilitated by the dance movement therapy program for Parkinson’s disease, working in more than 100 communities across around the world, including Russia. Dance therapy can partially address the specific problems of Parkinson's disease: loss of balance, poor coordination, shuffling gait, tremors, freezing, social isolation, depression and increased levels of anxiety.

According to an American study of 52 Parkinson's disease patients, regular practice of Argentine dance reduced symptoms of the disease, improved balance and improved the performance of complex movements in Parkinson's disease.

All patients develop slowness of movement, often combined with stiffness and trembling in the limbs, and instability when walking. These motor symptoms of the disease are called “parkinsonism” (shaking palsy).

Parkinson's disease is the most common cause of parkinsonism, but this set of symptoms can also be a consequence of other brain damage: drug (with long-term use of antipsychotics), vascular (dyscirculatory encephalopathy, consequences of repeated strokes), infectious (for example, consequences).

Causes of Parkinson's disease

The causes of the disease are unknown. Scientists believe that genetic disorders play a role, but the currently known mutations that increase the risk of the disease are not detected in all patients with Parkinson's disease.

Factors that increase the risk of developing the disease:

• , during which there was a loss of consciousness;
• migraine with aura (headache of a pulsating nature, often in half of the head; before the development of an attack, an “aura” is noted - neurological symptoms: flashing spots or stripes before the eyes, tinnitus, burning sensation and pins and needles sensation in the extremities);
• living in industrial areas contaminated with manganese, copper and lead;
• living in rural areas and working in agriculture (possibly due to exposure to pesticides);
• contact with organic solvents, especially trichlorethylene (used in industry, printing, for anesthesia);
• constant consumption of milk in large quantities;
• overweight, obesity;
• the patient has high intelligence.

These factors only increase the likelihood of Parkinson's disease, but are not its direct causes. It is possible that their action causes symptoms to appear more quickly, but the cause of the disease is other disorders that are still unknown to science.

Parkinson's disease is less common among smokers, but is more common in those who previously smoked and then quit. This does not mean that smoking in any way protects against the disease. Simply, changes in the brain in Parkinson's disease lead to a decrease in the pleasure of smoking. It becomes easier for patients to give up this bad habit.

Symptoms of Parkinson's disease

In Parkinson's disease, the brain disrupts the production of a substance necessary for the normal functioning of nerve centers deep in the cerebral hemispheres, under the cerebral cortex. Normally, they should ensure smooth movements.

• As a result of overexcitation of the motor zones of the cerebral cortex, muscle tone increases, tremors appear (it occurs at rest and resembles “counting coins”, “rolling pills”).
• In patients, fine movements are disrupted, and reflexes that maintain balance are affected. Posture is impaired - Parkinson's patients often look bent over (“supplicant pose”).
• In some cases, the development of motor disorders is preceded by other symptoms: constipation, depression, sleep disturbances, and disturbances in the sense of smell.
• In the later stages, movement disorders are often accompanied by a decrease in blood pressure when moving to a vertical position (orthostatic hypotension), and bowel movements, and a decrease in potency.

Intelligence is often not affected, however, a small proportion of patients develop dementia in the later stages. A significant proportion of patients, both in the early and late stages, suffer from apathy and depression.

The progression of symptoms of Parkinson's disease occurs slowly and gradually. With proper treatment, the disease does not have a significant impact on life expectancy.

Diagnosis of Parkinson's disease

The diagnosis is established after examining the patient by a neurologist. Diagnosis criteria are based on clinical signs and the sequence of their development. Confirmatory laboratory and instrumental studies are not needed.

Computer or brain scans do not reveal any characteristic changes in patients. These studies are carried out to exclude conditions similar to Parkinson's disease (tumors, vascular diseases, degenerative diseases).

Single-photon emission tomography (SPECT) detects abnormalities in the brain before symptoms of Parkinson's disease develop, but often does not distinguish the disease from similar conditions.

Positron emission tomography (PET) can improve the accuracy of the diagnosis of Parkinson's disease in doubtful cases.

SPECT and PET are rarely used. These studies are very expensive, and the possibility of carrying them out is limited by a small number of devices, and the corresponding devices are still rare.

When a patient comes in with characteristic complaints, even an experienced doctor makes a preliminary diagnosis and prescribes a trial treatment. To confirm the diagnosis, changes in the patient's condition over time and response to treatment are assessed.

Treatment of Parkinson's disease

At the moment, there are no treatment methods that could eliminate the cause of Parkinson’s disease or slow down the processes in the brain that cause it.

Modern medications are good at relieving the symptoms of the disease. These are pills that you need to take every day. Depending on the stage of the disease and the effectiveness of treatment, during repeated examinations the doctor changes the doses of drugs, adds and eliminates medications.

The most effective drugs are levodopa, which replenishes the deficiency of dopamine in the brain. Long-term use of these medications, especially in high doses, is often accompanied by complications. Taking the medicine may cause involuntary movements (dyskinesia) in the patient. You have to put up with such side effects to avoid stiffness of movement. In severe cases, to cope with dyskinesia, they resort to surgical interventions: implantation of electrodes in the brain. This is the only case when Parkinson's disease requires surgery.

Drugs of other groups (dopamine agonists, COMT inhibitors) are less effective, but their use can delay the prescription of levodopa and reduce complications associated with its use. The selection of a treatment regimen should be carried out by a neurologist with special training and experience in managing such patients.

Physical therapy helps to cope with symptoms and improve the patient’s quality of life: walking and balance training, small movements under the supervision of an instructor. Recently, Nordic walking has been widely used as an exercise.

Special attention is required if a person with Parkinson's disease is undergoing surgery or treatment for other conditions. This may affect the effectiveness of antiparkinsonian therapy and cause complications. To avoid negative consequences, it is necessary to discuss any upcoming interventions with your attending neurologist.

There are currently no effective measures to prevent Parkinson's disease. New laboratory studies are being conducted, and the results of some of them look very encouraging.