How to independently distinguish Parkinson's disease from parkinsonism. Parkinson's disease: symptoms, causes, treatment and prognosis How quickly parkinson's disease develops

Parkinson's disease (another name is idiopathic or primary parkinsonism) is the most common neurodegenerative disorder after Alzheimer's disease. It occurs mainly after 60 years of age, but is increasingly being diagnosed in middle-aged people. The predisposition to it is inherited, and many people with this disease are not even aware of it, since they do not live to the age when the disorders appear.

The first symptoms can occur 10 or more years after the development of the pathology, when about 60% of the neurons in the area of ​​the brain responsible for movement die off. The insidiousness of the disease lies precisely in its long asymptomatic course. The task of doctors will be not only the early detection of pathology, but also a predisposition to it, because only then can the death of brain cells be stopped in time.

Pathogenesis and causes of development

In Parkinson's disease, damage occurs to the substantia nigra, basal ganglia and other structures of the extrapyramidal system. Severe disturbances are especially evident in the anterior sections. The first manifestation of pathology is noted after the death of more than half of the neurons in this zone. Microscopic examination reveals depigmentation of the locus coeruleus and substantia nigra, and a decrease in the number of neurons is also visible.

As the pathology progresses, the number of Lewy cells increases and is found in different parts of the brain.

The etiological factor of the disease is not completely clear. The risk group includes people with a predisposition when there have already been cases of the disease in their family. Environmental factors can trigger the development of Parkinson's disease. Age also matters, because the disease is more often diagnosed in older people, which is associated with involutional processes. Aging is accompanied by a decrease in neurons and the discovery of Lewy bodies. A young body is not subject to such changes.

People over 60 also experience a decrease in the number of dopamine receptors and the release of dopamine itself. With the disease, accelerated degradation of neurons in the substantia nigra is observed.

This disease is genetic, but the gene responsible for it has not been identified, despite the fact that more than 15% of patients have a family history of the disease.

Environmental factors that can cause pathology are chemicals, namely herbicides, pesticides and metal salts. Medicines with extrapyramidal side effects can contribute to the disease.

There is a theory that the risk of pathology increases several times in smokers. This is due both to the presence of certain compounds in tobacco and to its dopamine-stimulating effect. However, people with this habit develop the disease extremely rarely.

Parkinson's disease, its causes, treatment, pathogenesis, diagnosis and prevention are dealt with by neurology, and a neurologist treats patients.

First manifestations and symptoms

Previously, it was believed that the first manifestations of the disease were motor disorders. It is now known that the disease makes itself felt several years before problems with the musculoskeletal system appear. You can identify warning signs yourself, after which you should immediately contact a doctor with a description of the condition to check your suspicions.

Signs of Parkinson's disease:

• fatigue, to the point where it is difficult to do household chores;
• depressed psycho-emotional state, episodes of depression, decreased activity;
• disturbance of urination and sexual function;
• deterioration of the sense of smell, which is observed in 80% of patients;
• disruption of the intestines, namely frequent constipation;
• problems sleeping, involuntary movements of arms and legs, screaming, falling out of bed;
• apathy, increased level of anxiety, psychological discomfort.

Externally, the gait will be disturbed. The patient begins to walk in short steps. There is a slight trembling of the hands and feet. An important criterion is that in a horizontal position the patient tilts his torso slightly forward.

The disease is characterized by a syndrome of 4 characteristic signs: rigidity, tremor, hypokinesia, postural instability. They are accompanied by mental disorders.

Tremor is the most common symptom that is easily detected in patients. In Parkinson's disease, this phenomenon appears at rest; other types of it are observed less frequently. Trembling begins from the distal part of one arm, and as the pathology develops, it spreads to all extremities.

As a result of the tremor, the handwriting changes, and where there should be straight lines, ragged ones are visible. An adult begins to write like a child.

Characteristic symptoms of Parkinson's disease:

1. Hypersalivation or increased salivation is observed due to increased secretion of the salivary glands. This affects speech and interferes with normal swallowing.
2. Hypokinesia - will be expressed by a decrease in movements, which is observed in any form of the disease. The symptom progresses rapidly, and at the same time there is a decrease in speed and a decrease in the amplitude of movements. Gesture suffers from this, facial expressions become weakly expressed.
3. Muscle rigidity is a symptom well expressed in advanced stages of pathological changes. It is characterized by a stooped back, and constant pain in the joints and muscles.
4. Trembling of the face, namely the jaw, tongue and eyelids.
5. With Parkinson's disease, the genitourinary system suffers in women, and impotence develops in men.
6. Episodes of depression become chronic.

As the pathology develops, patients experience a decrease in intellectual abilities. This is not observed in certain forms of pathology. Once dementia has manifested itself, it is actively progressing, and it is no longer possible to get rid of it.

Stages

Parkinson's disease develops gradually, going through 6 stages. Each is characterized by its own disorders and clinical signs.

Stages of Parkinson's disease with symptoms and signs:

1. Stage zero is the beginning of the disease; it does not reveal itself in any way, but changes are already occurring in the brain. There may be absent-mindedness, memory impairment, and forgetfulness.
2. The first is the early period, when pathology begins to manifest itself on one side. Clinical symptoms are still weak, so they rarely turn to a specialist for help. A slight tremor that occurs with excitement is noticeable. Posture and facial expressions begin to change.
3. The second is that symptoms begin to appear on both sides. There is a slight sign of postural instability, coordination is impaired, and it becomes difficult to maintain balance. It is more difficult for the patient to cope with physical work.
4. Third, there is marked postural instability, but the person can still cope without outside help and remains sane.
5. Fourth, the patient needs the help of loved ones, motor function is severely impaired, it is no longer possible to move independently, rarely can a person stand without support.
6. Fifth and sixth - the elderly person is incapacitated, bedridden, and requires care.

At an early stage of pathology, voice changes are noted. The person begins to speak more quietly, some words are difficult and unintelligible.

If a pathology is suspected in young people, foot weakness is observed. This is noticeable when walking, when the emphasis is on its outer edge. Important signs at the initial stage of the disease will be observed in the psycho-emotional sphere. The patient develops irritability, apathy, constant fatigue, and excessive sweating even at normal temperature.

At an advanced stage, the patient becomes difficult to maintain balance. He begins to use a cane because without support he may fall. An important sign will be a loss of automaticity, when habitual actions are difficult.

In patients at an advanced stage, facial expressions are disrupted, facial expression changes, and the voice becomes monotonous and calm. Swallowing becomes very difficult. A small percentage of patients in the later stages of the disease are susceptible to dementia.

What could be the consequences?

The disease has serious consequences. At the last stage, the patient is bedridden. The longer therapy is delayed, the more actively symptoms from various organs increase.

Consequences of the disease if not treated promptly:

• inability to make movements or akinesia, the most severe consequence is complete immobility;
• dementia - manifests itself in the form of isolation of the patient, passivity, susceptibility to depression and pallor of the emotional background; without treatment, the prognosis worsens;
• pathologies of the organs of vision - the patient begins to blink rarely, about 4 times a minute, which leads to inflammation of the eyelid and conjunctivitis, the eyes always look tired;
• Chronic constipation is a dangerous sign; the disorder is associated with a change in diet, because patients cannot consume the amount of food necessary for normal gastrointestinal function, which can lead to death.

How is it diagnosed?

The disease and its type can be recognized by its clinical complex; other diagnostic methods cannot indicate pathology. Complex instrumental and laboratory tests are prescribed to identify concomitant disorders that may aggravate the underlying disease.

The doctor may prescribe the following diagnostic methods:

• computed tomography (CT);
• rheoencephalography (REG).

Surely, 3 successive stages help to make a diagnosis:

1. Identification of specific signs of the disease, their differences from other pathologies of the central nervous system. The doctor takes into account the presence of rigidity, tremor, postural instability, and hypokinesia.
2. Exclusion of all kinds of diseases that have similarities. These are cerebral hemorrhage, stroke, vascular pathologies, benign and malignant neoplasms, traumatic brain injuries, intoxication.
3. Determination of at least 3 mandatory signs: disease duration of more than 10 years, active development, predominance of unilateral disorders.

Positron emission tomography can detect changes in the brain that are present in this disease.

Treatment methods

The disease cannot be completely cured, therefore symptomatic therapy is carried out. The choice of treatment regimen will be influenced by the degree of pathology, severity, age and many other factors. In each case, many medications are prescribed. Depending on how quickly the disease progresses in an individual case, surgery may be required.

The main treatment is conservative. It includes the prescription of drugs of three main groups. These are Levodopa, dopamine receptor agonists, enzyme inhibitors. Some need to be taken orally, others are prescribed intravenously and intramuscularly.

The drug Levodopa is able to transform into dopamine, which helps eliminate tremor and rigidity. Taking the medicine allows patients to maintain the ability to move. Timely initiation of treatment with this drug has a positive effect on activity, and those who were previously partially immobilized can move again.

Levodopa can be supplemented with Carvidopa. They enhance each other's effectiveness, increasing their impact on the brain. In addition, Carvidopa reduces the risk of side effects from Levodopa. Together, these medications relieve symptoms such as twitching of the limbs, mouth, and eyelids.

After 5 years of taking Levodopa, a decrease in its effectiveness is observed. The patient's activity deteriorates, which turns into immobility. In this case, the medicine no longer helps, its dosage is reduced, but the frequency of administration increases.

Drug therapy must be supplemented with diet, therapeutic exercises, and physiotherapeutic procedures. The patient should be treated not only by a neurologist, but also by specialized doctors, depending on the concomitant pathologies.

Surgery is prescribed if drug therapy is ineffective. There are 2 types of surgical interventions: destruction and stimulation. Destructive methods include pallidotomy and thalamotomy.

Thalamotomy is performed to eliminate tremor. It involves destruction of the ventral gap of the thalamus. Its efficiency reaches 96%. The operation has a high probability of complications, including convulsions, dysarthria, limb weakness, hypersalivation, and postoperative psychosis. Recovery after surgery can be difficult, so this approach is considered in extreme cases.

Pollidotomy is prescribed more often for motor abnormalities when drug therapy does not give the desired result. It involves inserting a needle into the globus pallidus, followed by its destruction.

Neurostimulation is one of the most effective modern treatment methods. It has separate indications and is a minimally invasive operation.

In what cases is neurostimulation indicated:

• lack of results from treatment with properly selected conservative therapy;
• progression of the disease with the need to increase doses of medications when adverse reactions do not allow this;
• risk of disability with the need to keep the patient active in connection with his activity;
• loss of the ability to care for oneself and carry out daily activities, where the patient may remain confined to a hospital bed until death.

The technique involves stimulating certain areas of the brain responsible for body movement with current. Electrodes connected to a neurostimulator are inserted into the patient. The operation is performed in two stages, and the last one requires general anesthesia. During the recovery period, the patient is trained and the device is programmed.

Benefits of neurostimulation for Parkinson's disease:

• prolonging the period of ability to control symptoms;
• safety, minimal risk of complications;
• reversibility;
• use for bilateral lesions;
• possibility of non-surgical changes in stimulator settings.

The disadvantages of the technique are the risk of infectious complications, the likelihood of displacement and breakage of the stimulator, high cost, and the need to change the generator after several years.

Prognosis and prevention

The disease tends to progress, and the patient gradually loses the ability to work, and then to self-care. Proper treatment can slow down the process and reduce the severity of symptoms. Life expectancy with the possibility of normal movement depends on the timely detection of pathology. The condition is assessed using the motor impairment scale.

Without treatment, a person becomes immobilized after 8 years; when treated with Levodopa, the period increases to 15 years. Full recovery is impossible.

• promptly treat pathologies that increase the risk of developing Parkinson's disease, including intoxication, cardiovascular disorders and traumatic brain injuries;
• follow a special diet that prevents an increase in the level of homocestin in the blood. This diet is dominated by B vitamins and folic acid; it is recommended to include nuts, soy, sour milk, and olive oil in the diet;
• avoid contact with fertilizers, refuse to work in hazardous industries;
• avoid traumatic injuries, beware of sports activities, extreme recreation, work with an increased risk of injury;
• control hormone levels, especially after genital surgery, which concerns women, since a connection has been identified between disturbances in estrogen levels and the development of severe pathology.

Another preventative measure, the effectiveness of which has not been fully proven, would be switching from morning tea to coffee. The latter stimulates the production of dopamine and helps the body strengthen defense mechanisms that prevent the development of Parkinson's disease.

Scientific research confirms that Parkinson's disease is practically not found among coffee drinkers and smokers. But this should not be considered as a guide to action, because there are many other equally dangerous pathologies that provoke these habits.

An annual preventive examination by a neurologist will help reduce the risk, providing a detailed answer on how to prevent the disease. Doctors recommend paying more attention to the nervous system and leading a healthy lifestyle. A preventive measure would be to avoid stress, overexertion, and anxiety. Nutrition also matters, therefore, if you are predisposed, it is recommended to include more foods with fiber and B vitamins in your diet. At the same time, it is better to avoid berries, since scientists have established a connection between their frequent consumption and the risk of Parkinson’s disease.

Parkinson's disease is most common in people over 60 years of age. The disease is difficult both for the patient himself and for relatives, since the developed pathology leads to the patient being bedridden and requiring constant attention and care. Although the consequences of Parkinson's disease cannot be completely eliminated, few people know that the pathology can be suspected 5-10 years before its first signs appear.

Timely diagnosis makes it possible to stop the degenerative process in certain areas of the brain and maximally prolong the period of normal motor activity of the patient.

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Parkinson's disease - what is it?

Parkinson's disease is a medical term from the field of neurology, identical to shaking palsy and idiopathic parkinsonism syndrome. What it is? Parkinson's disease is a progressive pathology in which degenerative processes developing in the extrapyramidal system of the brain (primarily in the substantia nigra) lead to a decrease in the production of the neurotransmitter dopamine.

In this case, the transmission of nerve impulses is disrupted, and the patient gradually loses the ability to control his own movements. The process of development of degeneration of brain tissue develops slowly, but in the end it steadily leads to the patient’s complete loss of independently performing basic life norms - eating, dressing, etc.

The reasons for the failure of dopamine synthesis are still not clear, but doctors identify the following facts that influence the occurrence of Parkinson’s disease:

• Age factor - pathology is diagnosed in every hundredth person over 60 years of age. Moreover, men are more susceptible to this disease.
• Heredity - having parkinsonism in relatives increases the risk of Parkinson's disease by 20%.
• Changes at the gene level lead to degeneration of certain parts of the brain. This fact causes the appearance of symptoms of parkinsonism in young people.
• Smoking and drinking large amounts of coffee triples the risk of Parkinson's disease. People whose diet contains a sufficient amount of milk are more susceptible to the disease.
• Parkinson's disease is more susceptible to people who are engaged in mental activity, as well as with a pronounced character trait - the desire to control everything.

Degenerative processes in the central nervous system can be triggered by traumatic brain injuries, encephalitis, atherosclerosis and other vascular pathologies, chronic intoxication of the body - both when exposed to poisons from the outside (carbon monoxide, manganese production) and taking many medications (neuroleptics, narcotics), and and with severe damage to the kidneys and liver.

Signs of Parkinson's disease, first symptoms

one of the first signs is pathological mobility in sleep

The first symptoms of Parkinson's disease appear 10-15 years after the onset of degeneration of the extrapyramidal system of the brain. Moreover, the more common degenerative changes are and the less dopamine is produced, the more pronounced the characteristic manifestations of parkinsonism. However, Parkinson's disease, in the absence of characteristic symptoms, can be suspected by the following signs:

• A decrease in facial expression and slow movements of the limbs and body are often attributed to old age. However, these very signs may indicate a violation of nerve impulses from the brain to muscle fibers.
• Loss of smell - a decrease or complete inability to distinguish the smell of paint, garlic and other characteristic odors, according to recent research, is clearly associated with the development of Alzheimer's and Parkinson's diseases.
• Pathological mobility during “REM sleep”, when a person dreams - when degeneration of the substantia nigra has begun, a person swings his arms and legs in his sleep, often screams, and often falls out of bed.
• Changes in gait - lag of one leg when walking, emphasis on the outer edge of the foot are noticeable from the side, but often go unnoticed.

Frequent constipation, the urge to urinate at night, muscle pain, depression and excessive weakness often occur in older people, however In total with the above symptoms indicate a high likelihood of developing Parkinson's disease.

As the disease progresses, the patient develops characteristic motor disorders, autonomic disorders intensify, and mental abnormalities develop.

Symptoms of Parkinson's disease:

• Tremor

Trembling initially occurs in the hand of one hand with a frequency of 4-6 involuntary movements per second. and then spreads to other limbs (both upper and lower). The trembling of the fingers resembles counting coins, does not stop even at rest, increases with emotional excitement and, conversely, decreases with movement.

It is this specificity of tremor that distinguishes Parkinson's disease from cerebellar disorders. As the disease progresses, trembling spreads to the head (uncontrolled movements like “yes-yes”/“no-no”), lower jaw and tongue, more pronounced on the side of the primary lesion.

• Amimiya

The face of a patient with parkonsonism is mask-like due to decreased facial activity. Characteristic is the slow formation of a facial reaction to emotions (for example, crying) and their equally delayed extinction. The patient often has a frozen gaze and rarely blinks his eyes. Autonomic disorders are manifested by excessive salivation, excessive sweating and a greasy shine on the face.

• Speech impairment and handwriting changes

The patient’s speech loses expressiveness: everything is pronounced monotonously, and by the end of the conversation the speech becomes almost inaudible. Small-caliber tremor of the fingers provokes a decrease in the size of written letters (micrography) and intermittent handwriting.

• Hypokinesia, bradykinesia

General stiffness of the body is expressed by a decrease in controlled activity; the patient may freeze in one position for several hours. It can only be brought out of this state by an external stimulus - an attempt to move it or loud speech. All movements that the patient makes occur with some delay and are slowed down (bradykinesia).

• “Doll” gait and supplicant pose

Parkinson's patients are characterized by a "doll" gait: placing their feet parallel to each other, the patient moves in small steps. Uneven muscle rigidity is manifested by a supplicant pose: arms and legs bent at the joints, a hunched back, a head lowered to the chest.

• No synkinesis

The patient cannot make friendly movements: when walking, instead of the usual swinging, the arms are pressed to the body, looking up is not accompanied by a wrinkling of the forehead.

• Paradoxical kinesia

Often, with a pronounced emotional reaction or after waking up in the morning, all motor disturbances decrease or completely disappear, which allows the patient to move independently. However, after a few hours, the symptoms characteristic of Parkinson's disease return.

• Plastic waxy flexibility and the cogwheel sign

Increased muscle tone leads to the fact that all the patient’s movements are similar in nature to automatic ones: when flexing/extending the limbs, the gradual tension of certain muscles is clearly felt, and the patient remains in this position for a long time (Westphal phenomenon - a bent foot maintains its given position for some time).

• Postural instability

In the late stages of Parkinson's disease, it is difficult for the patient to overcome inertia: starting movement requires significant effort, and braking is difficult. When walking, the torso tilts in the direction of movement, ahead of the legs, so the patient often loses stability, and falls are fraught with various injuries and serious bruises.

• Autonomic disorders

Disorders of metabolic processes can manifest as cachexia (general exhaustion of the body), but obesity most often develops with Parkinson's disease. The patient’s erectile function also decreases, and impotence often develops.

• Mental disorders

Even with a slight decrease in dopamine, depression, insomnia and pathological fatigue develop. Patients with Parkinsonism are lethargic, obsessive (ask the same questions several times). Subsequently, various kinds of fears intensify, up to hallucinations and paranoid states.

Mental abilities also suffer, although to a lesser extent than with dementia: there is a decrease in memory and increasing absent-mindedness. Dementia is diagnosed only in some patients at a late stage of the disease, which also develops as a result of taking antiparkinsonian drugs.

Important! From a diagnostic point of view, macro- and microscopic changes in the extrapyramidal system of the brain, detected by high-precision studies (MRI, CT, PET, electroencephalography), are important: the presence of a large number of Lewy bodies and large-scale areas of degeneration of the substantia nigra. These signs of Parkinson's disease (within normal limits) also develop during the physiological aging process of the body.

Stages of Parkinson's disease + associated symptoms

Depending on the severity of pathological symptoms, Parkinson's disease is considered in stages:

1. The initial stage is the absence of characteristic symptoms of the disease.
2. Stage I - unilateral tremor, first on the arm, then on the leg.
3. Stage II - bilateral symptoms with the ability to overcome inertia.
4. Stage III - addition of postural instability, preservation of self-care.
5. Stage IV - although the patient is able to move independently, he requires constant supervision.
6. Stage V - immobility and severe disability, requiring constant care for the patient.

Treatment of Parkinson's disease - effective methods and drugs

Therapeutic measures for Parkinson's disease are aimed at stopping the degenerative process, but methods have not yet been developed that completely restore lost brain functions. At the same time, neurologists delay the prescription of antiparkinsonian drugs for as long as possible (they have a lot of side effects), therefore, with minimal signs of degeneration of the substantia nigra, they focus on water procedures, gymnastics, massage and physiotherapy.

The use of certain tablets in the treatment of Parkinson's disease is determined by its stage:

• Stage 1 - drugs that stimulate the production of dopamine and increase the sensitivity of nerve receptors to it - Selegelin, Amantadine (well tolerated, minimal side effects on the body);
• Stage 2 - drugs that imitate the dopamine effect - Cabergoline, Bromocriptine (treatment begins with minimal doses that give a therapeutic effect);
• 3 and later stages - Levodopa in combination (if necessary) with the above medications and agents that improve its absorption (Carbidopa, Benserazide).

Drug treatment for Parkinson's disease is prescribed individually, starting with minimal doses. The maximum delay in taking Levodopa is due to the fact that the effectiveness of the drug decreases markedly after 5 years of use, and there are no more effective drugs.

Surgical treatment methods

Modern medicine offers an innovative, effective way to reduce the symptoms of Parkinson's disease - deep electrical stimulation of the brain. The surgical technique involves implanting electrodes into the brain that emit high-frequency impulses that prevent the spread of the degenerative process.

Deep electrical stimulation of the brain shows excellent results in the fight against uncontrolled tremor, stopping the progression of the disease for a long time.

Also recognized as effective technologies in the treatment of Parkinson's disease are cryothalamotomy (freezing damaged areas of the brain with liquid nitrogen), pallidotomy (partial destruction of the globus pallidus) and stereotactic surgery (point exposure to pathological foci with high-dose radiation).

However, the complexity of these operations requires the clinic to have high-tech neurosurgical equipment and the experience of the operating surgeon. In addition, surgery is advisable in the early stages of Parkinson's disease.

• In case of severe disability and immobilization of the patient, therapeutic measures are reduced to quality care.

Forecast

In some patients, stage changes occur every 5-10 years, but rapid neuronal death cannot be ruled out. Also, the duration of the disease depends on the timeliness of treatment. Developed between the ages of 6 and 16 years (juvenile form), Parkinson's disease does not affect the patient's life expectancy. Pathology develops more rapidly in older patients.

The main question - how long do patients at the last stage of Parkinson's disease live - does not have a clear answer. Such patients can live 10 years or more, it all depends on the age at which the disease started, the level of treatment and the quality of care. Thus, if the onset of the disease is before 40 years of age, the average life expectancy of the patient is 39 years.

Those affected at 40-65 years of age can live another 21 years with proper care and adequate therapy. The death of elderly patients is most often caused by a heart attack, stroke, pneumonia due to exhaustion.

Parkinson's disease– a degenerative disease of the central nervous system, the main manifestation of which is severe impairment of motor functions. This disease is typical for older people and is otherwise called “shaking paralysis,” which indicates the main symptoms of this disease: constant trembling and increased muscle stiffness, as well as difficulty performing directed movements.

Parkinson's disease is a very common disease of the central nervous system, along with Alzheimer's disease and epilepsy. According to statistics, every 500 inhabitants of the planet suffer from it. The risk group mainly includes people over 40 years of age. The highest percentage of cases is observed in people over 80 years of age and amounts to 5-10%. Among people aged 40-80 years, about 5% of cases are detected. Parkinson's disease is very rare in childhood.

Interesting Facts:

• The disease is named after London surgeon James Parkinson, the first person to describe it as a distinct disease in 1817 in his Essay on the Shaking Palsy;
• In 2000, Swedish pharmacologist Arvid Carlson received the Nobel Prize in Medicine for his research into chemical compounds involved in the disease;
• At the initiative of the World Health Organization, April 11 (James Parkinson's birthday) is considered World Parkinson's Disease Day. On this day, various campaigns and events are held in all countries to inform the population about the causes, symptoms, diagnosis and treatment of this disease;
• For an unknown reason, men suffer from Parkinson's disease more often than women, and Europeans more often than Easterners;
• For smokers and coffee drinkers, the risk of developing the disease is reduced several times;
• The world symbol of the disease is the red tulip, a special variety of which was developed by a Dutch gardener who suffered from this disease and named the new variety “James Parkinson’s tulip.”

Anatomy and physiology of the nervous system

Basal ganglia is an auxiliary motor system. They do not work independently, but only in close connection with the cerebral cortex. The basal ganglia are involved in complex movements such as writing, drawing, walking, kicking a ball into a goal, tying shoelaces, etc. They are responsible for how quickly movement is carried out, as well as for the accuracy and quality of these movements. Such movements are voluntary, that is, they initially arise in the cerebral cortex. From here, information about these movements goes to the basal ganglia, which determine which muscles will participate in them and how much each muscle should be tense in order for the movements to be as precise and targeted as possible.

The basal ganglia transmit their impulses using special chemical compounds called neurotransmitters. How the muscles work depends on their quantity and mechanism of action (exciting or inhibitory). The main neurotransmitter is dopamine, which inhibits excess impulses, and thereby controls the accuracy of movements and the degree of muscle contraction.

In Parkinson's disease, certain areas of the basal ganglia are affected. They show a decrease in the number of nerve cells and destruction of the nerve fibers through which impulses are transmitted. Also a characteristic sign of this disease is a decrease in the amount of dopamine. It becomes insufficient to inhibit the constant excitatory signals of the cerebral cortex. These signals are able to travel directly to the muscles and stimulate their contraction. This explains the main symptoms of Parkinson's disease: constant muscle contractions (tremor, trembling), muscle stiffness due to excessively increased tone (rigidity), and disturbance of voluntary body movements.

Causes of Parkinson's disease

• Aging– with age, the number of nerve cells decreases, this also leads to a decrease in the amount of dopamine in the basal ganglia, which can provoke Parkinson’s disease;
• Heredity– despite the fact that the gene for Parkinson’s disease has not yet been identified, the presence of this disease in the family tree has been identified in many patients, in particular, the childhood form of the disease is explained precisely by genetic factors;
• Environmental factors– various toxins, pesticides, heavy metals, toxic substances, free radicals can provoke the death of nerve cells and lead to Parkinson’s disease;
• Medications– some antipsychotic drugs (for example, antidepressants) disrupt dopamine metabolism in the central nervous system and cause side effects similar to the symptoms of Parkinson’s disease;
• Brain injuries and diseases– bruises, concussions, as well as encephalitis of viral or bacterial origin can damage the structures of the basal ganglia and provoke illness;
• Wrong lifestyle– Parkinson’s disease can be caused by risk factors such as lack of sleep, constant stress, poor diet, vitamin deficiencies, etc.;
• Other diseases– atherosclerosis, malignant tumors, diseases of the endocrine glands can lead to complications such as Parkinson’s disease.

Symptoms and signs of Parkinson's disease

Symptom	Manifestation	Mechanism of occurrence
Tremor(constant involuntary shaking)		Excessive stimulating influence of the central nervous system on the muscles leads to the appearance of constant trembling of the limbs, head, eyelids, lower jaw, etc.
Rigidity(stiffness and reduced muscle mobility)		The absence of the inhibitory effect of dopamine leads to an excessive increase in muscle tone, causing them to become hard, immobile, and lose elasticity.
Hypokinesia(decreased motor activity)		When the basal ganglia, which are responsible for performing various movements, are destroyed, general stiffness, immobility, slow movements, rare blinking, etc. appear.
Bradyphrenia(slow thinking, speech, emotional reactions)		Due to the destruction of nerve cells and a decrease in the amount of dopamine in the central nervous system, thought processes, reaction speed, and expression of emotions are disrupted, speech becomes slurred, quiet, and monotonous.
Postural instability(decreased ability to maintain balance)		Since the regulation of movements when walking is carried out by the basal ganglia, when they are destroyed, the ability to maintain balance and move from one position to another is impaired, steps become slow and short.
Autonomic and mental disorders		In Parkinson's disease, general disorders of the nervous system are also observed: insomnia, dementia, impaired salivation, metabolism, etc.

What do people with Parkinson's disease look like?

Diagnosis of Parkinson's disease

To date, there are no laboratory tests that can confirm or refute the presence of Parkinson's disease. This creates certain difficulties in diagnosing this disease, as well as in distinguishing true Parkinson's disease from other diseases with similar symptoms.

The diagnosis of Parkinson's disease is made after a thorough physical examination, as well as a detailed medical history.

Stages of disease diagnosis

• Electroencephalography (study of the electrical activity of the brain);
• Computed tomography of the brain (layer-by-layer X-ray examination of the brain);
• Magnetic resonance imaging of the brain (electromagnetic study of brain structures);
• Electromyography (study of bioelectric processes in muscle tissue).

Treatment of Parkinson's disease

However, there are many methods that can slow the progression of the disease, as well as improve its symptoms.

Traditional treatment for Parkinson's disease

Alternative Treatment for Parkinson's Disease

Other Treatments for Parkinson's Disease

Primary and secondary prevention of Parkinson's disease

Is there any disability for Parkinson's disease?

There are 3 disability groups:
- first group: a person cannot do without outside help, does not move independently, remains in bed, is unable to work;
- second group: a person is capable of self-care to a limited extent, the manifestation of symptoms is bilateral, pronounced postural instability, limited work activity;
- third group: the person is capable of self-care, the manifestation of symptoms is bilateral, absence or moderate postural instability, reduced work activity.

What determines the life expectancy of people suffering from Parkinson's disease?

What is the prognosis for Parkinson's disease?

Parkinson's disease is a neurological disease with chronic symptoms. It progresses slowly and affects older people. To establish a diagnosis, the presence of clinical symptoms and data from instrumental research methods are required. To slow the progression of the disease and the deterioration of the condition, a patient with Parkinson's disease needs to take medications regularly.

We will consider in more detail what kind of disease this is, what factors are the impetus for its appearance, as well as the first signs and symptoms of Parkinson’s disease.

Parkinson's disease: what is it?

Parkinson's disease is a degenerative disease of the central nervous system, the main manifestation of which is severe impairment of motor functions. This disease is typical for older people and is otherwise called “shaking paralysis,” which indicates the main symptoms of this disease: constant trembling and increased muscle stiffness, as well as difficulty performing directed movements.

The symptoms of Parkinson's disease were first described by a doctor at the beginning of the 19th century. James Parkinson in “Essay on Shaking Palsy”, thanks to which the disease received the name of the scientist.

Parkinson's syndrome develops due to the death of the corresponding nerve cells in the brain that are responsible for controlling movements.

Damaged neurons lose the ability to perform their tasks, resulting in a decrease in the synthesis of dopamine (dopamine) and the development of disease symptoms:

• Increased muscle tone (rigidity);
• Decreased motor activity (hypokinesia);
• Difficulty walking and maintaining balance;
• Trembling (tremor);
• Autonomic disorders and mental disorders.

The first stages of Parkinson's disease usually go undetected. In rare cases, others notice some slowness of movements and less expressiveness of facial expressions.

As the pathology progresses, at the next stage of Parkinson's, the patient himself notices that it is difficult for him to perform some subtle movements. Handwriting gradually changes - up to serious difficulties when writing. It becomes difficult to carry out normal hygiene procedures (brushing teeth, shaving). Over time, facial expressions become so poor that the face becomes mask-like. In addition, speech is noticeably impaired.

Causes

Scientists have not yet been able to identify the exact causes of Parkinson's disease, but there is a certain group of factors that can trigger the development of this disease.

According to statistics, Parkinson's disease is diagnosed in 1% of the population under 60 years of age and in 5% of older people. Morbidity slightly higher among men.

The causes of Parkinson's disease can be identified as follows:

• aging of the body, in which the number of neurons naturally decreases, which leads to a decrease in the production of dopamine;
• hereditary predisposition;
• permanent residence near highways, industrial enterprises or railways;
• lack of vitamin D, which is formed when exposed to ultraviolet rays in the body and protects brain cellular formations from the destructive effects of free radicals and various toxins;
• poisoning with certain chemical compounds;
• the appearance of defective mitochondria due to mutation, which often leads to neuronal degeneration;
• neuroinfections ();
• tumor processes occurring in the brain or its trauma.

Parkinson's disease can also develop, according to some statements, against the background of drug intoxication associated with long-term use of phenothiazine medications by patients, as well as with certain narcotic drugs.

Scientists come to the conclusion that most often leads to the development of the disease rather a combination of several of these reasons.

The causes of the disease also depend on the type:

• Primary parkinsonism is caused by a genetic predisposition in 80% of cases.
• Secondary parkinsonism occurs against the background of various pathologies and existing diseases.

Risk groups include people 60-65 years old, most often the male population. It also occurs in young people. In this case, it proceeds more slowly than in people of the older age group.

It is worth noting that signs of Parkinson's disease in women and men have no obvious differences, since cell damage occurs regardless of a person’s gender.

Forms and stages of Parkinson's

In medicine, there are 3 forms of Parkinson's disease:

• Rigid-bradykinetic. It is characterized primarily by an increase in muscle tone (especially flexors) of the plastic type. Active movements slow down to the point of immobility. This form is characterized by a classic “hunched” posture.
• Trembling-rigid. It manifests itself as tremor of the distal limbs, which is eventually accompanied by stiffness of movement.
• Trembling. Manifested by constant tremor of the limbs, lower jaw, and tongue. The amplitude of oscillatory movements can be large, but the tempo of voluntary movements is always maintained. Muscle tone is usually increased.

Parkinsonism syndrome is divided into stages based on the severity of symptoms, each of them has its own characteristics in treatment methods. The stages of Parkinson's disease and disability groups are described in more detail using the Hoehn-Yahru scale:

1. At the first stage, signs of the disease are noted on one limb (with transition to the torso);
2. The second stage is characterized by the manifestation of postural instability on both sides;
3. At the third stage, postural instability progresses, but the patient, although with difficulty, still overcomes the inertia of movement when he is pushed, and is able to serve himself;
4. Although the patient can still stand or walk, he begins to greatly need outside help;
5. Complete immobility. Disability. Constant outside care.

According to the speed of development of the disease, the transition from one stage to the next is distinguished:

In end-stage Parkinson's disease, the main difficulties are associated with cachexia, loss of the ability to stand, walk and self-care. At this time, it is necessary to carry out a whole range of rehabilitation measures aimed at providing optimal conditions for the patient’s daily activities.

Parkinson's disease: symptoms and signs

It is impossible to predict the occurrence of the disease, because it is not genetic in nature, however, it is possible to stop its development in the early stages. Signs of Parkinson's disease at the very beginning, when the cells of the substantia nigra are just beginning to break down, are difficult to identify. As the disease acquires new stages, new symptoms of nervous system disorders appear. Parkinson's syndrome rapidly changes a person.

Symptoms of Parkinson's disease:

1. Tremor (constant involuntary shaking). Excessive stimulating influence of the central nervous system on the muscles leads to the appearance of constant trembling of the limbs, head, eyelids, lower jaw, etc.
2. Rigidity (stiffness and reduced muscle mobility). The absence of the inhibitory effect of dopamine leads to an excessive increase in muscle tone, causing them to become hard, immobile, and lose elasticity.
3. Limited and slow movements(which is defined as bradykinesia), this symptom especially manifests itself during a prolonged state of rest followed by the onset of movements on the part of the patient. A similar condition can occur when trying to turn over in bed to the other side or get up after sitting in a chair, etc.
4. Impaired coordination of movements. The danger of this symptom is that a person loses stability and may fall at any moment. Also, people with this disease often have a stooped posture, and they tend to droop their shoulders and tilt their head forward.

It is important to note that Parkinson's disease is a progressive disease, and quite often at the initial stage the disease has a latent course.

Despite the fact that tremor is one of the main symptoms indicating Parkinson's disease, its presence, however, is not exclusive evidence of the fact that a person has this particular disease. Tremor caused by other painful conditions, in contrast to tremor in Parkinson's disease, is less pronounced when the limb is immobilized and, conversely, is more noticeable during movement.

Other signs of Parkinson's disease

In addition to the above-mentioned main manifestations of parkinsonism, Parkinson's disease is accompanied by other symptoms, which in some cases may come to the fore of the clinical picture. Moreover, the degree of patient maladjustment in such cases is no less. Let's list just a few of them:

• salivation,
• dysarthria and/or dysphagia,
• constipation,
• dementia,
• depression,
• sleep disorders,
• dysuric disorders,
• restless legs syndrome and others.

Accompanied by parkinsonism and mental disorders:

• Changes in the affective sphere (decrease in mood of a depressive type or alternation of depression with periods of elevated mood).
• Dementia. Disorders of the cognitive sphere according to the type of deficit. Patients' intelligence sharply decreases and they are unable to solve everyday problems.

The first symptoms of psychosis (fear, confusion, hallucinations, with disorientation) are observed in 20% of individuals with parkinsonism. The decline in intellectual function is less pronounced than in senile dementia.

40% of individuals suffering from Parkinsonism have dream disorders and excessive fatigue, and 47% have depression. Patients are uninitiative, apathetic, and annoying. They tend to ask the same questions.

Consequences for humans

When you have parkinsonism, the problem becomes getting out of bed and chair, turning over in bed, and difficulties arise when brushing your teeth and doing simple household chores. Sometimes a slow gait is replaced by a fast run, which the patient cannot cope with until he collides with an obstacle or falls. The patient's speech becomes monotonous, without modulation.

The consequences of Parkinson's disease are:

• intellectual impairment;
• mental disorders;
• reduction, even complete disappearance, of the ability to self-care;
• complete immobilization, loss of speech function.

Diagnostics

Diagnosis of Parkinson's disease consists of 3 stages:

Stage 1

Identifying symptoms indicating the presence of parkinsonism. This stage includes a physical examination of the patient at the time of contacting the doctor. It allows you to identify the main signs of Parkinson's disease: constant muscle tremors, muscle stiffness, difficulty maintaining balance or performing directed movements.

Stage 2

It is important for the doctor to exclude all possible diseases with similar symptoms. These may be oculogyric crises, repeated strokes, secondary traumatic brain injuries, brain tumors, poisoning, etc.

Stage 3 - confirmation of the presence of Parkinson's disease

The final stage of diagnosis is based on the presence of at least three signs. This:

• the duration of the disease is more than 10 years,
• disease progression,
• asymmetry of symptoms with a predominance on the side of the body where the disease debuted, the presence of rest tremor, unilateral manifestations of the disease at the initial stage of its development.

In addition to these three diagnostic stages of a neurological examination, a person may be referred for an EEG, CT scan or MRI of the brain. Rheoencephalography is also used.

Treatment

A patient who has the initial symptoms of Parkinson's disease requires careful treatment with an individual course, due to the fact that missed treatment leads to serious consequences.

The main objectives of treatment are:

• maintain the patient’s physical activity for as long as possible;
• development of a special physical exercise program;
• drug therapy.

Drug treatment

When identifying the disease and its stage, the doctor prescribes medications for Parkinson’s disease that correspond to the stage of development of the syndrome:

• At first, amantadine tablets are effective because they stimulate the production of dopamine.
• At the first stage, dopamine receptor agonists (mirapex, pramipexole) are also effective.
• The drug levodopa in combination with other drugs is prescribed in complex therapy at later stages of the development of the syndrome.

The basic drug that can slow down the development of Parkinson's syndrome is Levodopa. It should be noted that the drug has a number of side effects. Before this drug was introduced into clinical practice, the only significant method of treatment was the destruction of the basal ganglia.

Symptomatic treatment:

1. Hallucinations, psychoses - psychoanaleptics (Exelon, Reminil), antipsychotics (Seroquel, Clozapine, Azaleptin, Leponex)
2. Autonomic disorders - laxatives for constipation, gastrointestinal motility stimulants (Motilium), antispasmodics (Detrusitol), antidepressants (Amitriptyline)
3. Sleep disturbance, pain, depression, anxiety - antidepressants (cipramil, ixel, amitriptyline, paxil) zolpidem, sedatives
4. Decreased concentration, memory impairment – ​​Exelon, Memantine-akatinol, Reminyl

The choice of treatment method depends on the severity of the disease and health status, and is carried out only by a doctor after a complete diagnosis of Parkinson’s disease has been carried out.

Exercise therapy

Exercise therapy is one of the best ways to relieve the symptoms of Parkinson's disease. Simple exercises can be performed both in the apartment and on the street. Exercise helps keep your muscles toned. In order for the effect to be better, the exercises must be performed every day. If the patient cannot do them on his own, then he needs help.

Surgical intervention

Surgery is performed only when medications have not helped. Modern medicine achieves good results even with partial surgical intervention - pallidotomy. The operation reduces hypokinesia by almost 100 percent.

Minimally invasive surgery – neurostimulation – has also become widely used. This is a precisely targeted effect of electric current on certain areas of the brain.

The basis of a normal life with such a diagnosis is a list of rules:

• Follow the recommendations of your doctor;
• Calculate your strength so that it does not cause aggravation of health problems;
• Systematically engage in physical exercise and follow a healthy diet;
• If necessary, seek advice from a qualified psychologist who will tell you how to overcome difficulties for a person with such a diagnosis.
• Do not resort to self-administration of medications. Ignore information regarding examples and advice from people who have overcome an illness or improved their health using any outside means.

Forecast

Life expectancy with Parkinson's disease is reduced; as symptoms progress, the quality of life irreversibly deteriorates, and the ability to work is lost.

Modern medicine allows a person with Parkinson's disease to live an active life for at least 15 years, only then does the person begin to need outside care. And death usually occurs due to other reasons - heart disease, pneumonia, and so on. If you follow all the doctor’s recommendations, a person can not only be independent in everyday life, but also be in professional demand.

Without treatment, unfortunately, after 10-12 years a person may find himself bedridden. And it is impossible to catch up, the changes are irreversible.

Prevention

There are no specific measures to prevent Parkinson's disease. However, it is within the power of a person to significantly reduce the risk of getting sick. To do this you should:

• Maintain a sufficient level of physical activity. Physical inactivity increases the risk of developing parkinsonism.
• Regularly “train” your brain. Solve problems, solve crosswords, play chess. This is a universal preventive measure against Parkinson's and Alzheimer's.
• Use antipsychotics with caution. Such drugs should only be taken under the supervision of a physician.
• Regularly undergo preventive examinations with a neurologist.

Parkinson's disease is a fairly dangerous disease that has a serious impact on human activity. Therefore, it is so important to know what symptoms are characteristic of this pathology. Timely identification of signs and immediate consultation with a doctor will allow a person to live a full life for a long time.

This is all about Parkinson's disease: what are the causes, first signs and symptoms, stages, treatment features. Do not be ill!

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). In fact, 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 by 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 turned out to be short-lived and a massive deterioration of 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.