Parkinson's disease symptoms
The first description of the progressive degenerative disease of the central nervous system, which is accompanied by slow motion, stiffness and trembling, was given in 1817 by James Parkinson. Then this disease was called "trembling paralysis", and then it became known as Parkinson's disease.
Parkinson's disease is caused by the gradually increasing death of nerve cells( neurons) in the gray matter of the brain. Neurons contact each other, releasing specific chemicals called neurotransmitters."Black substance"( substantia nigra) produces a neurotransmitter dopamine, which is important for fast, smooth and coordinated movement. With Parkinson's disease, the gradual destruction of the neurons that produce dopamine leads to sluggishness, trembling, immobility and uncoordinated movements. Parkinson's disease, one of the most common degenerative diseases of the nervous system, often begins at the age of 55 to 70 years, although quite often the cases of its occurrence belong to the earlier( juvenile) and later age. Isolate family cases of Parkinson's disease with a clear hereditary transmission of the disease. More often the disease is transmitted by an autosomal dominant type of inheritance with incomplete manifestation of the mutant gene.
Men get sick more often than women. Symptoms usually begin gradually and at first they are often overlooked, mistakenly attributing them to the aging process. Although there is no special analysis to establish an accurate diagnosis of Parkinson's disease, the increase in symptoms after some time allows a confident diagnosis. The cause of Parkinson's disease remains unknown, and there is as yet no way to cure it. However, drugs can alleviate many of the symptoms and improve the quality of life of patients.
In Europe and North America, Parkinson's disease affects an average of 100-200 people per 100 000 population. In Asia and Africa, this disease is less common. According to epidemiological studies conducted in the USA, in rural areas the percentage of people suffering from Parkinson's disease is higher compared to the urban population. This fact is explained by the extensive use in agriculture of pesticides and chemical fertilizers, which provokes the development of the disease.
Many individuals have certain body conditions that precede the development of the disease. To such features, which are formed long before the appearance of the first signs of the disease, are: punctuality, conscientiousness, excessive caution, propensity to depression, non-smoking, early impairment of smell.
Causes of
• The cause of Parkinson's disease is unknown. It is believed that it can arise due to genetic factors and environmental factors against the background of the aging process.
• Brain damage, tumors, complications after encephalitis and possibly carbon monoxide poisoning can cause symptoms similar to those of Parkinson's disease.
• Certain medications, especially those that interact with dopamine( eg, antiemetics and antipsychotics), can cause symptoms that are similar to those of Parkinson's disease( Parkinson's).
Mechanism of the development of the disease
The mechanism of the development of Parkinson's disease has not been fully disclosed to date. Many researchers compare the processes occurring in the aging brain with the processes observed in parkinsonism. For many persons of senile age, such features of parkinsonism as some slowness of movements, poverty of facial expressions, shuffling gait are characteristic. In this disease, there is a violation of the relationship in the brain of special chemicals, which are acetylcholine and dopamine. At the same time, the amount of acetylcholine increases, and the amount of dopamine, on the contrary, decreases.
Symptoms of
• Slow motion.
• Rhythmic oscillation of the hands( jitter) first from one side, especially during rest or during anxious moments.
• Stop or reduce jitter when driving or while sleeping.
• Muscular stiffness.
• Difficulty trying to change position, for example, get out of a sitting position or go after standing, get out of the car or roll over in bed.
• Temporary inability to move( in some cases).
• Shaky gait in small, seminal steps.
• Loss of balance.
• Inclined body position.
• Lack of facial expression.
• Difficulty swallowing.
• Salivation.
• Oily skin of the body and head( seborrhea).
• Fine narrow handwriting.
• Shivering, inexpressive voice;muttering;low speech.
• Emotional depression and anxiety.
• Gradual confusion, memory loss and other mental disorders( only in some serious cases).
The presence of a Parkinson's disease in a person is reliably confirmed if it has the following symptoms:
1) occurrence of two or three symptoms of parkinsonism during the year: slowness of movement, stiffness of movements, trembling;
2) one-sidedness of the lesion at the onset of the disease;this condition is called hemiparkinsonism;
3) a pronounced positive response to preparations containing the substance L-dofa. A positive reaction manifests itself in the form of a decrease in the severity of Parkinsonian symptoms;
4) gradual development of all signs of Parkinson's disease;
5) absence of acute onset and step-like progression of pathology;
6) the absence during the life of episodes of cerebral inflammation( encephalitis), poisoning with toxic substances, prolonged intake of drugs from the group of neuroleptics, and the absence of severe craniocerebral trauma;
7) absence of vascular diseases and cysts of the brain.
Slow motion( bradykinesia) is one of the leading manifestations of Parkinson's disease. With the appearance of slowed movements associated with such manifestations of parkinsonism as: poverty of movements;facial expression;small, illegible handwriting;monotonous, fading speech, which periodically turns into an inaudible, silent whisper;Seizing gait with small steps;decrease in the frequency of blinking movements;reduction of friendly movements, for example, waving hands while walking;difficulty at the beginning and end of the movement, propensity to fall forward with a quick stop after walking or with a slight push, a tendency to walking backwards.
Rigidity is a kind of change in the muscle tone that the people themselves suffering from Parkinson's disease describe as stiffness of movements. The study reveals difficulties in trying to make passive movements in the limbs. With the rigidity of the muscles, the flexural posture characteristic of Parkinson's disease is associated.
Tremor( tremor) is the third characteristic sign of Parkinson's disease .Parkinsonian tremor is characterized by the following features: quivering of rest, which decreases or completely disappears when moving;shaking is often of a fine-grained type( reminiscent of the appearance of "rolling pills" or "counting coins");trembling is more often localized in the hands and upper parts of the legs, rarely there is trembling of the head, lower jaw and tongue;the frequency of trembling movements is 4-8 per second. In 15% of all persons suffering from Parkinson's disease, the trembling of elongated arms is much more pronounced than the trembling of the hands at rest.
A few years after the appearance of the first signs of Parkinson's disease, instability appears in a vertical posture, a person begins to fall often, progressive walking disorders occur. This state is designated as postural instability. At such people at inspection reveal a symptom of "freezing" when it is especially difficult for them to make the first step, "to tear off legs from a floor".However, the ability to walk fairly well on the steps of the staircase, along the sleepers, remains when there is an "external organization of the motor space."
Dementia( dementia) is not characteristic of early stages of Parkinson's disease, and some people are observed many years later( more than 5) after the appearance of the first signs of the disease. In this case, the degree of dementia is usually combined with the severity of motor disorders. In the early stages of relatively easy violations of memory and attention, slow mental processes( bradyphrenia).Some individuals have some changes in personality and behavior: a tendency to associate with others with the same questions( acaiya), motor anxiety, pathological restlessness( akathisia) arises.
Often, Parkinson's disease affects the vegetative department of the nervous system, which is manifested by the following signs: the allocation of a large amount of saliva;greasiness of the face;propensity to constipation;frequent urination;dry skin of the shins and forearms, the appearance in these areas of peeling and cracks;disturbances from the eyes in the form of weakening the reaction of pupils to light;pain in the limbs and lower back.
In the late stages of the disease, other pathological changes may occur: a sharp decrease in blood pressure during the transition from horizontal to vertical position, impaired swallowing, progressive weight loss.
These signs of Parkinson's disease are formed in 75% of patients.
Forms of the disease
Depending on the prevalence of certain symptoms of the disease, the following forms of Parkinson's disease are distinguished:
1) rigidly-trembling form. In this form, among all manifestations of the disease, the increase in muscle tone and general slowed-down movements are at the forefront. These symptoms are formed in 21% of all cases of Parkinson's disease;
2) a shaking-rigid form. With this form, trembling comes to the fore. This form is 37% of all cases;
3) akinetic-rigid form. With this form of Parkinson's disease, the tremor is either absent, or is slightly expressed, but occurs only in case of agitation. This form accounts for about 33% of all cases of the disease;
4) akinetic form. This form is characterized by the absence of arbitrary movements and accounts for about 2% of all cases of Parkinson's disease;
5) Shake shape. At the first stages of the disease, the main manifestation is trembling, the increase in muscle tone is absent, the slowness of voluntary movements and impoverishment of mimicry are not very pronounced. This form of Parkinson's disease accounts for 7% of all cases.
Parkinson's disease is a continuously progressive disease, which is why several stages are distinguished in its development.
Stage 1 is characterized by a one-sided lesion( ie, only the right arm and leg or only the left are involved in the pathological process);while the function on the affected side is not significantly affected.
In the 2 nd stage there is a bilateral defeat, expressed in an easy degree, the balance is not violated.
Stage 3 is characterized by lack of rigidity in turns, the appearance of functional limitations in the performance of any work;while in everyday life a person remains independent.
At the 4th stage of Parkinson's disease, a person is completely dependent on surrounding people, however, patients can walk and stand alone.
The onset of the 5th stage of the disease is characterized by the fact that a person becomes confined to a bed or a wheelchair.
Parkinson's disease has a relatively slow progressing course. A slower progression is observed if the first sign of the disease is trembling, when the trembling form of parkinsonism develops, as well as at the early onset of the disease( up to 45 years).Less favorable course takes place at the onset of the disease with the appearance of a feeling of stiffness in the limbs, with akinetic or akinetic-rigid forms of the disease, and also in the case of the onset of the disease at the age of more than 70 years. As the disease progresses, not only disability, but also the ability to elementary self-service is disrupted: it becomes difficult for a person to take a bath alone, lace up shoes, put on coats and perform other basic actions.
There are three types( rate) of progression of Parkinson's disease:
1) a fast rate is characterized by a change in the stage of the disease for two years or less. Most often this type of disease progression occurs in the akinetic and akinetic-rigid forms;
2) A moderate rate is characterized by a change in the stages of Parkinson's disease within 3-5 years. Most often this type of disease progression occurs with rigidly-trembling and jitter-rigid forms;
3) the slow rate of disease progression is characterized by the change of stages for 5 years or more. Most often this type of disease progression is observed with a trembling form.
The most common causes of death in Parkinson's disease are bronchopneumonia, various infectious or septic complications, exacerbation of chronic cardiovascular insufficiency. With Parkinson's disease, infarctions of the myocardium and strokes are extremely rare.
Diagnosis
• Case history and physical examination by a therapist or neuropathologist with experience in working with patients with Parkinson's disease. The therapist will identify other diseases that cause similar symptoms. These include stroke, tumors, Wilson-Konovalov's disease( accumulation of copper), progressive paralysis, and sometimes Alzheimer's disease.
Treatment of
• Treatment may not be required in the early stages, if symptoms do not interfere with the performance of the functions. With the intensification of symptoms, help can be provided by a variety of medications. It takes time and patience to find the right medicine and dosage. Drugs used to treat Parkinson's disease have many side effects, including excessive motor activity in case of an overdose.
• "Levodopa" is the main therapeutic tool that allows us to weaken the symptoms of Parkinson's disease. In the brain of "Levodopa" dopamine is transformed into the missing neurotransmitter."Levodopa" is used in combination with inhibitors of decarboxylase( carbidopa or benserazide) to increase the effectiveness of the drug and reduce its side effects by preventing the conversion of "levodopa" to dopamine outside the brain.(Side effects include nausea and vomiting, dizziness and ringing in the ears in a sitting position, or when straightening out from a bent position.) Since the effectiveness of Levodop gradually decreases with time, doctors often do not prescribe the medicine until the symptoms begin to severely interfere with the dailyactivities.
• Deprinil, also known as selegiline, can be prescribed immediately after diagnosis. This drug can slow the development of symptoms, thus pushing back the time when the patient can not do without "Levodopa".
• Anticholinergic agents( such as trihexylphenidyl) block some nerve impulses and can be prescribed to reduce jitter and immobility.
• Benzthropine mesylate and antihistamines such as diphenhydramine can also be used to reduce jitter and immobility.
• Amantadine, which increases the production of dopamine in the brain, can be prescribed to reduce trembling, immobility and movement difficulties.
• Substances that have an affinity for dopamine receptors( such as bromocriptine, pergolide, praminexol, and ropinirole) that work directly in the dopamine receptors in the brain can be used in combination with Levodopa for additional symptom control;They are increasingly being used in the early phase of therapy for the early stage of Parkinson's disease.
• Catechol-methyltransferase inhibitors, such as tolcapone, are added to "Levodopa" for improved symptom control.
• To stop the jitter, consider the possibility of surgical therapy: either thalamotomy( in which a small amount of brain thalamus cells are destroyed) or an electric stimulator room in the thalamus cells to shunt the flow of nerve impulses into them.
• For motor vibrations that often complicate Parkinson's disease at a late stage of development, it is possible to perform pallidotomy, in which an incision is made in the cerebral cortex to reduce the excessive activity of nerve cells. Electrostimulation of the cerebral cortex and other areas is intensively researched and looks promising.
• The introduction of embryonic tissue into the basal nucleus of the brain has yielded positive results in only a few patients.
• Patients should be active and exercise regularly so that the muscles remain as flexible as possible.
• Physical and speech therapy can help patients adapt to the limitations imposed by the disease.
• Psychological counseling can help patients cope with depression and provide emotional support. Family members of patients with Parkinson's disease may also benefit from the recommendations.
• In order for the "Levodopa" to have a greater effect, the doctor can advise changes in diet, such as eating the bulk of the daily protein norm with an evening meal and maintaining a carbohydrate to protein ratio of 7: 1.
If a few decades ago parkinsonism was an almost incurable disease, at present medicine has a significant arsenal of effective antiparkinsonian drugs. However, until now there are no drugs to treat the cause of Parkinson's development, and the main thing is the therapy aimed at inhibiting the mechanisms of the development of this disease.
In the history of the treatment of Parkinson's disease the first effective antiparkinsonian agent was the drugs from the cholinolytics group. They prevent relative or absolute increase in the content of the brain of a special substance - acetylcholine, which is observed in the development of Parkinson's disease. Reception of anticholinergics( especially in large doses) can cause a number of side effects, which include: dry mouth, palpitations( tachycardia), constipation, urination disorders, disorders of eye adaptation to vision of objects at different distances( accommodation).
Admission of anticholinergic drugs in the elderly requires special care, as they increase disruption of thinking, memory, speech, analysis and synthesis of events occurring around it, and cause mental disorders such as hallucinations and various disorders of consciousness. When you cancel or reduce the dose of drugs in this group, side effects occur. Taking drugs from the anticholinergic group is contraindicated in cases of glaucoma, heart rhythm disorders and prostate adenoma.
The discovery of a deficiency in the brain of a particular substance - dopamine - in Parkinson's disease has revolutionized the development of methods for treating Parkinsonism. Since dopamine itself is unable to penetrate into the brain when it is introduced into the body, a dopamine precursor is used for substitution treatment, which is L-dopa( dioxyphenylalanine).In the body of this precursor, dopamine is formed under the influence of special enzymes.
At the very beginning of L-dopa treatment( synonyms: levodopa, levopa, dopa-flex) are prescribed in a dose of 0,125-0,25 g 2-3 times a day. After the start of treatment, the dose of the drug is gradually increased until the optimal for a particular person is selected. Selection of a dose is performed only by a qualified specialist. The optimal individual dose is selected within 3-4 weeks. This drug is taken 3-4 times a day. Treatment with L-dopa is a substitution therapy, and the effectiveness of the drug is preserved only during its use.
When taking this medication, the following side effects are possible:
1) Disturbances from the gastrointestinal tract, which manifests itself in the form of nausea, vomiting, loss of appetite, there may be a feeling of heaviness in the stomach. These side effects are to some extent observed in almost 60% of people taking L-dopa;
2) disorders of the cardiovascular system: heart rhythm disturbances, angina pectoris, rapid heart rate( tachycardia), a sharp decrease in blood pressure when going to the vertical position( orthostatic hypotension), which is accompanied by dizziness. These side effects are observed in 10-20% of cases.
3) involuntary movements of mimic muscles, muscles of the trunk and extremities( 70% of cases);
4) mental disorders, such as the appearance of anxiety, fear, agitation, aggression, hallucinations, delirium;
5) Depression.
The positive effect of using L-Dopa is significantly higher than when taking other drugs used to treat Parkinson's disease. In this case, in a short time, almost complete disappearance of difficulties with arbitrary movements, reduction of muscle tone and trembling can be achieved. With the prevalence of only static jitter among all manifestations of the disease, the L-dopa preparation is ineffective, as well as in case of motor instability( see above).A few years after the start of treatment, the effectiveness of the L-dopa drug is reduced, which is due to further progression of the disease and a decrease in sensitivity to exogenous( injected from outside) dopamine. In 50% of people suffering from this disease, there comes the phenomenon of depletion of the dose, the essence of which is to reduce the effectiveness and reduce the duration of the effect after taking a single dose of the drug.
An average of 5-7 years( and in some cases after 3 years) of sufficiently effective therapy with L-dopa is accompanied by serious complications, which can be manifested by the following symptoms:
1) reduction in the duration of action of the accepted dose of the drug( up to 3 hours or less).This complication occurs within 5 years in 50% of persons suffering from Parkinson's disease. This condition is called the phenomenon of depletion of the effect of the dose;
2) the effect of taking a single dose of the drug comes in an hour or more, which is designated as the phenomenon of delay in the onset of the effectiveness of the dose taken;
3) a person has fluctuations in motor activity during the day;
4) severe disorders of coordinated motor activity are formed;
5) the drug begins to act toxic to neuropsychic activity, which is manifested by panic attacks, mood swings for a short period of time, the occurrence of various kinds of hallucinations.
Other symptoms that can not be fully associated with long-term L-dopa treatment and which are largely attributable to the progression of Parkinson's disease may also add to them:
1) decreased memory, intelligence, thinking( up to the development of dementia);
2) motor instability with gait disturbance and frequent falls;
3) speech and swallowing;
4) the phenomenon of congealing, "freezing", which manifests itself in the form of a sudden loss of motor activity for a few seconds or minutes. This inhibition usually occurs before the start of walking, when turning, when passing through a doorway, in an open area.
To fluctuations in motor activity resulting from long-term use of L-dopa preparations, include:
1) the phenomenon of "on-off", when during the day the periods of complete immobility( "shutdown") develop, then periods of increased motor activity( "inclusion").This condition is often accompanied by the appearance of involuntary obsessive movements, which can be observed up to 10-12 times a day;
2) violation of coordinated motor activity;
3) Morning impairment of the tone( increase or decrease) of individual muscle groups( more often the lower leg and the foot).
Also used to treat Parkinson's disease are substances that block the enzyme monoamine oxidase. They are called monoamine oxidase inhibitors( MAO).These drugs are used both as a primary treatment for the disease( in the initial stages) and in combination with L-dopa preparations to prolong the positive effect of L-dopa and reduce the daily fluctuations in motor activity. The effect of the MAO inhibitor is due to the suppression of the activity of the monoamine oxidase enzyme, which is involved in the conversion of dopamine to other chemicals. The introduction of an MAO inhibitor increases the content of dopamine in the brain, a deficiency of which is observed in Parkinson's disease. This leads to increased efficacy of L-dopa preparations. The drug is usually well tolerated, side effects occur extremely rarely. MAO inhibitors also have an antidepressant effect.
In the treatment of Parkinson's disease, dopamine agonists are widely used. Drugs of this group are substances that can initiate the physiological action of dopamine produced in the body. The most studied drug from this group is bromocriptine( parlodel), although much remains unclear in its use. Some researchers recommend using it in small and slowly increasing doses;others recommend large doses of the drug. The effectiveness of parlodel, when using only this substance in the treatment of Parkinson's disease, is moderate enough. However, it is usually used in combination with other antiparkinsonian drugs. When you receive parlodela quite often( up to 40% of cases), there are side effects: a sharp decrease in pressure when going to the vertical position with fainting and fainting, dizziness.
Another dopamine agonist, pergolide, is more effective. When it is received, there is a significant reduction in the periods of stiffness. Side effects in the form of a sharp decrease in pressure during the transition to a vertical position are observed in 25% of cases.
Treatment of complications of prolonged treatment with L-dopa and other complications of Parkinson's disease. In recent years, prolonged( longer-acting) forms of this drug have been used to reduce fluctuations in motor activity in the form of an on-off reaction and also to maintain a more constant level of L-dopa in the blood plasma. Such forms include the synemet and the madopar.
There is the possibility of surgical correction of Parkinson's disease. Recently, a new method is developing - neurotransplantation. In this case, the cerebral tissue of a certain brain region of the embryo of the 6-9 week-old age is transplanted into the brain of the patient. At a part of persons after carrying out of such operation there are: reduction of inhibition of voluntary movements and increase of a muscular tonus, good effect starts to be noted at application of small doses of preparations of L-dofa, the effect from the accepted dose of a medicinal substance also lengthens. The effect of the operation on the severity of motor instability and tremor is negligible. As a result of the operation, there is no complete disappearance of all signs of the disease. In addition, as well as after other operations concerning parkinsonism, people are forced( albeit in smaller doses) to take antiparkinsonian medications. The operation is not performed with the trembling form of parkinsonism. Contraindications to the operation are expressed diseases of internal organs and dementia. In a number of foreign clinics, as a transplant, not the brain tissue of the embryo, but the tissue of one of the adrenal glands of the patient.
Juvenile Parkinsonism
Juvenile( juvenile) parkinsonism is a fairly rare form of Parkinson's disease that occurs before the age of 40.There is a children's subtype of juvenile parkinsonism, which is characterized by the onset of the disease at the age of 6 to 16 years and the presence, along with all the characteristic manifestations of Parkinson's disease, of muscle tone of the foot. Juvenile Parkinsonism is a hereditary disease that is transmitted by an autosomal dominant or autosomal recessive type of inheritance. In contrast to Parkinson's disease, which develops in middle and old age, a relatively benign slow rate of progression is characteristic of juvenile parkinsonism. With this form of the disease, there are no marked disorders of memory, attention and intellect, disorders of the autonomic nervous system( skin fatigue, dryness of the palms and soles, a sharp drop in blood pressure when moving to a vertical position) and instability in movement( stumbling, unstable gait, tendency to fall).There is a good effect even from small doses of L-dofa, but complications in the form of disorders of muscle tone and motor activity fluctuations occur quite quickly.
Prevention of
• There are no known methods for preventing Parkinson's disease.
• Consult your doctor if you develop symptoms of Parkinson's disease.
• Consult a doctor if new symptoms appear during treatment( some prescription medications may have severe side effects, for example, lower blood pressure, cause confusion or hallucinations).