Parkinson's disease and parkinsonism ( shaking palsy ) - Causes, Symptoms and Treatment .MF .
Parkinson's disease or parkinsonism - a slowly progressive condition, which manifests itself slowness of movements, muscle rigidity and tremor of rest.The disease was first described by the British physician James Parkinson, who called him shaking palsy In 1877
There are idiopathic parkinsonism (Parkinson's disease), and Parkinson's syndrome due to various reasons, and often serving the manifestation of other degenerative diseases of the nervous system.Parkinson's disease or Parkinson's disease occurs in 60-140 per 100 000 population;its frequency increases sharply with age.According to statistics, parkinsonism occurs in 1% of the population 60 years old and 5% of older persons.Men suffer more often than women.
Causes of Parkinson's disease
The basis of Parkinson's disease and parkinsonism are reducing the number of neurons in the substantia nigra and the formation of inclusions in them - Lewy bodies.Its development contribute to genetic predisposition, elderly age, the impact of exogenous fact
parkinsonian syndrome occurs as a result of the transferred acute and chronic infections of the nervous system (tick-borne encephalitis and other types).The causes of Parkinson's disease and parkinsonism may be acute and chronic disorders of cerebral circulation, cerebral arteriosclerosis, cerebrovascular diseases, tumors, trauma and tumors of the nervous system.Perhaps the development of Parkinson's disease due to drug intoxication with prolonged use of drugs phenothiazine series (chlorpromazine, triftazin) metildofy, some narcotic drugs - medicinal parkinsonism.Parkinsonism may occur in acute or chronic intoxication with carbon monoxide and manganese.
main pathogenetic link shaking palsy and Parkinson's syndrome is a violation of the catecholamine metabolism (dopamine, norepinephrine) in the extrapyramidal system.Dopamine carries out an independent mediator in the implementation of the function of motor acts.Normally, the concentration of dopamine in the basal nodes many times greater than its concentration in other structures of the nervous system.Acetylcholine is a mediator between the excitation of the striatum, pale globe and a black substance.Dopamine is his antagonist, acting Braking.With the defeat of the substantia nigra and globus pallidus decreases dopamine levels in the caudate nucleus and the shell is broken relationship between dopamine and norepinephrine, there is disorder of the extrapyramidal system functions.Normally modulated impulses toward suppressing the caudate nucleus, the shell, the substantia nigra and globus pallidus stimulation.When you turn off the function of the substantia nigra occurs pulses block coming from the extrapyramidal areas of the cerebral cortex and striatum to the anterior horns of the spinal cord.At the same time to enter the cells of the anterior horns pathological impulses from the globus pallidus and substantia nigra.As a result, the pulse is enhanced in the circulation system of alpha- and gamma-motoneurons of the spinal cord with a predominance of alpha activity that leads to pallidarno-nigral muscle rigidity and tremor fibers - the main signs of parkinsonism.
Pathology Parkinson's disease and parkinsonism.
main pathological changes observed in parkinsonism in the substantia nigra and globus pallidus in the form of degenerative changes and death of nerve cells.On the site there are pockets of dead cells proliferation of glial cells or remain empty.
forms of parkinsonism:
shaking, tremor - rigid, stiff - tremor, akinetic - rigid mixed.
severity distinguish five stages of Parkinson's disease.The most widespread classification proposed in 1967 hyun and Yar:
• Stage 0 - motor manifestations no
• I stage - unilateral manifestation
disease • II stage - bilateral symptoms without postural disorders
• III stage - mild postural instability, but the patientdoes not need any help
• IV stage - a significant loss of motor activity, but the patient is able to stand and walk without support
• V stage - in the absence of outside help the patient confined to a chair or bed
symptoms of Parkinson's disease and parkinsonism
symptoms of parkinsonism- a movement disorders and muscle tone, and combinations thereof.Stiffness, tone increase, tremor of the hands and the head, movements of the lower jaw on the "chewing" type violations handwriting and accuracy of movements, gait "bent" small steps, "shuffling" the poverty of facial movements - the "frozen face", the reduction of emotional behaviordepression.Symptoms initially unilateral, further progress, in severe cases lead to disability, immobility, cognitive impairment.
Symptoms of Parkinson
main clinical syndrome in Parkinson's disease and parkinsonism - akinetic-rigid or hypertonic-hypokinetic.For the shaking palsy, and Parkinson's is characterized by hypo- and akinesia.Appears peculiar flexion posture: head and torso bent forward, arms bent at the elbow in, wrist and metacarpophalangeal joints, often densely given to the sides of the chest, torso, legs bent at the knee.There poverty facial expressions.The rate of voluntary movements with the development of the disease is slowing down, sometimes complete immobility can occur quite early.The gait is characterized by small steps sharkayushimi.Often there is a tendency to involuntary run forward (propulsion).If the patient to push forward, he runs to keep from falling, as it were "chasing its center of gravity."Often push in the chest leads to the running back (retropulsion), in the direction (lateropulsii).These movements also occur when you try to sit, stand, tilt the head back.Often, when a pronounced parkinsonism syndrome patient's posture resemble cataleptic.Akinesia and plastic hypertension particularly sharply manifested in the muscles of the face, neck and chewing muscles, muscles of the limbs.When walking, no friendly hand movements (aheyrokinez).This quiet, monotone, without modulation, with a tendency to decay at the end of the phrase.
the passive limb movement marked a kind of muscle tone due to increased resistance of the antagonist muscles, the phenomenon of "gear" (the impression that the articular surface is made up of the coupling of two gears).Improving the tone of muscles-antagonists in passive movements can be determined by the following method: if you raise your head lying, and then abruptly let go of his hand, then his head will fall to the pillow and fall relatively smoothly.Sometimes the head in the supine position slightly raised - the phenomenon of "imaginary pillow."
Tremor - typical, though not necessarily for the syndrome of Parkinson symptoms.It's rhythmic, regular, involuntary trembling of the limbs, facial muscles, head, jaw, tongue, more pronounced at rest, decreases with active movements.The oscillation frequency of 4-8 per second.Sometimes there finger motion as a "pill rolling" "Coin counting".Tremor increases with the unrest, almost disappears during sleep.
Mental disorders are manifested loss of initiative, activity, narrowing of vision and interests, a sharp decrease in the different emotional reactions and passions, as well as a surface, and slow thinking (bradifreniya).Observed bradipsihiya - hard active switching from one thought to another, akayriya - stickiness, viscosity, self-centeredness.Sometimes there are paroxysms of mental excitement.
Autonomic disorders are manifested in the form of greasy skin of the face and scalp, seborrhea, hypersalivation, hyperhidrosis, trophic disorders in the distal extremities.Detect violations of postural reflexes.Sometimes special methods of investigation determined irregular frequency and depth of breathing.The tendon reflexes, generally without deviations.When atherosclerotic and postentsefaliticheskom parkinsonism may be determined by an increase of tendon reflexes and other signs of pyramidal insufficiency.When postentsefaliticheskom parkinsonism meet the so-called oculogyric crises - fixing gaze upwards for a few minutes or hours;sometimes the head at the same time thrown back.Crises can be combined with the violation of convergence and accommodation (progressive supranuclear palsy).
To distinguish several clinical forms of shaking palsy and Parkinson's;rigid-bradikineticheskuyu, tremor, rigidity and tremor.Stiff-bradikineticheskaya form is characterized by an increase in muscle tone by plastic type, progressive deceleration of active movements up to immobility;appear muscle contracture, flexor posture of patients.This form of Parkinson's disease, most unfavorable for the current, is more common in atherosclerotic and less when postentsefaliticheskom parkinsonism.Shaking-rigid form is characterized by tremor of the extremities, especially their distal portions to which the development of disease associated stiffness of voluntary movements.For tremor form of Parkinsonism is characterized by continuous or nearly continuous medium and pattern of major tremor of limbs, tongue, head, lower jaw.Muscle tone is normal or slightly elevated.The rate of voluntary movements saved.This form is more common in postentsefaliticheskom and posttraumatic parkinsonism.
have violated human movement, muscle control and balance of the body in space.Formed this state once again due to the destruction of the cluster of nerve cells (black substance) of the brain stem.These nerve cells are connected by their fibers with both brain hemispheres.They occur production and release of specific substances (neurotransmitters), which help to control the movement and coordination of the body in space.Their absence leads to the appearance of such outwardly visible signs of Parkinson's disease, as reduced range of motion with an increase in muscle tone, tremor of limbs, mask-like facial expression, walking with small steps and similar symptoms.
These laboratory and functional studies.
When posttraumatic parkinsonism revealed increase in cerebrospinal fluid pressure in the normal cellular protein and its composition.Parkinsonism, either due to poisoning by carbon monoxide in the blood carboxyhemoglobin detected when manganese parkinsonism - manganese traces of blood, urine, cerebrospinal fluid.Global electromyography during Shaking Palsy and Parkinson reveals violation electrogenesis muscles - increase of bioelectrical activity of muscles at rest and the presence of rhythmic group discharges of potentials.When electroencephalography found predominantly structurally unstable diffuse changes of bioelectric activity of the brain.
Diagnosis and differential diagnosis of parkinsonism.
The first doctor examines patsientai have these data can make a preliminary diagnosis.It is necessary to differentiate Parkinson's disease from Parkinson's syndrome.For postentsefaliticheskogo parkinsonism characterized by oculomotor symptoms;torticollis can be observed, the phenomenon of torsion dystonia who have never observed in the Shaking Palsy.There are sleep disturbances, respiratory dyskinesia with bouts of yawning, coughing, adiposogenital disorders, autonomic paroxysms.Post-traumatic parkinsonism can be reliably diagnosed in patients younger and middle-aged.The disease develops after a severe, sometimes repeated craniocerebral trauma.For post-traumatic Parkinson's uncharacteristic anteretropulsii, cramp sight, chewing disorders, swallowing, breathing, cataleptoid phenomenon.At the same time, frequent vestibular disorders, intelligence and memory, visual hallucinations (due to lesions of the cerebral cortex).Often marked regredientnoe or for the stabilization of the pathological process.For the diagnosis of manganese parkinsonism have a history of value (information about the work in contact with manganese or oxides), manganese detection in body fluids.Diagnosis oksiuglerodnogo parkinsonism based on the determination of carboxyhemoglobin in the blood.
When atherosclerotic parkinsonian tremor and rigidity combined with signs of cerebral arteriosclerosis or occur after acute cerebrovascular events.Are identified focal neurological symptoms in the form of pyramidal insufficiency expressed pseudobulbar symptoms.Often defined unilateral rigidity and stiffness.The blood found dyslipidemia characteristic of atherosclerosis.Enroll REG certain changes in the form of a flattening of the pulse waves.
clinical picture that resembles Parkinson's disease, can be observed in senile atherosclerotic dementia, for which the most typical rough mental disorders until the dementia.The rigidity and stiffness moderately pronounced tremor usually absent.Some clinical manifestations of Parkinson's disease can be detected in other hereditary degenerative diseases of the nervous system: Friedreich's ataxia, olivopontotserebellyarnoy atrophy, orthostatic hypokinesia, Creutzfeldt-Jakob disease.In these diseases, along with an akinetic-rigid symptoms are progressive cerebellar ataxia phenomena.
At insufficiency neurologic examination for diagnosis may be used methods:
- REG, Doppler ultrasound of the neck vessels and brain
- radiographs of the cervical spine with functional tests
- MRI of the brain and its vessels
- MRI of the cervical spine, etc..d.
begins Parkinsonism in 45-52 years, when activity is greatly reduced dopaminergic structures.This neurotransmitter metabolism disease - produced enough dopamine in the basal ganglia and the loss of 70% of dopamine in the striatum (caudate and putamen) clinical signs of parkinsonism.The only reliable diagnostic test - it positron - emission tomography.In practice, a specific reaction to levodopa, reception which leads to the disappearance of symptoms.
course and prognosis of Parkinson's disease and parkinsonism.
disease steadily progresses.The exception is some forms due to drug intoxication (improvement may occur when you cancel preparations).It is generally recognized that in the initial stage of treatment to reduce the severity of the symptoms, to slow the progression of the disease.In the later stages of the treatment measures are less effective.The disease leads to disability in a few years.Even the treatment of levodopa currently slows down for a short time.This confirms the position that the basis of the disease is not only the primary biochemical defect, but has not yet learned the neuropathological process.
Treatment of Parkinson's disease and parkinsonism.
Treatment of patients with shaking palsy syndrome and Parkinson's should be complex, lengthy and include specific anti-Parkinsonian medications, sedatives, physiotherapy, exercise therapy, psychotherapy based on etiology, patient age, clinical form and stage of the disease, as well as the presence of concomitant diseases.In milder forms beginning administered amantadine (midantan) and parasympatholytics because they cause fewer side effects.
neurologist Kobzev SV