Causes, Symptoms and Treatment of Parkinsonism

Parkinsonism is a syndrome that includes hypokinesia, restless tremor, postural instability and muscle rigidity. If the cause of Parkinsonism can not be established, it is Parkinson's disease. If it is possible to establish a damaging agent, then the syndrome is secondary. The reasons for the development of the disease are many, the treatment of parkinsonism and the choice of drugs will directly depend on them.

How does parkinsonism develop?

The disease is based on damage to neurons related to the black substance, which is located in the brain stem. This breaks the connection between the various parts of the nervous system: the cortex of the large hemispheres, the thalamus, the spinal cord, the basal ganglia.

The neurons of the black substance that synthesize the neurotransmitter dopamine die. In Parkinson's disease, the basis for their death is the excessive accumulation of pathological protein, which is deposited in the body of Levy. In secondary parkinsonism, neurons are damaged by a pathological agent: toxin, oxygen deficiency, tumor, etc.

The amount of dopamine in this region is falling, which causes the cholinergic neurons of the striatum to become disinhibited. That is, the main "blow" occurs in the extrapyramidal system of the brain. Because of the excessive activity of this structure, all the symptoms of the disease are formed.

How to suspect parkinsonism?

There are four main signs of parkinsonism, combined in varying degrees.

1. Hypokinesia - the inability to carry out normal movements. At the beginning of the disease manifests itself as motor awkwardness, awkwardness. Patients note that previously available automatic actions require concentration and take more time. First of all, small motor skills suffer. It becomes difficult to tie the laces, to fasten the buttons. Changing handwriting, especially characterized by a decrease in the size of the letters at the end of the phrase. Gradually, the symptoms progress, any movement becomes difficult.
2. The tremor of the limbs in parkinsonism manifests itself at rest, captures at first one group of muscles, more often the arms, then spreads to the rest. As a result, at rest, not only hands and feet are shaking, but also the head, lips, and eyelids. The tonus of all muscles rises, because of what the movements become taut and difficult to achieve.
3. The center of gravity shifts, coordination is disturbed, it becomes difficult to maintain balance. This is especially noticeable when driving in a straight line. When it is necessary to stop or change direction, patients "stomp" for a while, "catching up" with their own center of gravity.
4. With a severe disease, any movement is very slow. You may need help with self-service, as it becomes difficult to perform daily activities: wash, eat, cook, etc.

Important! Gradually, the neurons of the cerebral cortex are affected, which leads to the development of dementia( dementia).

Features of vascular and toxic parkinsonism

The cause of development is the degeneration of the black substance due to the hypoxia of this site in the atherosclerosis of the vessels. Symptoms of vascular parkinsonism begin symmetrically, whereas Parkinson's disease usually first captures one side. Most often in this case, the lower extremities are affected, and not the hands.

The tremor of rest develops seldom, usually there is an increase of a muscular tonus. For this disease is characterized by a rapid development of walking disorders, as well as symptoms of dementia. Persons suffering from vascular parkinsonism are characterized by incontinence, quick temper, tearfulness, which reflects the defeat of the frontal lobes during hypoxia.

Toxic parkinsonism develops under the influence of many typical neuroleptics( haloperidol, triftazin, etc.).Characteristic is a large-scale tremor of hands in combination with strong salivation and restless legs syndrome.

How to treat Parkinsonism?

Treatment of the syndrome should be comprehensive, include both drugs and physiotherapy with physiotherapy exercises.

Medications

At the initial stage, the drug of choice for the treatment of parkinsonism is Amantadine( Midantan).It has a minimum of side effects and leads to a relaxation of spasms. As a result, the movement is facilitated.

The basic drug of therapy for parkinsonism is Levodopa( Dopamine) in combination with a decarboxylase inhibitor to correct side effects. This medication is a donator of dopamine for the nervous system. To avoid adverse effects, dosage should be increased slowly, observing the patient's condition.

Holinolitic drugs( Kombipark, Norakin) block the cholinergic receptors and relax the musculature. In vascular parkinsonism, the most important is neuroprotective and vascular therapy: Cerebrolysin, Cerepro, Piracetam, Vinpocetine, Gliatilin. The choice of a particular substance depends on the patient's condition and the prevailing symptoms.

If the syndrome is caused by hypoxia, dopamine receptor agonists( Piribedil, Bromocriptine) are recommended. In this case, they are more effective than levodopa drugs, since they not only normalize the metabolism of dopamine, but also have a neuroprotective effect.

Important! It should be remembered that all medicines for Parkinsonism cause serious side effects, so their appointment must necessarily be agreed with the doctor.

Surgical treatment of

In case of ineffectiveness of drug treatment and severe, disabling disease, neurosurgical intervention becomes the output - stereotactic destruction of the pallid sphere or the posterior nucleus of the thalamus. It reduces tremors and improves the quality of life.