parkinsonism

Parkinsonism - a syndrome associated with damage to the basal ganglia and their connections and manifested akinesia, rigidity, resting tremors, unstable posture change when (postural instability). In 80% of cases the cause of parkinsonism is Parkinson's disease.

Parkinson's disease (shaking palsy , primary, or idiopathic Parkinson's disease) - a degenerative disease of the central nervous system of unknown etiology that selectively affects dopaminergic neurons of the substantia nigra. Symptoms begin gradually, often with shaking or clumsiness in one of the limbs, sometimes with difficulty or general stiffness of gait. In the debut of the patients often complain of pain in the limbs or back, muscle cramps . Gradually, the symptoms are bilateral, grow slow motion, increased muscle tone (rigidity), often with a phenomenon of "gear". As a result of weakening of the face becomes masklike facial expression. The jitter observed in 75% of patients, it is usually more pronounced in the rest and like a "pill rolling." The gait becomes shuffling or mincing, hands do not participate in the walking (aheyrokinez). To move, patients often have to make a few small steps. In the later stages of postural reflexes are lost, ensuring the maintenance of equilibrium, so that there are staggering when walking, falling , or propulsion retropulsion (off-balance push forward or backward patient suddenly accelerated, trying to "catch up" with the center of gravity of his body). Often there are autonomic disorders (increased greasiness of the skin, hypersalivation, constipation , orthostatic hypotension, impotence). A significant proportion of patients develop depression, which is sometimes the first manifestation of the disease, preceding motor disorders. In 20% of patients develop dementia . At the beginning of the disease, some patients lose weight, then it is usually stabilized at a lower level. The disease progresses steadily, but at different rates. Death usually occurs from pneumonia. Currently, however, the average life expectancy of patients corresponds to the total for the population.

Parkinson's disease is differentiated from vascular, drug parkinsonism associated with taking neuroleptics, metoclopramide (Cerucalum) pipolfen, methyldopa, reserpine, calcium antagonists (cinnarizine, flunarizine, diltiazem), amiodarone, indomethacin, cyclosporin, sodium valproate, lithium drugs, tricyclic antidepressants. After discontinuation of therapy in most patients the symptoms disappear within 4-8 weeks, but sometimes recovery takes several months or even years. Anticholinergic agents (tsiklodol, akineton) reduce symptoms.

Parkinson's Disease Treatment involves constant reception of medicines, especially levodopa (L-DOPA), which contain a combination of levodopa with a peripheral decarboxylase inhibitor (carbidopa or benserazide), which prevents its metabolism in peripheral tissue, which can significantly reduce the dose of levodopa and reduce the likelihood of side action. The majority of patients with Parkinson's disease levodopa causes a dramatic improvement, but this effect is purely "cosmetic" because the drug does not prevent further progression of the disease, and a few (an average of 3 - 5) years after the start of treatment in most patients the drug's effectiveness is inevitably reduced , there are fluctuations in motor activity and excessive motor activity (dyskinesia). In younger patients (under 60 years) term of the appointment of levodopa are trying to delay appointing selegiline, dopamine agonists, amantadine, anticholinergics, or a combination thereof.

With the sudden discontinuation of anti-money reduce their dose or malabsorption (due to gastrointestinal disease) may develop akinetic crisis, eye-patient to the bed. This is a medical emergency that requires first of all the maintenance of vital functions, fluid and electrolyte balance, adequate nutrition, prevention of deep vein thrombosis calf pneumonia, bedsores. If the crisis - the result of the abolition of levodopa, it is necessary to re-appoint the drug, but at a slightly lower dose and then raise it to the former within 1-2 days.

In addition to drug therapy, showing massages, physiotherapy, patients should be continually encouraged to feasible for their activities, bearing in mind that the "bed - parkinsonika enemy." Important normalization motility of the gastrointestinal tract (constipation, delayed gastric emptying) using foods rich in dietary fibers, special exercises laxative intake. When sleep disorders shown antidepressants with sedative effects - such as amitriptyline, 10 - 25 mg at night. In the later stages of psychosis can develop under the influence of anti-virtually any means. With the development of psychosis or confusion should first decompensation exclude somatic illness, infection or dehydration (urogenital system, the lung, etc.). If the correction of violations did not lead to success, it is necessary to reduce the dose of anti-funds or, if possible, gradually cancel some of them, and / or assign antipsychotics, choosing the ones that are less likely to cause extrapyramidal side effects: sulpiride (eglonil), thioridazine (sonapaks), clozapine (leponeks).