Parkinson disease (PD) is a chronic progressing degenerative disease of the central nervous system clinically manifested in the volitional movements disorder. This chronic, slowly progressing disease of the central nervous system, was first described in 1817 by the English doctor James Parkinson. The name which has been known to everyone for 50 years now was offered later by the great French neurologist Charkot. Parkinsonism arises when for any reasons a small part of the brain (so-called «black substance») ceases to function normally and there occurs a deficiency of the substance which is vital for normal brain activity – dopamine, which plays a role of neurotransmitter participating in muscular activity. This discovery was the first successful moment in the treatment of PD and became a starting point in the further research.
The causes of the disease:
- Ageing - one of causal factors of parkinsonism can be age-related decrease in the quantity of brain neurons. A person loses about 8 % of neurons withineach 10 years of life. Compensatory possibilities of the brain are so great that the parkinsonism symptoms appear only when 80 % of neural mass are lost.
- Genetic background - 15-20 % of persons ill with this disease have close relatives with parkinsonism symptoms (such as tremor). Nowadays scientists have revealed several genes responsible for the occurrence ofparkinsonism at young age. Genetic mutation, as it is assumed, can be caused by the influence of some toxins in the environment.
- Some toxins and substances - there have been revealed the cases when various chemical substances started pathological process in the brain neurons and caused the displays of heavy parkinsonism. Parkinson disease has been found in young drug addicts taking synthetic heroin.
Other reasons of PD include:
- virus infections leading to post-encephalitic parkinsonism;
- atherosclerosis of brain vessels;
- Heavy and repeated craniocerebralinjuries;
- Long-term intake of certain preparations which blockdopamine release and transfer (for example neuroleptics) may lead to the occurrence of parkinsonism symptoms as well;
- certain diseases of brain (hypostases, tumors).
Those whom the destiny gave such a gift as long life, have a higher chance of falling ill with Parkinson disease - which acts selectively, without hurrying, and visits approximately every 100th elderly person. Among them there are many people who have reached the tops of power and honors. Among the victims of this disease, suffering from it in the twilight of their lives, were Salvador Dali, Mao Tze-Tung, Yasser Arafat, Pope John Paul II. The dopaminergic neurons disorder leads to the disbalance of inhibitory (dopamine) and excitatory (acetylcholine) neurotransmitters, which is clinically manifested in PD symptoms.
The symptoms of Parkinson disease include the following:
- hypokinesia - manifested in the movements getting slower and less numerous;
- crooked pose - reflects the rigidity in the flexor muscles of the body which is manifested in thedeclining postureduring walking;
- slow walking–a person ill with PD walks in small shuffling short steps which sometimes compel him/her to quicken the pace to preserve the vertical position and sometimes even to run (so-called "propulsion");
- acheirokinesis- reduction of the hands swinging during walking;
- Difficulties with balance preservation (postural instability). Postural reflexes participate in the regulation of standing and walking and are involuntary. The disorder of these reflexes explains frequent falls of people who have parkinsonism;
- episodes of “freezing” - confusion at the beginning of walking or before overcoming of an obstacle (for example, a doorway). It can also be manifested in writing and speaking;
- "cogwheel" type rigidity - it is clinically manifested in the increase of muscular tone. In the process of the patient’s passive movements examination a characteristic resistance in the extremities muscles can be felt, which has received the name of "cogwheel phenomenon". The enhanced tonus of skeletal muscles causes a typical round-shouldered pose of patients with PD (so-called “pleader” pose);
- resting tremor - emerges because of rhythmic contractions of muscles-antagonists with the frequency of 5 fluctuations per minute. Trembling is most of all noticeable in the hands, it reminds of "pills rolling" or "coins counting" and becomes less expressed or disappears at when directed movements are performed;
- micrography – coordination disorder arising in the wrist and causing small indistinct handwriting;
- rare blinking - arises owing to hypokinesia in the eyelid muscles. The patient’s look is perceived as "non-blinking";
- hypomimia (masklike face);
- monotonous speech–the loss of coordination in the muscles participating in the articulation, leads to the patient’s speech becoming monotonous, losing emphases and intonations (dysporosody);
- monotonous speech–the loss of coordination in the muscles participating in the articulation, leads to the patient’s speech becoming monotonous, losing emphases and intonations (dysporosody); swallowing disorders - for those who suffer from PD hypersalivation is not typical, but difficulties with swallowing prevent the patients from clearing the oral cavity from the normally produced saliva;
- bladder function disorder - decrease of the bladder contractions’ strength and frequentvesicaltenesmus (so-called "neurogenetic bladder");
- vegetative disorders - include frequent constipations caused by languid bowel contractility, increased skin greasiness (oily seborrhea), sometimes orthostatic hypotonia;
- depression - approximately a half of the patients with Parkinson disease (according to different data, from 30 up to 90 % of cases) have depression manifestations.
Beside the listed symptoms, many patients complain about difficulties with rising from the bed and turning in the bed during the night sleep, which essentially aggravates not only the night sleep quality but also, as a consequence, the quality of daytime wakefulness.
The disease state.
As a rule, PD is progressing slowly, so at the early stages sometimes it is not possible to diagnose the disease during several years. To characterize the PD stages a number of scales are used, includingHoehn and Yahr Rating Scale and Unified Parkinson's Disease Rating Scale. Some scales test the level of daytime activity and adaptation of a sick person (Activity of Daily Living Scale).
Parkinson disease diagnostics.
At the early stages of PD development even experiencedneuropathologists have difficulties with diagnosing this pathology. So far there are no laboratory tests which would help to diagnose PD. A doctor has to observe the patient during a certain time period in order to determine that the tremor is constant and connected with other classical symptoms of the disease to be able to exclude other diseases which can cause similar symptoms. For example, the doctor mayprescribe МRТ to check if there are no signs of brain tumor stroke. Since other forms ofparkinsonism can have similar traits, but demand different treatment, it is very important that PD is diagnosed a.s.a.p. and the corresponding treatment is prescribed.
Treatment can be aimed either at increasing of dopamine level in the brain, or at decreasing of acetylcholine level to restore the balance of neurotransmitters. Parkinson disease demands continuous treatment. Timely and correctly chosen treatment, as a rule, keeps up the patient’s professional and everyday activity for many years to come. Medicinal therapy combined with diet, special physical exercises, massage, psychotherapy and physiotherapy not only prolong the patient’s life, but also considerably enhance its quality. Help and psychological support of the patient by his/her family has a big importance as well. It is possible to control the symptoms and to facilitate the disease condition by means of medical preparations. Levodopa is the best medication with the help of which the symptoms of PD can be controlled. However long-term treatment with the help of this preparation or intake of the preparation in big doses may lead to various disorders. For this reason many doctors prescribe other medical preparations to people who suffer from PD at the early stage of the disease. This makes it possible to gain time and to postpone the treatment with Levodopa preparation, the need for which can emerge in due course in connection with the disease progressing.
In some cases a treatment called deep brain stimulation is prescribed. This treatment is made in the following way: a surgeon makes an operation on placing of electrodes in the patient’s brain. The electrodes transmit small electric signals to certain brain areas which control movements. Weak electric signals improve the work of these brain areas. After the stimulator is implanted in the patients’ brain, they get back the state of health which they had before the disease.
How to live with Parkinson disease?
- The main thing is not to self-medicate, but to strictly follow all prescriptions of the doctor, to try to adhere to the recommended diet and to make physical exercises.
- Learn to accept certain dependence on the surrounding people with dignity and to constrain your emotions in the case of strangers’ tactless behavior.
- Make use of the experience of other people who have the same difficulties as you, but who have already learned how to overcome them, communicate with them - since a sick person can feel better if he/she will know that he/she is not alone.
- Try to maintain physical and social activity to a possible extent.
- Think of how you could change your life. You might discover unrealized abilities and talents in yourself.
- It is not only the patients themselves who suffer from Parkinson disease-but also their close people, so let them render you the necessary help, support and help you make important decisions.
Diseases do not choose whom to affect. And if the doctor has diagnosed Parkinson disease, you should not run into despair. Yes, this disease is chronic. Yes, it demands continuous treatment. Yes, it limits your motion activity both at work and at home. But thus it is important to understand that modern methods of treatment can provide you with worthy and high quality compensation and enable you to maintain your ability to work for a long time. What needs to be made is timely diagnosis and qualified treatment.