Parkinson's disease Signs and symptoms Treatment

Parkinson

    * Introduction
    * Signs and symptoms
    * Causes and Risk Factors
    * Diagnosis
    * Treatment
Parkinson's disease is a degenerative disease that occurs after the slow and progressive destruction of neurons. Since the affected area plays an important role in controlling movements, gestures patients have rigid, jerky, uncontrollable, tremor and postural instability.
Disorders related to Parkinson's disease occurs most often between 50 and 70 years, mean age of occurrence of the disease is 57 years. At first, symptoms can be confused with the normal aging process, but progressing their diagnosis becomes obvious. When the manifestation of symptoms, it is believed that between 60% and 80% of cells in the motor control activities are already destroyed.
Parkinson's disease is a progressive evolution, and the signs and symptoms accumulate over time. Although this disease is potentially debilitating, it moves slowly so that most patients benefit from many years of active life after diagnosis. Moreover, unlike other serious neurological disorders, Parkinson's disease is treatable. Treatment is medical and surgical implantation but may also consist of a device for brain stimulation. On a global scale, the disease is diagnosed in 300,000 people each year. The incidence and prevalence of disease increases with age. Parkinson disease affects 1% of persons> 65 years. Rarely, the disease occurs in childhood or adolescence. The incidence is 1.5 times higher in men than in women.

Treatment
Although there is no cure for Parkinson's disease, its symptoms can be alleviated with drugs, but also by lifestyle changes. In general, symptoms can be controlled if treatment is successfully adapted to the disease.
Despite depression and anxiety caused by Parkinson's disease, we recommend maintaining an active lifestyle.
The objective of treatment is to control the signs and symptoms over a long period of time possible, and reducing adverse effects. Drugs offer a good symptomatic control for 4-6 years. After this time, disability progresses despite treatment, and many patients develop long-term motor complications. Other causes of disability in late stages of Parkinson's disease are postural instability (balance disorder) and dementia.
Neuroprotective treatment (possibly)
Neuroprotective therapies are those that slow the loss of dopamine neurons. Currently, there is no proven neuroprotective therapy for Parkinson's disease role.
Selegiline is a medicine considered as possible neuroprotective agents, although beneficial effects have not been fully demonstrated. Selegiline may be prescribed right from the onset. It diminishes natural degradation of dopamine and dopamine formed with levodopa. In addition, it seems that selegiline prevents the formation of free radicals and toxins, thereby protecting healthy cells.

Symptomatic
Appropriate time to initiate medication depends on many factors (age, lifestyle, severity of symptoms, etc..) Prescription medications designed to reduce symptoms but do not stop evolution. We recommend reporting any new symptoms that occur during treatment to make the necessary adjustments. The combination of levodopa and a dopa decarboxylase inhibitor (carbidopa or benserazide) is standard for the symptomatic treatment of Parkinson's disease, with fewer side effects short term.
Levodopa or L-dopa is a precursor of dopamine. Levodopa is often associated with carbidopa or benserazide in order to obtain optimal effects or to minimize side effects (nausea, vomiting, dizziness). Since its effectiveness decreases over time - the drug becomes ineffective in 5 -6 years - doctors generally expected that the symptoms of Parkinson's disease to be marked before prescribing levodopa.
Dopamine agonists - bromocriptine, pergolide, pramipexole and ropinirole - can be prescribed immediately after diagnosis, or in combination with levodopa in advanced stage of disease. Comparable effects of dopamine agonists with levodopa + carbidopa / benzerazida in the early stages of the disease but are not sufficiently effective in controlling signs and symptoms in advanced stages.

 
Levodopa and dopamine agonists may cause drowsiness and decreased vigilentii so making driving ability may be impaired.
Anticholinergic drugs - benzotropina, trihexifenidil - help to reduce tremor in some people, restoring the balance between dopamine and acetylcholine in the brain.

Amantadine - has beneficial effects for patients with Parkinson's. Because amantadine allows only a slight reduction in symptoms, it is used in patients in early stages of the disease. The mechanism of action in the brain is not yet known.
Antidepressants are prescribed to some patients with Parkinson's disease. Several factors can cause depression in patients suffering from a chronic degenerative disease: the daily tasks that become progressively more difficult, the physiological changes that occur in the brain during disease and side effects of some drugs.

Surgery
For patients who find themselves in an advanced stage of disease, the symptoms not responding to usual medication, recourse to surgery, depending on the person's overall health and quality of life. One method that can be used is talamotomia - consists in the destruction of part of the thalamus to reduce parkinsonian tremor. Talamotomia not act on bradikineziei, rigidity, motor fluctuations and dyskinesia. Over 90% of patients who perform this procedure shows a significant improvement in limb tremor on the opposite side of the lesion. Complications of bilateral talamotomii are common, over 25% of patients have disorders of speech, for which bilateral talamotomiile are avoided. Palidotomia surgical damage consists of a part called the globus pallidus and formation resulting in significant improvement of the three radical signs of Parkinson's disease (tremor, rigidity, bradykinesia) and a reduction of dyskinesia. Bilateral Palidotomia is not recommended, because it shows the common complications, including difficulty in speech, dysphagia and cognitive impairment. These techniques have been replaced lesion deep brain stimulation - which consists of implanting electrodes in certain brain structures (subthalamic nucleus, globus pallidus, thalamus). The electrodes are connected to a pacemaker implanted in the subclavian region by means of bond wires. The device stimulates specific regions of the brain and can be adapted depending on the disease to control symptoms and eliminate adverse effects. The patient can control the pacemaker with an external device. Implantation of a pacemaker requires medical visits to adjust the parameters according to changes in symptoms during the disease. Talamica Driving - consists of implanting a stimulator in the thalamus. Talamica stimulation reduces tremor in approximately 90% of patients but no other symptoms of Parkinson's disease such as rigidity, bradykinesia, dyskinesia and motor fluctuations. Candidates for stimulating talamica are patients with drug-resistant tremor and bradykinesia and rigidity requirements. Pale Driving - consists of a pacemaker implantation in globus pallidus and controlling faction called all cardinal symptoms of Parkinson's disease (tremor, rigidity, bradykinesia) and dyskinesia. Candidates are pale to stimulate patients with disabling motor fluctuations, resistant to medication and / or levodopa-induced dyskinesia. Subthalamic stimulation - is currently the most common surgical intervention in Parkinson's disease and consists of implanting a stimulator in the subthalamic nucleus. Subthalamic stimulation controls all cardinal symptoms of Parkinson's disease and motor fluctuations and dyskinesia.
Physical therapy and Ortofon
Physical therapy is an important therapeutic adjunct and consists of: daily physical exercises and gymnastics, physiotherapy, postural balance recovery, etc.. Ortofon disartriei allows treatment (speech disorder), due to difficult joints.