Parkinson's disease overview

Posted by Doctor CKII Pham Thi Son - Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital

1. What is Parkinson's disease? Parkinson's disease affects more than 1% of people over the age of 50. The incidence is similar between men and women. All races have the same incidence of the disease. Parkinson's disease is an incurable, progressive disease. However, with the right treatment, the patient can have a comfortable time, the symptoms improve and the patient can work, take care of himself etc. for a long time (about 10 years).
The main feature of Parkinson's disease is damage to the dopamine system of the striatum-black crescent in the brain. Dopamine is a chemical mediator between nerve cells.
When dopamine is reduced, it leads to Parkinson's disease symptoms. The main treatment is to make up for the lack of dopamine. Therefore, the patient's treatment is continuous, lifelong. Parkinson's disease is divided into two groups: Parkinson's disease and Parkinson's syndrome. Parkinson's disease usually responds well to treatment and is thought to be caused by degenerative black sickle cell disease. And Parkinson's syndrome responds slowly to treatment and often occurs after diseases that cause brain damage such as: multiple system atrophy, progressive supranuclear palsy, drug use, stroke, essential tremor. ..

2. Symptoms of Parkinson's Disease The early stages of clinical symptoms are often subtle. The patient is tired, feels stiff in the back, neck, shoulders, groin. The spine and limbs tend to be flexed, less flexible, and movements are slowed down. When walking, the arm swings little or no to the rhythm of the step. Gradually, the walk shortens. Blinking frequency is also reduced. The eyelid slit seems to widen, creating the feeling that the patient is always looking "attention". If you knock on the base of the nose, the patient loses the ability to inhibit blinking, causing eyelid twitching.
When the disease manifests itself, the patient has the following symptoms:
Tremor at rest : Occurs when the attacks are at rest. This sign disappears when exercising, when sleeping. Tremor increases when emotional, focused. The tremor of Parkinson's disease is characteristically regular, four cycles per second. Trembling often occurs in the fingers, causing movements such as "rolling pipe tobacco or counting money". Tremor can be experienced in the lower extremities, mouth, or head area.

Hypoactivity: Is the basic symptom and appears early in Parkinson's patients. The movements are slow to start. Slow movement speed (bradykinesia) and reduced range of movements (hypokinesia) make movement poor. Immobility is evident in the upper extremities. Dyskinesia can be seen in the following types of movements: gait, facial expressions, and speech.
Increased muscle tone: Extrapyramidal causes the phenomenon of "lead-tubular stiffness or wax bending". During passive movement, signs of stiffness are often accompanied by signs of "cog wheels": when doing stretching movements, the doctor feels that the stretching phenomenon occurs step by step, not continuously.
In addition, at the late stage, the patient also experiences symptoms: sleep disturbance, autonomic nervous disorder, urination disorder, mental disorder such as delusions, hallucinations, depression, etc. The disease usually manifests on one side at first, after about 3 years, symptoms will appear to the opposite side.

Staging of Parkinson's disease according to Hoehn and Yahr scale
Stage 0: No symptoms Stage 1: Manifesting unilateral lesions Stage 1.5: Manifestations of unilateral lesions, with axial deviation Stage 2: Lesions both sides, but no balance disorder Stage 2.5: bilateral injury, mild degree, can still regain balance on the push maneuver Stage 3: Bilateral injury, mild to moderate, some disturbances in posture, normal activities Stage 4: Severely disabled, but still able to walk or stand without assistance Stage 5: Must use a wheelchair or bedridden without help

4. Treatment of Parkinson's disease 4.1 Drug treatment Parkinson's disease drug classes are circulating
L-dopa preparations are drugs that directly replace dopamine deficiency: madopar, modopa, sinemet Dopamine agonists: ronipiron (requip), peribidil (trivastal), pramipexole (sifrol), apomorphine (apokinon), bromocriptin (parlodel) Inhibitors of dopamine catabolism: MAO-B inhibitors (séligiline, rasagiline), inhibitors COMT (entacapone, tolcapone) Anticholinergics (Artane, trihex) 4.2 Surgical treatment Localization surgery: Methods to destroy the pallidus or VOA nucleus or sip VIM of the thalamus are increasingly giving positive results.
Black sickle-striatal electrical stimulation: Electrodes are implanted in the VIM nucleus and the stimulation pulse is controlled by a pacemaker.
Nerve tissue transplantation: This method is not yet widely applied. Several cases of progressive supranuclear palsy and multisystem atrophy syndrome were used with this approach but failed.
4.3 Rehabilitation Besides drug treatment, rehabilitation plays an important role in helping patients improve their quality of life. Rehabilitation measures should be carried out in parallel with drug treatment to overcome the disability caused by the disease.

5. Caring for Parkinson's Patients First of all, we need to understand that Parkinson's is a lifelong disease that progresses slowly and progressively. Therefore, the treatment strategy is not that we use drugs to achieve comfort and perfection right away for the patient. The dose of treatment needs to be explored by the doctor slowly, depending on each patient so that 2 goals are achieved. is: The dose is the lowest that the patient can still work and do personal activities. For example: The patient can walk alone, exchange and talk with others, but it is not necessary for the patient to go very fast, the operation must be flexible, eat quickly, speak quickly... Understand This will help us make a long-term, sustainable treatment plan for the patient. Avoiding too much expectation on the treatment methods that lead to the patient, when not achieving perfection, will become depressed, depressed, quit smoking.

Families can recognize signs of aggravation of the disease such as: facial expressions become less flexible, stiffer, more shaky, walking more slowly or appear more psychotic symptoms, sleep disturbances, urinary disorders.... When there are signs of seriousness in the family, the patient should be re-examined so that the doctor can adjust the medicine.
Families should keep their prescriptions carefully, and always bring them with them to the doctor's visit so that the doctor knows exactly what dose the patient is taking.
Encourage the patient to exercise regularly, so choose slow, flexible exercises.
Preventing falls for sick people such as: The floor is not uneven, there are not many steps up and down, anti-slip tiles, do not let water drop on the floor, especially when entering the bathroom, the floor is wet, or there is soap. patient facilitator. Parkinson's disease does not kill the patient. But if left to the patient: aspiration leads to suffocation and pneumonia, or falls and fractures or hits the head. But that can be life-threatening.

Prevention of constipation: When taking parkinson drug, patients often suffer from constipation, dry mouth, so patients should drink enough water, eat a lot of fiber, rub the abdomen daily and go to the toilet at a certain time to create a habit familiar. Always close and talk to the patient, encourage the patient to read books to avoid depression and rapid memory decline. bananas (if the underlying disease is not contraindicated). Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit. and hospital treatment.