Parkinson's disease: diagnosis and principles of therapy

Parkinson's disease is a severe degenerative disease. It is diagnosed in 60–140 people out of 100 thousand patients. Mostly elderly people are affected. The onset of the disease is diagnosed at the age of 55–58 years. Refers to incurable pathologies. Men are more often affected. The juvenile form also occurs in twenty-year-old patients.

The pathology is chronic, accompanied by motor disorders. But drugs have been developed that can slow the progression of Parkinson’s disease, relieve symptoms, and improve the patient’s quality of life and care.

The symptoms of Parkinson's disease have been known for more than a millennium, but J. Parkinson described and systematized them at the beginning of the 19th century. Pathology was named after him. The biochemistry of destructive processes in the extrapyramidal system began to be studied in detail in the 50s. last century.

Treatment of Parkinson's disease was carried out using belladonna alkaloids, surgical therapy was developed - destruction of the basal ganglia was carried out. Currently, the gold standard of treatment is the use of Levodopa.

Definition of disease, cause of disease

Parkinson's disease is a chronic neurodegenerative disease of the extrapyramidal motor system. Develops slowly. The main cause of the pathology is the destruction of neurons that produce dopamine in the substantia nigra and other parts of the brain.

The causes of Parkinson's disease have not been determined. Factors contributing to the development of the pathological process:

1. Aging is accompanied by a decrease in the number of neurons and an increase in Lewy bodies.
2. Heredity - 15% of patients have a family history of Parkinson's disease. But the gene responsible for its development has not been identified.
3. Intoxication, living in disadvantaged areas - the influence of pesticides, herbicides, insecticides, FOS, heavy metal salts has been proven.
4. The use of medications that have extrapyramidal disorders as a side effect.

Smoking is not a provoking factor. Parkinson's disease is diagnosed less often in patients with bad habits than in non-smokers. This is associated with the dopamine-stimulating effect of nicotine.

Types of medications for drug therapy for parkinsonism

The main treatment for the disease is tablets. Several types of medicines are used. Symptomatic therapy is:

1. Dopaminergic drugs;
2. Central anticholinergic blockers.

Two classes of substances can reduce the symptoms of the disease. This therapy is taken by the patient throughout his life.

Doctors recommend neuroprotective drugs. They may help restore the function of lost neurons and slow down the degeneration of remaining cells. Unfortunately, this group of drugs does not have serious evidence.

Elderly people need supportive care. These are vitamins, protein supplements, microelements (iron, magnesium, selenium).

Symptomatic therapy

This includes drugs that affect dopamine metabolism. The neurotransmitter is known to be depleted in Parkinson's disease. The following groups of products help restore its production and function:

1. Levadopa (increases the amount of dopamine in cells, is a precursor of this substance);
2. MAO-B inhibitors (inhibit the enzyme that destroys dopamine);
3. Dopamine receptor agonists (improves cell response to dopamine);
4. Amantadines (remove DOPA from its storage sites).

Neuroprotective therapy

This type of treatment improves the conduction of impulses along the nerve ending and slows down the degeneration of fibers. Medicines in this group help neurons recover.

The following drugs are used:

• Emoxipin;
• Actovegin;
• Pirocetam;
• Cerebrolysin;
• Thioctic acid.

Maintenance therapy

This is a group of medications that allow the patient to live comfortably. These include pills to improve sleep, treat urinary problems, and relieve pain and inflammation. As well as vitamins, minerals, and of course dietary supplements.

Symptoms of Parkinson's disease

There are true Parkinson's disease and parkinsonism syndrome - a complex of symptoms that develop after head injuries and severe intoxication.

Characteristic signs of the disease:

1. Tremors in the arms and legs - in Parkinson's disease, they occur at rest. Frequency of up to 6 involuntary movements per second. Occurs at an early stage of the disease. Starts with one arm, then spreads to the other side of the body. A “yes-no” symptom may be observed. During sleep and at rest, the tremor stops, but intensifies during emotional shocks.
2. Hypokinesia – decrease in motor activity. This symptom manifests itself as a change in handwriting, speech, and the disappearance of characteristic facial expressions.
3. Muscle rigidity – increased muscle tone. The limb freezes in a bent or straightened state. A typical symptom is the “supplicant pose.”
4. Postural instability - this symptom occurs in the later stages of the pathological process. Patients have difficulty starting and finishing movement. The body may begin to move faster than the legs. In this case, the center of gravity shifts and the patient falls.

In addition to the main diagnostic signs, Parkinson's disease is accompanied by autonomic and mental symptoms. They are individual. Both obesity and exhaustion, sweating, drooling, psychosis, and hallucinations are observed.

New drugs

Azilect was one of the last drugs to enter the pharmacological market. It is available in tablet form. The active ingredient is an MAO-B type blocker. It can be used in monotherapy for Parkinson's disease. It is also necessary to relieve the side effects of Levadopa.

Azilect should not be used in severe liver failure. It is worth considering its interaction with cytochrome CYP1A2. The medicine should not be used during pregnancy or breastfeeding.

A new drug is being tested in Tomsk. Diol has been announced as a new treatment for Parkinson's. It was developed by Russian scientists. To date, testing of Diol has not been completed. Perhaps this drug for Parkinson's disease will soon enter the market and be included in the list of preferential drugs.

For the second and third stages of the disease, the neurostimulation method is used. This new development has been used for the last 10 years. And the results of the method are impressive. The patient undergoes a functional MRI. The areas of the brain where the electrodes will be installed are determined. Then, using a stereotaxic device, the conductors are immersed in the brain. A mini-computer is installed in the subclavian region.

Stem cells and genetic engineering methods are under development. Clinical trials are conducted only on animal models. Testing on humans is a limited trial. For large-scale experiments it is necessary to make adjustments to the legislation.

Pathogenesis

The target organ for Parkinson's disease is the brain, the structures of the extrapyramidal system. With the development of the pathological process, the death of nerve cells in the substantia nigra occurs. Overt symptoms occur when 60% of neurons are lost.

In parallel, an increase in Lewy bodies is detected. The latter are also formed during natural aging, but in Parkinson's disease their number is several times higher.

The death of glial cells and an increase in phages are observed. Although Lewy bodies are not considered a characteristic symptom of the disease, as the disease progresses they are found in all structures of the brain. In later stages - and in the cerebral cortex.

The components of the extrapyramidal system are responsible for the automation of movements - walking, running, emotional reactions. Normally, this part of the brain sends impulses to peripheral motor nerve cells and ensures that the muscles are ready for movement. The ability to take the intended posture depends on the coordinated work of the extrapyramidal system.

The identification of dopamine helped explain the functions of this part of the brain and explain the symptoms of Parkinson's disease. A characteristic sign of the disease is a sharp decrease in neurotransmitter in all parts of the brain. Symptoms of Parkinson's disease depend on which part of the extrapyramidal system is affected.

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Parkinson's disease

is a progressive neurodegenerative disease associated with the loss of dopaminergic nigrostriatal neurons. Parkinson's disease belongs to a group of diseases called movement disorders and is characterized by muscle rigidity, tremors, slowness of movements (bradykinesia) and, ultimately, the absence of muscle movements (akinesia).

Primary symptoms result from excessive stimulation of the motor cortex by the basal ganglia, resulting from insufficient dopamine synthesis by dopaminergic neurons in the substantia nigra. Secondary symptoms may include cognitive and speech impairment. The disease is chronic and progressive.

Pathophysiology

The main finding in pathological examination in Parkinson's disease is the loss of pigmented dopaminergic neurons and the presence of Lewy bodies in the substantia nigra. A decrease in the number of dopaminergic neurons is observed mainly in the ventrolateral part of the substantia nigra. By the time clinical symptoms of the disease appear, the number of dopaminergic neurons decreases by 60-80%. Lewy bodies found in Parkinson's disease are a characteristic feature of idiopathic Parkinson's disease. Parkinson's disease accounts for 75–80% of parkinsonism cases.

Lewy bodies with neurons of the substantia nigra

According to global data, the incidence of the disease is 4.5 - 21 cases per 100,000 per year. In Russia, according to various sources, there are from 117,000 to 338,000 patients with Parkinson's disease. Parkinson's disease is one of the most common diseases of older people (after 65 years, its prevalence reaches 1%, and in the population over 85 years of age, 2.6%). The prevalence of Parkinson's disease in the general population is about 140 cases per 100,000 population. The average age of onset of Parkinson's disease is 55 years. At the same time, in 10% of patients the disease debuts at a young age, before 40 years of age (early-onset parkinsonism) or before 20 years of age (juvenile parkinsonism). The male to female ratio in Parkinson's disease is approximately 3:2. Parkinson's disease is sporadic, but approximately 5% of cases have a positive family history.

Clinical symptoms of the disease

Initially, the symptoms of the disease may be subtle. The onset of Parkinson's disease manifests itself gradually, the neurological manifestations are asymmetrical, usually starting with tremors (tremors) or awkwardness in one arm (about 20% of cases) or leg, less often difficulty in gait or general stiffness. The tremor usually occurs in one limb. There may be fluctuations in the degree of its severity. The amplitude of the tremor increases after stress and decreases after sleep. The patient may notice limited mobility when moving the affected arm, and a foot hitting the floor. After some time, the posture becomes more and more stooped and a shortening of the step length is observed.

Classic image of a patient with Parkinson's disease

At first, patients often complain of pain in the limbs or back, muscle cramps. Some patients experience soreness or a feeling of tightness or pressure in the shoulder or calf area. The initial symptoms of Parkinson's disease can be nonspecific and include fatigue, depression, and sleep disturbances. Autonomic disorders are also characteristic: constipation, orthostatic hypotension, impotence, urination disorders, sweating disorders, seborrheic dermatitis.

When the disease has developed, the main symptoms are:

1. Hypokinesia (slowness, difficulty initiating voluntary movements). Hypokinesia is characterized by slowness of movements (bradykinesia), difficulty initiating movements, inability to generate muscle force of adequate strength and pace (hypometry), for example, when changing body position, a rapid decrease in amplitude and speed during repeated movements (oligokinesia), for example, when squeezing and unclenching brushes Hypokinesia is manifested by the following symptoms:

• Hypomimia (poor reaction of facial expressions).
• Rare flashing.
• Hypophonia (quiet speech).
• Micrography (small handwriting).
• Brachybasia (shortened step length).
• Acheirokinesis (decreased swinging of arms when walking).
• Difficulty getting up from a chair, turning to the sides, or walking.

2. Rigidity (increased muscle tone). Muscle rigidity is an increase in muscle tone, manifested by increased resistance to passive movements. The increased resistance may be monotonous (wax doll phenomenon) or intermittent (cogwheel phenomenon).

3. Rest tremor with a frequency of 4 – 6 Hz (tremor that occurs in resting limbs, head). There are several types of tremor possible. Classic parkinsonian resting tremor with a frequency of 3-6 Hz, in the hand looks like “rolling pills” or “counting coins”. Tremor occurs in a resting limb, decreases with movement in it, but intensifies at rest, with active movements in other limbs, when walking and when attention is distracted. Parkinsonian tremor is often asymmetrical or unilateral (over time becoming bilateral). Most often, resting tremor occurs in the arms, sometimes the legs are involved (usually in the distal parts of the arm or leg), chin, lips, and very rarely the head. Tremor is observed in 80–85% of cases. Postural tremor occurs when maintaining a posture (tremor of arms extended forward or to the sides). Postural tremor is often combined with resting tremor and, as a rule, it is of the same frequency and localization. A differential diagnostic sign that distinguishes postural tremor in parkinsonism from essential tremor is that it does not appear immediately after stretching the arms forward, but after a few seconds. In a number of patients with parkinsonism, high-frequency (6-12 Hz) postural-kinetic tremor is detected, reminiscent of essential tremor, which sometimes appears several months or years before the development of the main manifestations of parkinsonism.

4. Postural instability (instability when changing body position or walking). Postural reflexes ensure the maintenance of balance and vertical position of the body. Their weakening or loss is manifested in an impairment of the ability to maintain balance when changing body position or when walking, which, in combination with hypokinesia and rigidity, leads to impaired walking and falls. When the patient initiates walking or tries to change the direction of his movement, it seems that he is marking time, leaning more and more forward. At the same time, he tries to catch up with the center of gravity of the body with small mincing steps (propulsion), which often ends in a fall.

Classification of Parkinson's disease.

The classification of stages of Parkinson's disease proposed by Hoehn and Yarh (1967) is generally accepted: Stage 1.0 - only unilateral manifestations. Stage 1.5 - unilateral manifestations involving the axial muscles. Stage 2.0 - bilateral manifestations without signs of imbalance. Stage 2.5 - mild bilateral manifestations. The ability to overcome induced retropulsion is preserved. Stage 3.0 - mild or moderately severe bilateral manifestations. Slight postural instability. But the patient does not need outside help. Stage 4.0 - severe immobility; however, can still walk or stand without support. Stage 5.0 - Confined to a chair or bed without assistance.

Drug treatment

Therapy for Parkinson's disease includes treatment of motor disorders (akinesia, rigidity, tremor, postural instability) and non-motor syndromes (mental, autonomic, sleep disorders, etc.). Currently, there is no pathogenetic therapy for Parkinson's disease, i.e. There is no treatment proven to slow or stop the loss of dopaminergic cells. There are two areas of treatment for movement disorders - neuroprotective and symptomatic therapy, the latter being the main one at present. Neuroprotective therapy is designed to slow the loss of dopaminergic neurons, and thereby slow down the progression of the disease. Currently, there are no neuroprotective agents with proven effectiveness. MAO-B inhibitors (selegiline (Yumex), rasagiline), dopamine receptor agonists (pramipexole (Mirapex), ropinirole) and amantadine (Midantan, PC-Merz) are considered as possible neuroprotective drugs. The main goals of treatment are to ensure maximum functional (primarily motor) preservation and quality of life of the patient. In general, therapy is aimed at correcting and alleviating motor and other non-motor symptoms, as well as minimizing side effects, primarily as a result of the use of levodopa. Levodopa is the most effective drug for the treatment of movement disorders in Parkinson's disease; it provides good control over the symptoms of the disease for 4 to 6 years. Long-term use of levodopa is complicated by side effects, the most common of which are motor fluctuations (fluctuations in motor activity) and dyskinesias (hyperkinesis), which increase the patient's maladjustment and are difficult to correct. The current paradigm for the treatment of Parkinson's disease is to initiate levodopa as late as possible through the use of less potent dopaminergic agents that do not contain levodopa. This approach is not shared by all clinicians. Treatment of motor symptoms in persons under 50-60 years of age with moderate severity of the process (stage I-II according to Hoehn and Yarh) begins with dopamine agonists (ropinirole, pramipexole, bromocriptine) or with MAO-B inhibitors (selegiline, rasagiline) or amantadines (midantan , PC-merz). In elderly patients, the drugs of choice are levodopa at all stages of the disease. When a patient is initially diagnosed with stage III (with the development of postural instability) stage of the disease according to Hoehn and Yarh, or when the disease moves to stage III and the therapy used is not effective (even with increasing dosages of drugs), levodopa is usually prescribed, seeking, if possible, a delay in its use and using the minimum effective dose of the drug. The latter is possible, in particular, through the combined use of levodopa and a dopamine agonist (MAO inhibitor, amantadines). If a patient develops side effects of levodopa, in particular a combination of the “wear-out” phenomenon (resumption or significant increase in symptoms of the disease less than 4 hours after taking the last dose of levodopa) and inclusion dyskinesia (peak dose dyskinesia), a reduction in the dose of levodopa and its combination with COMT inhibitor (or dopamine agonist, or MAO inhibitor). In patients with treatment-resistant motor fluctuations or tremor, surgical intervention—deep brain stimulation—can be performed. If rest tremor predominates in the clinical picture of the patient, anticholinergic drugs (cyclodol, akineton) can be prescribed to relatively young patients in the early stages of the disease, or to patients over 60 years of age with the tremulous form of Parkinson's disease (if levodopa is insufficiently effective). In relation to action tremor (postural and kinetic), obzidan is a more effective drug. In general, all antiparkinsonian drugs are less effective against tremor than against akinesia and rigidity, and least effective against postural instability. All of the drugs listed below do not provide a cure for Parkinson's disease, but they can alleviate its symptoms. Typically, treatment must be taken for the rest of your life to prevent symptoms from returning.

Surgical treatment of Parkinson's disease.

Destructive operations. Before the discovery of levodopa and the advent of stimulation of deep brain structures, it was used quite widely. The operation is a surgical destruction (destruction) of certain brain structures (so-called palidotomy, thalamotomy). Currently, destructive operations are a rather rare treatment method, since the consequences of the operation are irreversible. The Federal Center for Neurosurgery, created on the basis of the Federal State Budgetary Institution "Treatment and Rehabilitation Center" is the only institution in Russia that performs destructive operations for Parkinson's disease using modern equipment using a Cosman-Roberts-Wells stereotactic frame

Unilateral destructions:

• thalamotomy
• pallidotomy

Bilateral destruction increases the risk of swallowing disorders, dysarthria, and memory impairment by up to 20%, which is why they are not currently used. The indication for unilateral thalamotomy is disabling tremor, predominantly in one arm. The operation has a fairly high success rate (elimination of symptoms in 80-90% of patients), but does not affect rigidity and bradykinesia in these limbs. Complications of the operation (hemiparesis, dysarthria, memory impairment) are observed in up to 20% of patients, persistent neurological complications - in 10% of patients.

MRI of a patient after performing a right thalamotomy.

The indication for performing unilateral pallidotomies is the presence of severe drug dyskinesia while taking medications. The operation leads to a decrease in tremor, stiffness and bradykinesia in the contralateral limbs (on the side opposite to the destruction).

MRI of the patient after left pallidotomy.

The advantages of destructive operations are their low cost, the possibility of performing them for patients who do not have the opportunity to regularly visit a doctor due to a persistent effect, the absence of the need to correct the parameters of implanted equipment and eliminate the breakdown of components. The disadvantages of destructive operations are the possibility of only unilateral destruction, the impossibility of correcting bilateral disorders, irreversibility of side effects, a relatively high risk of persistent side complications (10% of patients have permanent neurological disorders in the form of dysarthria, hemiparesis, memory impairment). Neurostimulation (DBS, deep brain stimulation) A modern treatment method that is a minimally invasive neurosurgical operation. Beginning of clinical use since the 1990s (stimulation of the globus pallidus, stimulation of the subthalamic nucleus). Currently, more than 55,000 patients have been operated on in the world. Neurostimulation is a proven effective treatment for idiopathic Parkinson's disease, essential tremor and primary generalized dystonia.

This method is used in cases where:

• Despite correctly selected drug therapy, the patient cannot achieve a significant reduction in symptoms.
• progression of the disease leads to the need to increase doses of medications, and the side effects of the drugs become intolerable.
• the patient is socially active and is afraid of losing his job due to the disease.
• the patient becomes incapacitated and becomes dependent on his family to perform daily activities.

Contraindications to neurostimulation are:

• History of lack of effectiveness of L-dopa drugs
• Low intelligence, severe depression, history of suicide attempts
• Unused reserves of drug therapy
• Psychological unpreparedness of the patient for long-term surgery
• Decompensation of diabetes mellitus, severe hypertension, cardiovascular failure, coagulation disorders
• Contraindications for MRI (pacemaker)
• Poor family relationships (need for frequent consultations in the postoperative period)
• High expectations from surgery
• Age over 70

The essence of the method: the therapeutic effect is achieved by stimulating certain brain structures responsible for controlling body movements with a precisely calculated small amplitude electric current. To do this, thin electrodes are inserted into the patient's brain, which are connected to a neurostimulator implanted subcutaneously in the chest area under the collarbone. The operation itself is usually carried out in two stages. At the first stage, under local anesthesia with the help of magnetic resonance imaging and stereotactic neuronavigation, electrodes are introduced into the deep structures of the brain responsible for the control of movements - in the region of the subthalamic nucleus (STN).

Patient with a stereotactic frame fixed to the head

Test stimulation is then performed, during which the patient reports the somatosensory sensations that occur under various stimulation parameters. If the result is positive, the second stage is carried out: the patient is implanted with subcutaneous parts of the system - connectors and a pulse generator (neurostimulator). Usually the second stage is carried out under anesthesia. In the postoperative period, the neurostimulator is programmed and the patient is trained. The patient has the opportunity to adjust the stimulation settings himself (within the limits specified by the doctor) depending on his own well-being and the characteristics of the activity being performed.

Control MRI of the patient's brain after bilateral stimulation of the subthalamic nucleus.

Results of the operation: the period of effective control over the symptoms of the disease increases, the need for anti-Parkinsonian drugs is significantly reduced

Benefits of DBS:

1. Allows non-invasive adjustment of stimulation settings as the disease progresses.
2. Unlike palidotomy and thalamotomy, it is reversible.
3. Can be bilateral (that is, effective for symptoms on both sides of the body).
4. It is easily tolerated and is a relatively safe method.

Disadvantages of DBS:

1. High cost of equipment
2. Contraindications to MRI and electromagnetic therapy
3. The need for regular visits to the doctor to correct generator settings and check the possible duration of therapy
4. The need to replace the generator after 3-7 years (except for the Restore generator)
5. Possibility of technical breakdown, displacement of electrodes (up to 15%) with the need for repeated operations
6. The risk of infectious complications is up to 3-5%
7. Risk of sudden shutdown of the neurostimulator when passing through an electromagnetic field with the need to turn it on using a special patient remote control

It must be remembered that deep structure stimulation surgery DOES NOT CURE Parkinson's disease , but allows for temporary control of some symptoms!

Classification and stages of disease development

Doctors distinguish 5 stages of Parkinson's disease. The basis is the progression of symptoms.

Classification according to Hoehn and Yahr:

1. Stage zero – there are no signs of the disease.
2. The first is that motor symptoms appear. One side of the body is affected.
3. The second is a bilateral defeat. Symptoms intensify and new areas of the body are affected.
4. Third, postural instability is diagnosed, but the patient can care for himself.
5. Fourth, the symptoms of the movement disorder progress, the patient can only move short distances.
6. The fifth stage of the pathological process - the patient is completely incapacitated. Symptoms of mental disorders and autonomic disorders intensify.

There are 3 main forms of the disease. The classification is based on the severity of one or another group of characteristics:

• Rigid-bradykinetic – increased muscle tone, contractures. The patient freezes in one position for a long time. For example, "petitioner" or "mannequin".
• Trembling-rigid form - the main symptom is trembling of the limbs, general stiffness of movements.
• Trembling - tremor of the limbs, tongue, jaw, tongue. Muscle tone is normal, the patient can control motor activity.

Diagnosis of Parkinson's disease

It is almost impossible to recognize Parkinson's disease at an early stage. Initial symptoms - trembling fingers, fatigue - are attributed to stress and fatigue. But early diagnosis improves the patient’s prognosis, increases the duration of socially active life, and reduces the rate of destruction of brain cells. As symptoms progress, one can even assume Parkinson's disease in absentia.

The initial diagnosis is established based on an analysis of the patient’s complaints and the results of a neurological examination. It is also recommended to obtain an opinion from 2 doctors, since in a quarter of cases the diagnosis of Parkinson's disease is made incorrectly.

Differential diagnosis

If there are 4 characteristic symptoms, an error in the diagnosis of Parkinson's disease is unlikely. But in any case, other similar diseases should be excluded. The following are not typical for the pathology:

• early postural instability, dementia, impotence, urinary incontinence, difficulty swallowing and speaking;
• lack of any response to Levodopa;
• rapid progression of brain disorders;
• cerebellar damage;
• visual disturbances not caused by drugs.

Treatment of Parkinson's disease

Parkinson's disease is an incurable destructive disease. Therapy is aimed at eliminating symptoms, reducing the rate of patient degradation, improving quality and increasing the active period of life.

In the conservative treatment of Parkinson's disease, the following drugs are used:

1. Drugs that increase the amount of dopamine in the brain - Levodopa. To stabilize the active substance in tissues, Tasmar (Tolcapone) is prescribed.

Tasmar is prescribed as part of combination therapy for Alzheimer's disease - in parallel with the main therapeutic agents. The drug reduces the activity of the enzyme that converts levodopa into one of the phenylalanine derivatives. Levodopa is an effective drug used in the treatment of Alzheimer's disease.

1. Dopamine receptor agonists - to stimulate this area, mimic the action of the neurotransmitter.
2. MAO inhibitors – inhibit enzymes that break down dopamine. For example, such as Segan (Yumex, Selegiline, analog Deprenil, Eldepril).

One of the effective anti-Parkinsonian medications is the drug Segan (Yumex). Its main active substance, Seleginine, reduces the destruction of dopamine in the brain, and also enhances the effect of another substance - levodopa, which, when it enters neurons, is converted into dopamine. The use of selegiline improves brain function and also has a positive effect on mood and overall well-being.

1. Dopamine reuptake inhibitors - increase the sensitivity of receptors to the neurotransmitter.
2. Anticholinergics - to relieve symptoms of the disease such as hypersalivation, hyperhidrosis and excessive activity of the sebaceous glands.

If conservative treatment of Parkinson's disease is ineffective, surgical intervention is indicated. Destructive operations and stimulation of brain areas are used.

Methods of surgical treatment of Parkinson's disease:

1. Thalamotomy - indicated when the main symptom is tremor and only one side of the body is affected.
2. Pallidotomy - such an intervention for Parkinson's disease is performed when the main symptom is movement disorders.
3. Neurostimulation – if conservative treatment of Parkinson’s disease is ineffective or if there is intolerance to medications. This procedure involves implanting electrodes into brain structures. The patient can independently regulate the intensity of stimulation.

The intervention is permitted for Parkinson's disease with bilateral involvement. This operation is reversible and easily tolerated. The downside is its high cost.

Effective therapy

There are no drugs that can completely stop PD.

Parkinson's disease, like parkinsonism, is characterized by a long-term, steadily progressive nature. Clinical manifestations are constantly increasing, which worsens the prognosis for the patient. Neurologists note that treatment should be comprehensive and be aimed at the following things:

• eliminating clinical manifestations that complicate the patient’s life or reducing their intensity;
• it is necessary to prevent the development of new neurological symptoms, as well as reduce the risk of progression of Parkinson’s disease from one stage to another;
• increasing the quality of life, especially in people in early old age.

Parkinson's disease is a significant problem for older people, leading to a decrease in their quality of life.

Existing methods of treating Parkinson's disease can be divided into several types, depending on the type of treatment used:

• use of medications;
• various methods of physiotherapy, physical therapy, massage, etc.;
• surgical interventions;
• methods of social rehabilitation.

Therapy for neurodegenerative diseases should always be comprehensive, since in addition to impaired neurological functions, the patient experiences depression and personality changes.

Prognosis, prevention of Parkinson's disease

The prognosis is unfavorable. Without treatment, after 8 years the patient becomes completely dependent on relatives and cannot care for himself. When using Levodopa, the active life expectancy for Parkinson's disease is 15 years. But the speed of its development is individual.

Prevention is as follows:

• high-quality treatment of brain pathologies and head injuries;
• avoid stress;
• take vitamins and supplements such as phenylalanine (L-Phenylalanine);
• Observe safety precautions when working with pesticides and chemicals.

Parkinson's disease is an incurable pathology. But scientists are conducting research and developing new therapy methods. At the first signs of Parkinson's disease, you should consult a doctor and begin drug treatment.

Bibliography

1. Vasiliev Yu.N. Parkinson's disease: pathogenetic significance of stress. Irkutsk, 2009, “Imprint”. – 128 p.
2. Samii A., Nutt JG, Ransom BR Parkinson's disease (English) // The Lancet. – Elsevier, 2004. – Vol. 363. – P. 1783 – 1793. – PMID 15172778.
3. Levin O.S., Fedorova N.V. Parkinson's disease. – M.: 2006. – 256 p.
4. Sayutina S.B., Shprakh V.V. Parkinson's disease (in questions and answers). Irkutsk: RIO IGIUVA, 2010. – 124 p.
5. Yakhno N.N.. General neurology: textbook. allowance / N. N. Yakhno, V. A. Parfenov. – 2nd ed., rev. and additional – M.: MIA, 2009. – 208 p.
6. Zhukova N.G., Zhukova I.A., Gashilova F.F. Diagnostic criteria and treatment algorithms for Parkinson's disease: Textbook. – Tomsk: Publishing House “Printed Manufactory”, 2007. – 122 p.
7. Fahn S. The medical treatment of Parkinson disease from James Parkinson to George Cotzias. Mov Disord. 2015; 30(1):4–18.
8. Mak MK, Wong-Yu IS, Shen X, Chung CL.Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2021 Nov;13(11):689–703.
9. https://ru.wikipedia.org/wiki/Parkinson's_Disease#Pathogenesis