Parkinsonism

Parkinsonism is a pathological condition characterized by a slow but progressive course, and is manifested by a decrease in movement speed, stiffness of the muscles and tremor of the extremities.

Back in the 80th of the 19th century, after the discovery of James Parkinson's, the disease was called a trembling paralysis. It is proved that Parkinson's syndrome is the main clinical symptom of a large number of neurological diseases.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Parkinsonism is observed in approximately 0.6-1.4%, most cases occur in the elderly and the older the person, the higher the likelihood of the disease.

So, up to 60 years the percentage of cases of this disorder does not exceed 1, and after 60 the frequency of the disease reaches 5%. In addition, it is worth noting that the male half of the population suffers from pathology more often than women.

[8], [9], [10], [11], [12], [13], [14], [15]

Causes of the parkinsonism

To date, it has not been possible to find out the true cause of muscle stiffness, trembling of limbs and slow movements. However, nevertheless, some factors contributing to the emergence of Parkinsonism, it is necessary to distinguish.

The causes of parkinsonism can be endo- and exogenous. Most pathology is manifested in relatives, since it has a genetic way of transmission, when the mutated gene is transmitted by an autosomal dominant type.

Parkinsonism occurs as a result of a malfunction in the metabolic processes of catecholamines, which is provoked by traumatic injuries, various intoxications, infectious diseases or atherosclerotic vascular lesions.

The reasons may lie in the previously transmitted infectious pathology of the nervous system, for example, tick-borne encephalitis. It is also worth highlighting violations of the cerebral circulation, atherosclerosis of cerebral vessels, vascular genesis, neoplasms of neural tissues and brain, and also CCT.

Parkinsonism can occur due to toxic damage on the background of long-term use of drugs phenothiazine series, such as tryptazine, aminazine. The nervous system is adversely affected by the prolonged course of methyldopa and certain drugs of the drug group.

Intoxications of various genesis provoke the development of this disorder as a result of damage to nerve tissues and impaired transport of impulses. Long-term exposure to carbon monoxide or manganese also gradually destroy the structures of the nervous tissue.

[16], [17], [18]

Pathogenesis

The basis for the development of parkinsonism is the reduction in the number of nerve cells of the black substance, as well as the appearance in them, the so-called Levi bodies. The pathogenesis of parkinsonism is caused by age-related changes in neurons, hereditary factors and the influence of exogenous causes.

Violation of motor activity, tremor and muscle stiffness may occur due to a failure in the metabolic processes of catecholamines in brain tissues or dysfunction of enzyme systems that affect these processes.

Trembling develops as a result of an imbalance of dopamine and norepinephrine. So, normally the content of dopamine is at a certain level, which makes it possible to inhibit the activity of acetylcholine, which is an activator of the excitation process.

Thus, with the defeat of structures such as a black substance, as well as a pale ball, a decrease in the concentration of dopamine is observed, which leads to a failure of the transmission of nerve signals to the anterior horns.

Pathogenesis provides active circulation of impulses in motor neurons - gamma and alpha with a predominance of the latter, which in turn contributes to the formation of stiffness and jitter.

[19], [20], [21], [22], [23], [24], [25], [26], [27],

Forms

It is customary to single out an idiopathic form when it comes to Parkinson's disease, and parkinsonism syndrome with various causes of development and concomitant many degenerative processes in nerve cells and fibers.

Parkinson's Syndrome

A significant part of the diseases of the nervous system is accompanied by the appearance of Parkinson's syndrome. It is one of several clinical manifestations of pathology.

A tremor paralysis is characterized by hypo- and akinesia. As a result, a typical posture is observed - the head is lowered, the back is bent, the arms are in a half-bent state in the elbows and more distal joints. In addition, it is worth noting the poverty of facial expressions.

Parkinsonism syndrome causes the gradual slowing down of voluntary movements, the gait becomes "shuffling feet," and there is no friendly work of hands and feet when walking.

The speech becomes very quiet, without intonation and emotion, with a tendency to fade at the end of the sentence. Tremor is a frequent but not necessary component of the syndrome. It can be manifested by the trembling of limbs, facial muscles, tongue and lower jaw, the intensity of which increases at rest.

The movement of the fingers is characterized as a "counting of coins". In a dream, tremor is practically absent, and when it becomes agitated, it increases significantly. Parkinsonism syndrome is also characterized by mental disorders in the form of loss of initiative, interest, narrowing of horizons, slow thinking and some of its surface. Often there are moments of excessive excitability.

Vegetative disorders look like the appearance of seborrhea, oily skin of the face and hair, increased salivation, hyperhidrosis and trophic changes on the lower limbs.

[28], [29], [30], [31]

Parkinson's disease and Parkinsonism

Each movement is caused by signals from the central nervous system, in particular the brain and spinal cord. Such pathology as Parkinson's disease manifests itself as a gradual loss of control over motor activity.

Parkinson's disease and parkinsonism are based on the defeat of the structures of the nervous system, which manifests itself in one or another clinical manifestation.

Parkinsonism is a progressive pathology, which is expressed by the appearance of rapid fatigue, inhibition of the performance of movements, tremor and increased muscle tone.

Depending on the cause of the disorder, this disorder can be primary, when neurons are affected by age-related changes, secondary - due to exposure to a harmful factor or as a complication of concomitant pathology, and also due to genetic gene mutations.

The concept of "parkinsonism" includes clinical symptoms that are inherent in Parkinson's disease, but are one of the syndromes of another pathology.

Most often, the first manifestations can be observed after 60 years, but in the case of a juvenile form, a clinic may appear before the age of 40. In this case, one should consider Hunt's parkinsonism with a slow current.

The defeat of the nervous system may have a different severity of symptoms, however, as the pathology progresses and pathogenetic therapy is absent, the intensity grows so much that the quality of life suffers significantly.

Severe neurologic disorders contribute to the appearance of dysfunction swallowing, resulting in a person quickly losing weight. In addition, due to minimal motor activity and prolonged immobilization, the risk of joining respiratory disorders and pressure sores increases. This is due to the reduced respiratory volume and circulatory disorders.

There is a certain division of pathology into the clinical forms of parkinsonism. Thus, a rigid, bradykinic, trembling-rigid, and trembling appearance is distinguished.

With a rigid-bradykinic form, there is an increase in muscle tone in a plastic form, which progresses by inhibition of active movements, ending with complete immobilization. In addition, it is worth paying attention to the appearance of muscle contractures and the typical posture of the patient with half-bent arms, legs, head lowered and bent back.

This form refers to unfavorable, manifested as a result of atherosclerotic changes and after the transferred enznfalita.

Another form - the trembling-rigid one, is distinguished by the present trembling of the extremities of the distal sections. In addition, stiffness is observed in the performance of voluntary motor acts.

For the next form (trembling) there is a constant or periodic tremor of medium and large amplitude, affecting the tongue, lower jaw and facial expressions.

Arbitrary movements are carried out in full and with normal speed. This form is noted in parkinsonism after trauma or encephalitis.

Man partially loses control over movements, muscles and the body as a whole. This occurs as a result of the defeat of the black substance, in which a connection occurs between the two hemispheres and orientation in space is provided.

Vascular Parkinsonism

A rare form of pathology is vascular parkinsonism, as a secondary lesion of cerebral tissue. The cause of the disease is ischemic or hemorrhagic genesis of communication disorders between the basal nodes, the middle brain and frontal lobes.

The prevalence of this disorder does not exceed 15% of all cases of pathology. The most common cause is arteriopathy due to hypertension.

The defeat of the small caliber of cerebral vessels can be hypertensive, senile microangiopathy, amyloid angiopathy, vasculitis and vasculopathy (SLE, nodular polyarteritis), as well as hereditary vascular damage.

Large cerebral arteries can be affected by atherosclerosis or meningovasular syphilis. In addition, cardiogenic embolism, hypokic encephalopathy, arteriovenous malformation, coagulopathy and antiphospholipid syndrome can also have a negative effect on the vessels of the brain.

The vascular form has some features. It is characterized by bilateral defeat, symmetrical symptomatology, absence of trembling at rest, ineffectiveness of dopaminergic drugs, pronounced clinic in axial sections and legs, earlier gait alteration, and lack of dyskinesia with prolonged use of levodopa.

Of the accompanying symptoms, it is worth noting the appearance in the early stages of pseudobulbar syndrome of severe form, disorders of urination of a neurogenic nature, dementia, cerebellar ataxia and focal symptomatology.

Medicinal parkinsonism

The cause of drug parkinsonism is drugs - neuroleptics and other drugs that can inhibit dopamine receptors (cinnarizine, metoclopramide), and sympatholytics (reserpine), which can deplete the stores of dopamine in presynapa.

The drug form is characterized by rapid progression, the presence in the medical history of a specific drug, a bilateral clinic that is marked on symmetrical parts of the body.

In addition, there is no typical tremor at rest, but postural tremor is present. An important feature is the regression of clinical manifestations after discontinuation of further administration of the drug.

However, it should be understood that the process of reducing the severity of symptoms can occur for several months, and in some cases takes years.

If the manifestations are not of high intensity, the pathology may progressively progress, destroying an increasing number of neurons. In this case, even after the withdrawal of the drug, the symptoms of the disease may continue to be present.

Idiopathic Parkinsonism

Chronic destruction of dopamine neurons of chronic course can provoke the development of a pathology such as primary or in other words idiopathic parkinsonism.

Pathology is observed after 60 years and requires constant medication support, given the fact that it is incurable.

Typical signs of this form is asymmetry of symptoms, when clinical manifestations are observed on the one hand. The onset of the manifestations can be represented by a slight trembling of the fingers, a slight noticeable inhibition of the function of speech and the absence of involuntary movements in walking.

Idiopathic form is also characterized by a lack of strength and energy, frustration, psychoemotional disorders and insomnia. In addition, the usual earlier actions cause difficulties for their implementation.

Trembling in the hands begins with the fingers and can move to the lower limbs. The "movements" of the fingers are like rolls of something, and at the feet of the trembling can disturb only one limb.

Tremor is enhanced by a disturbance of psychoemotional balance, when there is a feeling of anxiety and excitement. Conversely, a decrease in the expression of jitter is noted during sleep. The motor activity does not suffer much, but it brings some discomfort when performing.

Secondary Parkinsonism

In the case when parkinsonism becomes a complication of a certain pathology, in the process of pathogenesis of which metabolic disturbances and structural changes are noted, a secondary form should be suspected.

The cause of its development can become vascular and infectious lesions of brain tissue, TBI, intoxication caused by long-term drug intake, hydrocephalus, as well as oncological neoplasms of the brain.

The secondary form is much less common than Parkinson's disease and has certain distinctive features. These include the absence of trembling at rest, the ineffective effect of such a drug as levodopa, the rapid occurrence of cognitive impairment, and the presence of clinical symptoms of pyramidal and cerebellar origin.

Clinic of secondary parkinsonism is due to the cause of its development, which worsens the prognosis for life. In addition to the defeat of nerve cells of black matter, there is a dysfunction of some links of the cortical, subcortical and stem structures, due to which the motor activity is provided.

It is worth noting that the diagnosis requires careful investigation and identification of the true cause of the disease. So, probably, secondary parkinsonism can be a consequence of the appearance of a neoplasm in the cranial cavity, which after an operation will improve the patient's condition.

Also, if you take certain medicines (neuroleptics) for a long period of time, you may suspect a gradual appearance of this disorder.

In the process of diagnosis, it must be remembered that parkinsonism can develop after a previous trauma or encephalitis. In this regard, pathology requires a careful collection of anamnesis, taking into account the clinical manifestations and the patient's condition.

Toxic Parkinsonism

The defeat of brain neurons can result from prolonged intoxication of various substances, for example, carbon monoxide, mercury, FOS, methanol, lead and many others. The most frequent are intoxications due to the effects of manganese, carbon disulfide and herbicides.

Toxic parkinsonism can also develop after long-term use of heroin and "ecstasy", which are used to get narcotic action. In addition, it should be borne in mind that the defeat of the stritum is noted under the influence of methyl alcohol, and the black substance is destroyed under the influence of MPTP, hexane and lead. The least common is the defeat of the pale ball as a result of the action of carbon monoxide, cyanides or manganese.

Depending on the location of the affected area of the brain, certain clinical symptoms develop and a different response to levodopa is observed.

The toxic form can regress or is at one stage, provided that the pathological factor ceases to exist. But under the influence of manganese, and also after its cessation, there is a slow progression of parkinsonism and an increase in symptoms.

Juvenile Parkinsonism

A separate form of primary parkinsonism of hereditary genesis is the juvenile form. The most detailed study was made only during the last 10-15 years.

Women suffer more often. What is characteristic of pathology affects relatives due to transmission by an autosomal dominant type. The first clinical manifestations can be observed in 15-35 years, in rare cases, parkinsonism affects children of an earlier age.

Juvenile Parkinsonism has a number of characteristics, among which it is necessary to single out the absence of other mental disorders even in the long course. However, pathology is characterized by the appearance of an increased tendon reflex in combination with pyramidal symptoms.

The disease can progress for several decades, and it is worth noting that the outlook is relatively favorable.

The gene, whose mutation is the cause of the development of the juvenile form, was discovered in the last years of the 20th century. This gene encodes the protein parkin, which is located in the cytosol and the Golgi. With the juvenile form of pathology, parkskin is absent in all cerebral cellular structures.

Manganese Parkinsonism

"Manganism" is a clinical syndrome characterized by an elevated level of manganese. It was first talked about in the middle of the 19th century, when ore miners had a gait disturbance, speech function, increased salivation and lack of facial mimicry.

Manganese parkinsonism develops as a result of prolonged inhalation of manganese compounds. This can be observed in welders, steel and battery manufacturers, bactericides and gasoline.

In addition, it should be borne in mind that manganese intoxication can increase with long parenteral nutrition, renal or hepatic insufficiency, as well as with regular hemodialysis sessions.

The main clinical manifestations of pathology are slowed down movements, stiffness of the muscles, "cock" gait, falls and speech dysfunction.

During the study of MRI, a visualization of the manganese accumulation in the basal nodes was noted. Manganese parkinsonism does not respond to the therapeutic effects of levodopa, therefore, chelating agents are used in the treatment. It is worth remembering that even after the cessation of the effect of manganese on the body, this disorder can continue to progress to several years.

Postencephalitic parkinsonism

Epidemic encephalitis, even in an easy degree, can have clinical manifestations of CNS disturbance in the form of slow-growing slowing of movement, tremor and stiffness of muscles.

Postencephalitic parkinsonism can be expressed by endocrine, vascular or psychogenic symptoms. They are observed in the acute stage of encephalitis and even in comatose form. In addition, do not forget that encephalitis is manifested by the flu-like form, oculotergic, psychosensory or hyperkinetic forms, which, in combination with the symptoms, significantly reduces the chance of recovery.

With the postencephalitic form, there is an increase in the reflexes of the tendons and the remaining symptoms of pyramidal insufficiency.

It should be noted that this type of pathology is characterized by oculogic crises, when the sight is fixed upward for minutes or hours, and the head is thrown back.

In addition to the symptoms of the crisis, a convergence and accommodation failure can occur, as a result of progressive supranuclear palsy.

Atypical Parkinsonism

There is atypical parkinsonism, in which there are clinical symptoms that are not inherent in other forms of pathology. So, "parkinsonism plus syndrome" is based on the progression of supranuclear palsy.

In 80% of cases it manifests itself in a symmetrical syndrome of this disorder without trembling, extension of the head, discrete signs of hypokinesia, rigidity of the limb muscles and minimal therapeutic effect of taking levodopa.

In addition, an atypical form is characterized by vertical paralysis of the pupil with the position "below", when it changes its position in the process of passive head movement (the phenomenon of "pupal eyes").

Parkinsonism is characterized by frequent falls, pseudobulbar disorders with speech dysfunction and changes in the tone of the voice, especially at the onset of the disease.

In the course of progression of supranuclear paralysis, apraxia of opening the eyes, changing facial expressions in the form of raised eyebrows, slightly slightly opened mouth and nasal folding of the nasolabial folds are noted. Dementia of the frontal type is expressed by a decrease in motivation, a violation of the psychoemotional state with frequent depressions, decreased attention and especially memory.

[32], [33], [34], [35], [36],

Symptomatic Parkinsonism

As a result of exposure to various harmful factors, symptomatic parkinsonism may occur. These include drugs such as lithium preparations, sodium valproate, drugs that reduce blood pressure and depress the gag reflex, fluoxetine and antipsychotics.

A clinic of parkinsonism can be noted when toxic substances act on the body, for example, MFTP, methanol, manganese or carbon monoxide.

Symptomatic form is observed with endocrine pathology, when hormones in the blood change their qualitative and quantitative composition, as well as metabolic disorders. These can be basal calcifications or thyroid dysfunction.

Do not forget about the genetic predisposition, when there is a mutation of a certain gene, which causes the appearance of disorders and diseases. This group includes the syndrome of Gullervorden-Spatz, Huntington's chorea and others.

The cause of the emergence of clinical signs may be transferred infectious diseases that can have a negative impact on the nervous system, for example, neurosyphilis, encephalitis or AIDS.

Diagnostics of the parkinsonism

In each case of development of parkinsonism, it is necessary to select an individual examination program, due to which the cause and main lesions of the disease are identified.

Cerebrospinal fluid in traumatic parkinsonism during spinal cord puncture follows frequent drops, which indicates an increased pressure. In addition, during its investigation, the physiological composition of cells and proteins is found.

The diagnosis of parkinsonism is the laboratory examination of blood and other fluids. Thus, the detection of carboxyhemoglobin in the blood indicates the poisoning with carbon monoxide. If traces of manganese in the urine, cerebrospinal fluid or blood are detected, then it is worthwhile to suspect the intoxication of manganese.

When carrying out electromyography, there is a disturbance in the electrogenesis of muscle structures, which is manifested by an increase in the bioelectrical activity of muscles at rest and the appearance of rhythmic clusters of potential charges.

Diagnosis also uses electroencephalography, during which common abortive failures of brain bioelectric activity are detected.

Of course, do not forget about objective examination, when the leading symptoms and syndromes are determined, as well as about the anamnestic features (the course of the disease, professional experience or the presence of concomitant pathology).

For additional examination, ultrasound of the cervical and cerebral vessels is used, X-ray examination of the cervical spine with carrying out functional tests, tomography of the brain, vessels and the spinal column.

[37], [38], [39], [40], [41], [42], [43],

Treatment of the parkinsonism

To achieve the desired result, the treatment of parkinsonism should be combined and prolonged to gradually reduce the severity of the symptoms and the possible regression of the pathology.

To this end, it is necessary to include medicines (antiparkinsonics), sedatives, physiotherapy procedures, mental correction and exercise therapy, taking into account the cause, form, stage of the disorder and age, the concomitant pathology of the patient.

The treatment is rather complicated, since the damage to the nervous system occurs at the level of black matter, so that the reduction in the severity of clinical symptoms is a lengthy process.

The pathogenesis of Parkinson's development is characterized by abnormal morphological and biochemical changes, which is why replacement therapy with levodopa is necessary to prevent further progression of the disease. However, one must understand that the side effects of levodopa, like many other drugs, can aggravate the patient's condition.

The neurologist involved in the treatment of parkinsonism should have a lot of experience, and even the skill to correctly choose the drugs and dosage in order to avoid the development of side effects and aggravation of the general condition. In addition, it is necessary to develop a treatment regimen and control the dynamics of the disease.

Treatment of Parkinsonism with drugs

The mild form of the disease involves the use of medications such as amantadine (midantan) and parasympatolytic drugs, which have minimal side effects.

Of these, it is worth noting funds with a central mechanism of action, for example, cyclodone and narcotic, dopamine receptor agonists (bromocriptine, lizard), pyridoxine and amantadine.

Treatment with drugs in the case of severe clinical symptoms is carried out with levodopa with a co-administration of a decarboxylase inhibitor. Begin the treatment with minimal doses, gradually increasing them to achieve a therapeutic effect.

Levodopa has some side effects in the form of dystonic disorders and psychosis. The mechanism of action of the drug is based on its decarboxylation to dopamine when it enters the central parts of the nervous system. Thus, the formed dopamine is used for the normal functioning of the basal nodes.

The drug has an effect on akinesia (mostly) and other symptoms. Combining it with a decarboxylase inhibitor, the dosage of levodopa can be reduced to reduce the risk of side effects.

In addition to the main drug, holinolytics are used that can block cholinergic receptors and relax the muscles, thereby reducing bradykinesia, as well as atropine-like drugs and the phenothiazine series of agents.

The treatment of parkinsonism with drugs of various pharmacological groups is due to their insufficient therapeutic effect, the presence of side reactions and addiction to them.

Drugs from Parkinsonism

Therapeutic tactics in parkinsonism implies a return to the body of a normal position, posture, physiological flexion of limbs and elimination of clinical manifestations of the pathological condition.

Medications include medicines of various pharmacological groups. Due to their combined reception and therapeutic effect, in most cases it is possible to reduce the severity of symptoms and improve the quality of life of a person.

In addition to drugs, it is necessary to use physiotherapy, massage, physiotherapy exercises, whose action will be aimed at restoring normal muscle tone and ensuring the performance of the usual movements.

A special component of the treatment is the work with the psychoemotional state of the patient, because the intensity of the symptoms largely depends on the internal psychic balance. So, the severity of tremor largely depends on the state of the nervous system, which is manifested by increased tremor at the time of excitement, stress, anxiety or tension.

Drugs for Parkinsonism at an early stage include the use of pramipexole (mirapex), which has proven effective against a background of relatively low levels of adverse reactions.

[44], [45], [46], [47], [48]

Treatment of parkinsonism with alternative medicine

The methods of traditional treatment do not always provide the desired effect, so it is worth turning to alternative medicine. It will enhance the therapeutic effect and reduce the severity of side effects of pharmacological drugs.

Treatment with alternative medicine involves the use of infusions and decoctions of medicinal herbs, with the help of which the full blood circulation in the affected foci of the brain is restored and the activity of the pathological process decreases.

Tremor paralysis is most often treated with bellies. To prepare the medicine, it is necessary to grind the root, pour the white wine and heat on the fire. Boil 5-10 minutes on a small fire, should be cooled and take 5 ml three times a day. Storage is carried out in a darkened cool place.

The treatment of parkinsonism with alternative medicine is also carried out with bleached, ravenous eye and sage. In the presence of a pronounced spastic syndrome, in which the function of speech is disrupted, and convulsions appear, it is necessary to use the tincture of datura seeds.

One of the methods of treatment is eastern acupuncture, which has proven itself in the treatment of severe tremor of the extremities. Sometimes needles are replaced with pieces of pepper plaster and are glued on special energy areas of the extremities.

In addition to physical disorders, the patient is concerned about psychological discomfort. In this regard, the normalization of the psychoemotional state is one of the key directions in the treatment of this disorder.

For this purpose, various herbal preparations with valerian, mint, melissa and motherwort are used. Thus, irritability is removed and tremor decreases.

New in the treatment of parkinsonism

Despite the progress in medicine, nevertheless the treatment of parkinsonism does not always bring good results. The most commonly used drug - levodopa, helps to cope with akinesia and general stiffness. He is less active with respect to muscle rigidity and tremor.

It is worth considering that the drug in a quarter of all cases is absolutely ineffective and often causes side effects. In this case, it is rational to carry out stereotactic operative intervention on the subcortical ganglia.

During the operation, local destruction of the ventrolateral nucleus, pallid sphere and subthalamic formations is performed. As a result of surgical intervention, a positive effect is observed in the form of a decrease in muscle tone, hypokinesia and a decrease or even elimination of tremor.

The operation is performed on the side where there are no clinical manifestations. If there are indications, the subcortical structures are destroyed on both sides.

In recent years, new in the treatment of parkinsonism. Thus, implantation of embryonic cells from the adrenal gland into the striped body is performed. Long-term clinical results are not yet possible to assess. This type of surgery is performed with choreoathetosis, curvature and hemiballism.

Exercises in Parkinsonism

The complex treatment of pathology should include exercises in parkinsonism, but it must be remembered that they can not provide the desired result in the presence of contractures, dystonia and reduced endurance. Exercises help at the initial stage of the disease and provide a good result.

They are performed lying, sitting or standing to train all muscle groups. Exercises should provide relaxation to reduce stiffness, include slow rhythmic rotational movements, flexion and extension of the trunk, isometric exercises and stretching.

In addition, it is necessary to teach the correct sitting position and control over the movements (passive and active). Equilibrium exercises, coordination of movements, as well as anaerobic stresses are necessary to activate the functioning of the heart and the vascular system in the form of swimming or training walking.

Do not forget about the facial muscles and training in a deep breath before every phrase, including performing breathing exercises. Particular attention should be given to training on a bicycle ergometer and exercises for functional activity (transfer of the body from a reclining state to a sedentary state).

[49], [50], [51], [52]

Massage with Parkinsonism

One of the therapeutic methods is massage. It is very important in parkinsonism, since its therapeutic possibilities are aimed at restoring a person's ability to move normally.

Massage promotes an increase in muscle mobility, as well as an excellent effect on the central nervous system. Massage is recommended to be performed every day or every other day, which in combination with medicines, physiotherapy procedures and physical exercises provides a good effect.

To perform the tasks, you need to use stroking at the beginning of the massage. It can be direct, combined, zigzag, circular or alternating. This will relax and prepare the muscles for more essential techniques. Further, kneading, rubbing and percussion techniques are used, thanks to which muscles are toned down, and also vibration.

Massage with parkinsonism is performed on the collar zone, the back, especially in the paravertebral zone, and the limbs. The duration of the massage is a quarter of an hour. The number of procedures reaches 15-20, provided they are regularly carried out.

Massage is most effective in combination with hydrogen sulphide baths, physiotherapy exercises, sea water baths, inductotherapy and electrophoresis with medicines.

Exercise therapy in Parkinsonism

In addition to the main drug therapy, exercise therapy is used in parkinsonism, which reduces the intensity of clinical manifestations of pathology.

The effectiveness of therapeutic physical education depends on the degree and activity of the disease. The earlier the use of exercise therapy begins, the higher the probability of achieving maximum results.

LFK is not able to completely prevent the progression of the pathological process, but with its help there is a slowing down of the destruction of black matter and an increase in the severity of symptoms.

In addition, physical education is used to prevent the development of disability, damage to the muscular and bone structures of secondary genesis due to the lack of full physical activity of the patient, as well as improve the general condition of a person.

With the occasional use of curative physical education, the formation of severe contractures is observed even in the presence of pathogenetic drug therapy. In this case, orthopedic correction may be necessary to prevent the progression of the pathological process.

[53], [54], [55], [56]

Nutrition in Parkinsonism

An integrated approach to the treatment of parkinsonism involves the use of substitution drug therapy, physiotherapy, physical therapy and massage. However, it must be understood that very much depends on human nutrition.

To this end, patients with a diagnosis of parkinsonism should follow a certain dietary regime. Thus, nutrition implies the intake of low-calorie foods in order to avoid the development of atherosclerosis and additional damage to the brain vessels.

It is necessary to increase the consumption of fruits, vegetables, vegetable oil, low-fat varieties of cape and fish, sour-milk products. Categorically forbidden the intake of alcoholic beverages and smoking, as these bad habits can aggravate the course of the disease. In addition, compliance with this type of diet provides a full-fledged intake of vitamins and important minerals for the life of the body. A healthy diet will avoid the aggravation of many other related diseases.

Due to proper nutrition in parkinsonism, it is possible to reduce the severity of clinical symptoms of the disease, prevent exacerbation and improve the quality of life.

Prevention

Assuming the main factors for the emergence of parkinsonism, you can try to reduce the risk of developing, following certain recommendations. Thus, berries, apples, oranges, as well as products containing flavonoids reduce the likelihood of pathology.

Flavonoids are found in plants, fruits (grapefruit), chocolate and are known as vitamin P and citrine. An important direction in prevention is control over chronic pathology, infectious diseases and intoxication of the body.

Prevention Parkinsonism is to comply with a certain diet, reducing the consumption of fatty foods, fried foods and flour, sweet products. At the same time, it is recommended to eat fruits, vegetables, dairy products, vegetable oil and low-fat varieties of cape and fish.

In addition, you need to normalize your psycho-emotional state, avoid stressful situations and experiences. Physical education helps in the treatment and prevention of many diseases, including in preventing this disorder.

Sufficient physical activity allows you to keep your muscles toned, preventing the development of rigidity. So, daily walking, swimming and morning warm-up are great.

In addition, research has shown that regular mental and physical activity activates the production of dopamine, which is so necessary for prevention.

[57], [58], [59], [60], [61],

Forecast

Depending on the cause of the development of pathology, it is customary to determine the prognosis for the future. In most cases, the disease progresses, despite the ongoing substitution therapy and the use of various treatments.

In the case of development of pathology due to drug intoxication or poisoning with manganese and other substances, the prognosis of parkinsonism is much more favorable. It is due to the possibility of regression of clinical symptoms after drug withdrawal or cessation of exposure to a harmful factor.

At the initial stage of development, treatment can achieve good results, but in more severe stages, therapeutic methods are less effective. In the end, he leads to disability in a few years.

The most important thing is to timely identify the disease and start pathogenetic treatment. Thanks to modern techniques, parkinsonism can be treated both conservatively and surgically, which improves the patient's quality of life.

Parkinsonism is a pathology of the nervous system, in which certain structures of the brain are destroyed, and a typical clinic develops. Depending on the cause of the disease, the first manifestations may appear for about 20 years. However, following the recommendations for prevention, you can try to avoid the appearance of this disorder and not suffer from limb tremors and muscle rigidity.

[62], [63]