Parkinsonism

Parkinsonism is a pathological condition characterized by a slow but progressive course and is manifested by a decrease in the speed of movement, muscle stiffness and tremors of the limbs.

Back in the 80s of the 19th century, after the discovery of James Parkinson, the disease was called shaking palsy. It has been proven that Parkinsonism syndrome is the main clinical symptom of a large number of neurological diseases.

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

Epidemiology

Parkinsonism occurs in approximately 0.6-1.4% of cases, with the majority of cases occurring in the elderly and the older the person, the higher the likelihood of the disease.

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

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

Causes parkinsonism

To date, it has not been possible to discover the true cause of muscle rigidity, trembling of the limbs and slow movements. However, some factors that contribute to the development of Parkinsonism must be identified.

The causes of Parkinsonism can be endo- and exogenous. Most often, the pathology manifests itself in relatives, since it has a genetic transmission route, when the mutated gene is transmitted in an autosomal dominant manner.

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

The reasons may be a previous infectious pathology of the nervous system, such as tick-borne encephalitis. It is also worth highlighting cerebral circulatory disorders, atherosclerosis of cerebral vessels, diseases of vascular genesis, neoplasms of nerve tissue and brain, as well as TBI.

Parkinsonism may occur as a result of toxic damage against the background of prolonged use of phenothiazine drugs, such as triftazin, aminazine. A long course of methyldopa and some drugs of the narcotic group have a negative effect on the nervous system.

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

[ 16 ], [ 17 ], [ 18 ]

Pathogenesis

The basis for the development of Parkinsonism is a decrease in the number of nerve cells of the substantia nigra, as well as the appearance of so-called Lewy bodies in them. The pathogenesis of Parkinsonism is due to age-related changes in neurons, hereditary factors and the influence of exogenous causes.

Impaired motor activity, tremors and muscle stiffness may occur as a result of a failure in the metabolic processes of catecholamines in brain tissue or dysfunction of the enzyme systems that affect these processes.

Tremors develop as a result of an imbalance of dopamine and norepinephrine. Thus, normally the content of dopamine is at a certain level, which allows to suppress the activity of acetylcholine, which is the activator of the excitation process.

Thus, when structures such as the substantia nigra and the globus pallidus are damaged, a decrease in dopamine concentration is observed, which leads to a failure in the transmission of nerve signals to the anterior horns.

Pathogenesis ensures active circulation of impulses in motor neurons - gamma and alpha with a predominance of the latter, which in turn contributes to the occurrence of muscle stiffness and tremors.

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

Forms

It is customary to distinguish between the idiopathic form when it comes to Parkinson's disease, and Parkinsonism syndrome with various causes of development and accompanying many degenerative processes in nerve cells and fibers.

Parkinsonism syndrome

A significant portion of nervous system diseases is accompanied by the appearance of Parkinsonism syndrome. It is one of several clinical manifestations of the pathology.

Shaking palsy 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 semi-bent state at the elbows and more distal joints. In addition, it is worth noting the poverty of facial expressions.

Parkinsonism syndrome causes a gradual slowing of voluntary movements, the gait becomes “shuffling”, and there is no coordinated work of the arms and legs when walking.

Speech becomes very quiet, without intonation or expression of emotions, with a tendency to fade out at the end of a sentence. Tremor is a frequent but not obligatory component of the syndrome. It can manifest itself as trembling of the limbs, facial muscles, tongue and lower jaw, the intensity of which increases at rest.

Finger movements are characterized as "counting coins". Tremor is practically absent during sleep, but increases significantly when excited. 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 superficiality. Moments of excessive excitability are often encountered.

Vegetative disorders appear as the appearance of seborrhea, oily skin and hair, increased salivation, hyperhidrosis and trophic changes in the lower extremities.

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

Parkinson's disease and parkinsonism

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

Parkinson's disease and parkinsonism are based on damage to the structures of the nervous system, which is manifested by certain clinical manifestations.

Parkinsonism is a progressive pathology that is expressed by the appearance of rapid fatigue, inhibition of movement, tremors and increased muscle tone.

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

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

Most often, the first manifestations can be noted after 60 years, but in the case of the juvenile form, the clinical manifestations may appear before 40 years. In this case, Hunt's Parkinsonism with a slow course should be considered.

Damage to the nervous system can have varying severity of symptoms, but as the pathology progresses and in the absence of pathogenetic therapy, the intensity increases to such an extent that the quality of life suffers significantly.

Severe neurological disorders contribute to the development of swallowing dysfunction, as a result of which a person quickly loses weight. In addition, due to minimal motor activity and prolonged immobilization, the risk of respiratory disorders and bedsores increases. This is explained by reduced respiratory volume and circulatory disorders.

There is a certain division of pathology into clinical forms of Parkinsonism. Thus, rigid-bradykinetic, trembling-rigid and trembling types are distinguished.

In the rigid-bradykinetic form, an increase in muscle tone is observed in a plastic form, which progresses with 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, lowered head and bent back.

This form is considered unfavorable and appears as a result of atherosclerotic changes and after encephalitis.

Another form is tremor-rigid, characterized by the presence of tremors in the distal extremities. In addition, there is an addition of stiffness in the performance of voluntary motor acts.

The next form (tremor) is characterized by constant or periodic tremors of medium and large amplitude, affecting the tongue, lower jaw and facial expressions.

Voluntary movements are performed in full and at normal speed. This form is observed in Parkinsonism after trauma or encephalitis.

A person partially loses control over movements, muscles and the body as a whole. This occurs as a result of damage to the substantia nigra, where the connection between both hemispheres occurs and orientation in space is ensured.

Vascular parkinsonism

A rare form of pathology is vascular parkinsonism, as a secondary lesion of cerebral tissue. The cause of the disease is considered to be ischemic or hemorrhagic genesis of disturbances in the connection between the basal ganglia, midbrain 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.

Small-caliber cerebral vascular lesions may include hypertensive, senile microangiopathy, amyloid angiopathy, vasculitis and vasculopathy (SLE, polyarteritis nodosa), as well as hereditary vascular lesions.

Large cerebral arteries may be affected by atherosclerosis or meningovascular syphilis. In addition, cardiogenic embolism, hypoxic encephalopathy, arteriovenous malformation, coagulopathy, and antiphospholipid syndrome may also have a negative effect on the cerebral vessels.

The vascular form has some peculiarities. It is characterized by bilateral lesions, symmetrical symptoms, absence of tremors at rest, ineffectiveness of dopaminergic agents, pronounced clinical manifestations in the axial parts and legs, early changes in gait, and absence of dyskinesia with prolonged use of levodopa.

Among the accompanying symptoms, it is worth highlighting the appearance in the early stages of a severe pseudobulbar syndrome, neurogenic urination disorder, dementia, cerebellar ataxia and focal symptoms.

Drug-induced parkinsonism

The cause of drug-induced parkinsonism are drugs - neuroleptics and other agents capable of inhibiting dopamine receptors (cinnarizine, metoclopramide), and sympatholytics (reserpine), which can deplete dopamine reserves in the presynapse.

The drug form is characterized by rapid progression, a history of taking a certain drug, and bilateral clinical symptoms that are noted on symmetrical areas of the body.

In addition, typical tremor at rest is not observed, but postural tremor is present. An important feature is the regression of clinical manifestations after discontinuation of further drug administration.

However, it is worth understanding that the process of reducing the severity of symptoms can occur over several months, and in some cases it takes years.

If the manifestations are not very intense, the pathology can gradually progress, destroying an increasing number of neurons. In this case, even after the drug is discontinued, the symptoms of the disease may continue to be present.

Idiopathic Parkinsonism

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

The pathology is observed after 60 years and requires constant medical support, given the fact that it is incurable.

Typical signs of this form are considered to be asymmetry of symptoms, when clinical manifestations are observed on one side. The onset of manifestations may be represented by a slight tremor of the fingers, slightly noticeable inhibition of speech function and the absence of involuntary movements when walking.

The idiopathic form is also characterized by a lack of strength and energy, fatigue, psycho-emotional disorders and insomnia. In addition, previously habitual actions cause difficulties in their implementation.

Tremors in the hands start with the fingers and can move to the lower limbs. The "movements" of the fingers resemble rolling something, and in the legs, trembling can bother only one limb.

Tremor increases with disturbance of psycho-emotional balance, when a feeling of anxiety and excitement appears. On the contrary, a decrease in the severity of tremors is noted during sleep. Motor activity does not suffer significantly, but brings some discomfort when performed.

Secondary Parkinsonism

In cases where Parkinsonism becomes a complication of a certain pathology, in the process of pathogenesis of which metabolic disorders and structural changes are observed, a secondary form should be suspected.

The cause of its development may be vascular and infectious lesions of brain tissue, traumatic brain injury, intoxication caused by long-term use of drugs, hydrocephalus, as well as oncological neoplasms of the brain.

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

The clinical picture of secondary Parkinsonism is determined by the cause of its development, which worsens the prognosis for life. In addition to damage to the nerve cells of the black substance, dysfunction of some links in the connection of the cortical, subcortical and stem structures is noted, due to which motor activity is ensured.

It is worth noting that diagnostics requires careful examination and identification of the true cause of the disease. Thus, secondary parkinsonism may be a consequence of the appearance of a neoplasm in the cranial cavity, which will improve the patient's condition after surgery.

Also, in the case of taking certain medications (neuroleptics) over a long period of time, one can suspect the gradual onset of this disorder.

In the process of diagnosis, it is necessary to remember that Parkinsonism can develop after a trauma or encephalitis in the past. In this regard, the pathology requires a thorough collection of anamnesis, taking into account the clinical manifestations and the patient's condition.

Toxic Parkinsonism

Damage to neurons in the brain can result from prolonged intoxication with various substances, such as carbon monoxide, mercury, organophosphates, methanol, lead, and many others. The most common intoxications are those caused by manganese, carbon disulfide, and herbicides.

Toxic parkinsonism can also develop after long-term use of heroin and ecstasy, which are used to obtain a narcotic effect. In addition, it is necessary to take into account that damage to the striatum is observed under the influence of methyl alcohol, and the black substance is destroyed under the influence of MPTP, hexane and lead. Less common is damage to the pale globe as a result of carbon monoxide, cyanides or manganese.

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

The toxic form may regress or remain at one stage provided that the pathological factor is no longer influencing it. However, under the influence of manganese, as well as after its cessation, slow progression of parkinsonism and an increase in symptoms are observed.

Juvenile Parkinsonism

A separate form of primary parkinsonism of hereditary genesis is the juvenile form. It has been studied in most detail only over the past 10-15 years.

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

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

The disease can progress over several decades, and it is also worth noting that the prognosis is relatively favorable.

The gene, the mutation of which causes the development of the juvenile form, was discovered in the last years of the 20th century. This gene codes for the protein parkin, which is located in the cytosol and Golgi. In the juvenile form of the pathology, parkin is absent from all cerebral cellular structures.

Manganese Parkinsonism

"Manganism" is a clinical syndrome characterized by elevated levels of manganese. It was first discussed in the mid-19th century, when ore miners developed gait disturbances, speech problems, increased salivation, and poor facial expressions.

Manganese Parkinsonism results from long-term inhalation of manganese compounds. This may be seen in welders, steel and battery manufacturers, bactericidal agents and gasoline manufacturers.

In addition, it is worth considering that manganese intoxication can increase with long-term parenteral nutrition, renal or hepatic insufficiency, as well as with regular hemodialysis sessions.

The main clinical manifestations of the pathology are slow movements, muscle stiffness, a “cock” gait, falls and speech dysfunction.

During the MRI examination, visualization of manganese accumulation in the area of the basal nodes is noted. Manganese parkinsonism is not amenable to the therapeutic effect of levodopa, so chelating agents are used in treatment. It is worth remembering that even after the cessation of manganese exposure to the body, this disorder can continue to progress for several years.

Postencephalitic parkinsonism

Even mild epidemic encephalitis may have clinical manifestations of CNS disorders in the form of slowly increasing slowing of movement, tremors and muscle stiffness.

Postencephalitic parkinsonism may be expressed by endocrine, vascular or psychogenic symptoms. They are observed in the acute stage of encephalitis and even in the comatose form. In addition, it should not be forgotten that encephalitis manifests itself in a flu-like form, oculolethergic, psychosensory or hyperkinetic forms, which in combination with the symptoms significantly reduces the chance of recovery.

In the postencephalitic form, increased tendon reflexes and other symptoms of pyramidal insufficiency are observed.

It should be noted that this form of pathology is characterized by oculogyric crises, when the gaze is fixed upward for minutes or hours, with the head thrown back.

In addition, the symptoms of the crisis may be accompanied by a failure of convergence and accommodation, as a result of progressive supranuclear palsy.

Atypical Parkinsonism

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

In 80% of cases, it manifests itself as a symmetrical syndrome of this disorder without tremors, head extension, discrete signs of hypokinesia, muscle rigidity of the limbs and a minimal therapeutic effect from taking levodopa.

In addition, the atypical form is characterized by vertical paralysis of the pupil with a “downward” position, when it changes its position during passive head movement (the “doll’s eyes” phenomenon).

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

As supranuclear palsy progresses, apraxia of eye opening, changes in facial expressions in the form of raised eyebrows, slightly open mouth, and sunken nasolabial folds are observed. Frontal dementia is expressed by decreased motivation, impaired psychoemotional state with frequent depressions, decreased attention, and especially memory.

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

Symptomatic Parkinsonism

Symptomatic Parkinsonism may be observed as a result of exposure to various harmful factors. These include drugs such as lithium, sodium valproate, drugs that lower blood pressure and suppress the gag reflex, fluoxetine, and neuroleptics.

Parkinsonism clinical picture can be observed when toxic substances act on the body, for example, MPTP, methanol, manganese or carbon monoxide.

The symptomatic form is observed in endocrine pathology, when hormones in the blood change their qualitative and quantitative composition, as well as in metabolic disorders. These may be calcifications of the basal nodes or dysfunction of the thyroid gland.

One should not forget about genetic predisposition, when a mutation of a certain gene is noted, which causes the occurrence of disorders and diseases. This group includes Hallervorden-Spatz syndrome, Huntington's chorea and others.

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

Diagnostics parkinsonism

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

Cerebrospinal fluid in traumatic parkinsonism during spinal puncture flows out in frequent drops, which indicates increased pressure. In addition, its study reveals the physiological composition of cells and proteins.

Parkinsonism is diagnosed by laboratory testing of blood and other fluids. Thus, detection of carboxyhemoglobin in the blood indicates carbon monoxide poisoning. If traces of manganese are detected in urine, cerebrospinal fluid or blood, then manganese intoxication should be suspected.

When conducting electromyography, a violation of the electrogenesis of muscle structures is observed, which is manifested by an increase in the bioelectrical activity of muscles at rest and the appearance of rhythmic accumulations of potential charges.

Diagnostics also uses electroencephalography, which reveals common, minor disruptions in the brain's bioelectrical activity.

Of course, one should not forget about an objective examination, when the leading symptoms and syndromes are determined, as well as 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, X-ray examination of the cervical spine with functional tests, tomography of the brain, vessels and spinal column are used.

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

Treatment parkinsonism

To achieve the desired result, treatment of Parkinsonism should be combined and long-term to gradually reduce the severity of symptoms and possible regression of the pathology.

For this purpose, it is necessary to include in the treatment complex medications (antiparkinsonian), sedatives, physiotherapy procedures, correction of the mental state and therapeutic exercise, taking into account the cause, form, stage of this disorder and age, concomitant pathology of the patient.

Treatment is quite complex, since damage to the nervous system occurs at the level of the substantia nigra, as a result of which the reduction in the severity of clinical symptoms is a long process.

The pathogenesis of Parkinsonism development is characterized by pathological morphological and biochemical changes, which is why levodopa replacement therapy is necessary to prevent further progression of the disease. However, it should be understood that the side effects of levodopa, like many other drugs, can worsen the patient's condition.

A neurologist treating Parkinsonism must have extensive experience and even skill to correctly select medications and dosages to avoid side effects and worsening of the general condition. In addition, it is necessary to develop a treatment plan and monitor the dynamics of the disease.

Treatment of Parkinsonism with Drugs

Mild forms of the disease involve the use of drugs such as amantadine (midantan) and parasympatholytic drugs, which have minimal side effects.

Among them, it is worth noting agents with a central mechanism of action, for example, cyclodone and narcopan, dopamine receptor agonists (bromocriptine, lisuride), pyridoxine and amantadine.

In case of severe clinical symptoms, drug treatment is carried out using levodopa with the combined use of a decarboxylase inhibitor. Treatment should be started with minimal doses, gradually increasing them until the therapeutic effect is achieved.

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 into dopamine when it enters the central nervous system. Thus, the formed dopamine is used for the normal functioning of the basal ganglia.

The drug has an effect on akinesia (mainly) and other symptoms. By 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, anticholinergics are used, which are capable of blocking cholinergic receptors and relaxing muscles, thereby reducing bradykinesia, as well as atropine-like drugs and phenothiazine-type drugs.

Treatment of Parkinsonism with drugs of various pharmacological groups is due to their insufficient therapeutic effect, the presence of side effects and addiction to them.

Medicines for parkinsonism

Treatment tactics for Parkinsonism involve returning the body to its normal position, posture, physiological flexion of the limbs and elimination of clinical manifestations of the pathological condition.

Medicines include drugs of various pharmacological groups. Thanks to their combined use 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 medications, it is necessary to use physiotherapy procedures, massage, and exercise therapy, the action of which will be aimed at restoring normal muscle tone and ensuring the performance of habitual movements.

A special component of treatment is working with the patient's psycho-emotional state, because the intensity of symptoms largely depends on internal mental balance. Thus, the severity of tremor largely depends on the state of the nervous system, which is manifested by increased tremors during moments of excitement, stress, anxiety or tension.

Treatment for early stage Parkinsonism includes the use of pramipexole (Mirapex), which has proven effective with relatively few side effects.

[ 43 ], [ 44 ], [ 45 ], [ 46 ], [ 47 ]

Treatment of Parkinsonism with Traditional Medicine

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

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

Shaking palsy is most often treated with belladonna. To prepare the medicine, grind the root, pour white wine and heat over a fire. After boiling for 5-10 minutes over low heat, cool and take 5 ml three times a day. Store in a dark, cool place.

Treatment of Parkinsonism by folk medicine is also carried out with henbane, raven eye and sage. In the presence of a pronounced spastic syndrome, in which the speech function is impaired, and convulsions appear, it is necessary to use a tincture of datura seeds.

One of the treatment methods is considered to be Eastern acupuncture, which has proven itself in the treatment of severe tremors of the limbs. Sometimes needles are replaced with pieces of pepper plaster and are glued to special energy areas of the limbs.

In addition to physical disorders, the patient is bothered by psychological discomfort. In this regard, normalization of the psycho-emotional state is one of the key areas in the treatment of this disorder.

For this purpose, various herbal infusions with valerian, mint, lemon balm and motherwort are used. In this way, irritability is removed and tremors are reduced.

New in the treatment of Parkinsonism

Despite the progress in medicine, the treatment of Parkinsonism does not always bring good results. The most commonly used drug is levodopa, which helps to cope with akinesia and general stiffness. It is less active in relation to muscle rigidity and tremor.

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

During the operation, local destruction of the ventrolateral nucleus, globus pallidus and subthalamic structures 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 complete elimination of tremors.

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, something new has appeared in the treatment of Parkinsonism. Thus, implantation of embryonic cells from the adrenal gland into the corpus striatum is performed. Remote clinical results cannot yet be assessed. This type of surgery is performed for choreoathetosis, torticollis and hemiballism.

Exercises for Parkinsonism

The complex of treatment of pathology should include exercises for Parkinsonism, but it is necessary to remember that they will not be able to provide the desired result in the presence of contractures, dystonia and decreased endurance. Exercises help at the initial stage of the disease and provide a good result.

They are performed lying down, sitting or standing to exercise all muscle groups. The exercises should provide relaxation to reduce rigidity, 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 movements (passive and active). Balance exercises, coordination of movements, as well as anaerobic exercise to activate the functioning of the heart and vascular system in the form of swimming or training walking are also necessary.

Don't forget about the facial muscles and learning to take a deep breath before each phrase, including doing breathing exercises. Particular attention should be paid to training on a bicycle ergometer and exercises for functional activity (transferring the body from a lying to a sitting position).

[ 48 ], [ 49 ], [ 50 ], [ 51 ]

Massage for Parkinsonism

One of the treatment methods is massage. It is very important for Parkinsonism, as its therapeutic capabilities are aimed at restoring a person's ability to move normally.

Massage helps to increase muscle mobility and has a wonderful effect on the central nervous system. It is recommended to perform massage every day or every other day, which in combination with medications, physiotherapy procedures and physical exercises provides a good effect.

To accomplish the tasks set, it is necessary to use stroking at the beginning of the massage. It can be direct, combined, zigzag, circular or alternating. This will allow you to relax and prepare the muscles for more substantial techniques. Then kneading, rubbing and percussion techniques are used, thanks to which the muscles are toned, as well as vibration.

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

Massage is most effective when combined with hydrogen sulphide baths, therapeutic exercise, bathing in sea water, inductotherapy and electrophoresis with medicinal preparations.

Physical therapy for Parkinsonism

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

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

Exercise therapy is not able to completely prevent the progression of the pathological process, but with its help, a slowdown in the destruction of the substantia nigra and an increase in the severity of symptoms is noted.

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

With irregular use of therapeutic exercise, severe contractures are observed even with pathogenetic drug therapy. In this case, orthopedic correction may be needed to prevent progression of the pathological process.

[ 52 ], [ 53 ], [ 54 ], [ 55 ]

Nutrition for Parkinsonism

A comprehensive approach to the treatment of Parkinsonism involves the use of replacement drug therapy, physiotherapy, exercise therapy and massage. However, it is important to understand that a lot also depends on a person's nutrition.

For this purpose, patients diagnosed with Parkinsonism must adhere to a certain regimen - a diet. Thus, nutrition implies the intake of low-calorie food 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 meat and fish, fermented milk products. It is strictly forbidden to drink alcoholic beverages and smoke, as these bad habits can aggravate the course of the disease. In addition, adherence to this type of diet ensures a full supply of vitamins and important minerals for the body's vital functions. Healthy eating will help to avoid exacerbation of many other concomitant diseases.

With proper nutrition for Parkinson's disease, 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 occurrence of Parkinsonism, you can try to reduce the risk of development by following certain recommendations. Thus, berries, apples, oranges, as well as products containing flavonoids reduce the likelihood of developing pathology.

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

Prevention of Parkinsonism consists of following 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 meat and fish.

In addition, it is necessary to normalize your psycho-emotional state, avoid stressful situations and worries. Physical education helps in the treatment and prevention of many diseases, including the prevention of this disorder.

Sufficient physical activity helps keep muscles toned, preventing the development of rigidity. Daily walking, swimming, and morning exercise are excellent options.

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

[ 56 ], [ 57 ], [ 58 ], [ 59 ], [ 60 ]

Forecast

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

In 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 discontinuation of the drug or cessation of exposure to the harmful factor.

At the initial stage of development, treatment allows achieving good results, but in more severe stages, therapeutic methods are less effective. Ultimately, it leads to disability after a few years.

The most important thing is to detect the disease in a timely manner and begin pathogenetic treatment. Thanks to modern methods, 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 clinical picture develops. Depending on the cause of the disease, the first manifestations may appear around 20 years of age. However, by following the recommendations for prevention, you can try to avoid the occurrence of this disorder and not suffer from tremors of the limbs and muscle rigidity.

[ 61 ], [ 62 ]