What is Parkinsonism?

Parkinson's disease (PD), also known as tremor paralysis, is one of the most common neurodegenerative diseases. Epidemiology shows that the prevalence rate is 15 to 328 per 100 thousand population, about 1% of people over 65 years of age; the prevalence rate is 10 to 21 per 100 thousand population per year. The etiology and pathogenesis of PD have not been clarified, and may be related to social factors, drug factors, and patient factors. The pathological changes of PD include: dense parts of the mesencephalic substantia nigra, cyanotic neuron pigment loss, substantia nigra pigmentation and the appearance of Lewy bodies. The biochemical changes of PD nerves are: dopamine (DA) reduction in the above parts and their nerve endings caused by the loss of midbrain dense substantia nigra and blue spot neurons (the clinical manifestations of PD occur when DA is reduced by 70%), and In the body system, acetylcholine (ACH), which is antagonistic to DA, is relatively hyperactive, and DA and ACH are out of balance.

Basic Information

nickname

Tremor paralysis

English name

Parkinson disease, PD

Visiting department

Neurology

Common symptoms

Bradykinesia, myotonia, resting tremor, abnormal gait, cognitive / mental disorders, sleep disorders, autonomic dysfunction, sensory disorders

Contagious

no

Causes of Parkinson's disease

The etiology and pathogenesis have not yet been clarified, and may be related to social factors, drug factors, and patient factors.

Clinical manifestations of Parkinson's disease

Motor symptoms

Bradykinesia, muscular rigidity, resting tremor, and abnormal gait.

2. Non-motor symptoms

Cognitive / mental disorders, sleep disorders, autonomic dysfunction, sensory disorders.

Parkinson's disease test

CT, MRI examination can find brain atrophy, lacunar infarction, etc. PET and SPECT examination can show abnormal dopamine metabolism.

Parkinson's disease diagnosis

The diagnostic criteria are:

UK brain bank diagnostic standards, Chinese diagnostic standards, Japanese diagnostic standards, EU diagnostic standards, etc.

British brain bank PD diagnostic criteria:

Inclusion criteria

Slowness of movement (voluntary movement , progressive speech and repetitive movements become smaller), at least one of the following: muscle rigidity; 4-6Hz static tremor; posture instability (not by vision, vestibular function, cerebellum or Caused by proprioception).

2. Support standards

Unilateral onset; The presence of resting tremor; Progressive disease course; The symptoms are long-term asymmetric with the most obvious symptoms on the onset side; L-dopa responds well (70% to 100%); L-dopa-induced dance Response to L-dopa for 5 years or more; Clinical course for more than 10 years.

3. Exclusion criteria

History of repeated strokes and stepwise increase of Parkinson's-like symptoms; History of repeated head trauma; History of encephalitis; Symptoms are a history of sedative medication; Symptoms continue to resolve; Strict unilateral after 3 years Symptoms: Supranuclear paralysis; Cerebellar symptoms; Severe early autonomic dysfunction; Severe early dementia, memory, speech, and behavioral abnormalities; Babinski sign positive; CT examination found cerebellar tumors or traffic hydrocephalus No response to high-dose L-dopa treatment (excluding malabsorption); History of MPTP exposure.

Differential diagnosis of Parkinson's disease

Parkinson's syndrome

Common causes are the following: poisoning, infection, drugs, cerebrovascular disease, etc.

2. Parkinson's syndrome

Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), cortical basal ganglia degeneration (CBGD), Lewy body dementia (DLB), etc.

(1) The clinical manifestations of multiple system atrophy (MSA) are muscle rigidity and bradykinesia, but tremor is not obvious. It may be accompanied by cerebellar damage signs and autonomic nerve damage signs, and responds poorly to levodopa preparations. Neuropathology showed obvious neuronal loss, degeneration, and glial cell proliferation in the nucleus of the putamen, pale globules, caudate nucleus, nigra and blue spots. Silver inclusions were found in the cytoplasm of glial cells.

(2) Axial and symmetrical Parkinson's disease-like manifestations of progressive supranuclear palsy (PSP) , with early postural instability and backward tilting, and tremor are rare. Characteristic vertical gaze paralysis, manifested as paralysis of the common upward or downward vision of the eyeballs. Levodopa preparations should be treated in contrast. The head MRI can show "hummingbird sign".

(3) Cortical basal ganglia degeneration (CBGD) may have postural or motor tremor, muscle stiffness, poor response to levodopa preparations, apraxia, alien sign, cortical sensory impairment, some have cognitive impairment, and may be late Mild dementia.

(4) Lewy body dementia (LBD) Dementia is more severe, and its onset is earlier than that of Parkinson's disease. Dementia can also occur within one year after PD onset. Early visual hallucinations, delusions, delirium, fluctuating cognitive impairment, arousal, and changes in attention. Pathology: Lewy bodies and pale bodies can be seen in the cytoplasm of the cerebral cortex and brainstem neurons.

3. Degenerative (genetic) Parkinson's syndrome

(1) Huntington's disease (HD) ;

(2) Hepatolenticular degeneration (WD) liver damage, corneal KF ring, serum copper and aeruginin decreased;

(3) Papococcus nigra red nuclear pigment degeneration (HSD) MRI examination of T ₂ WI showed a low signal on the outside of the double pallidum and a small high signal on the inside, called "tiger eye sign". Marine blue tissue cells can be found in Giemsa-Wright staining of bone marrow macrophages and peripheral blood lymphocytes;

(4) Primary basal ganglia calcification

4. Primary tremor

It is the most common type of tremor-related diseases, and it is difficult to distinguish it from patients with Parkinson's disease whose main symptoms are tremor. Primary tremor occurs earlier, has a positive family history, and is autosomal dominant. The characteristics of tremor are posture or action, the frequency is 4-8Hz, the amplitude is small, usually aggravated during exercise and tension, drinking can reduce symptoms. Can spread to the head, taking Punelol is effective. No symptoms of muscle rigidity and bradykinesia.

Parkinson's disease treatment

Reasonable selection of drugs and physiotherapy to control or reduce symptoms and prevent secondary dysfunction; actively carry out exercise training to try to improve exercise, balance and coordination; actively perform occupational therapy and speech training to try to maintain or improve daily living activities .

Existing medical technology cannot cure Parkinson's disease for the time being. The treatment of patients mainly starts with reducing pain, delaying the development of the disease, and improving the quality of life of the patients. Therefore, one of the focuses of treatment is to adopt comprehensive rehabilitation therapy mainly based on exercise therapy to improve patient function and quality of life.

Parkinson's disease prognosis

The biggest harm of this disease is that the patient's quality of life is severely reduced, his life cannot be taken care of himself, and many complications often occur.