Open classification: biology, disease, Parkinson's disease

Parkinson's disease, also known as paralysis agitans, is a chronic central nervous system disease that affects the mobility of patients, mostly occurring in middle-aged and elderly people. APDA in the United States says that people who start to suffer from Parkinson's disease when they are less than 40 years old are young patients. It was first described by a British doctor named James Parkinson in 18 17, and later scholars adopted the name of Parkinson's disease, which became the basis of research. The early manifestations of the disease are static tremor, myotonia, slow movement, difficulty in starting movement, abnormal posture and so on. Resting tremor refers to the uncontrolled trembling of the patient's hands or arms, which appears at rest or aggravates when the mood is tense; Other early symptoms include difficulty in starting activities, frequent trembling of arms and legs, inability to do fine movements of upper limbs, and difficulties in daily life, such as dressing, taking off shoes and washing. Because the main factors of disability are bradykinesia, myotonia and postural disorder. Parkinson's disease is often accompanied by depression, anxiety, limb pain and discomfort, constipation, sweating, salivation and so on. Li explained this to her daughter in kindergarten: "Parkinson's disease is a disease that makes you unable to move."

The condition of Parkinson's disease varies from person to person. Some people have serious nervous system damage, while others will be better. Patients with this disease may only affect one side (left or right) at first, and soon, symptoms will appear on both sides of the body. Generally speaking, with the passage of time, the condition will change, different symptoms will appear in different periods, and the condition will become more and more serious. Usually, the memory and intelligence of patients with Parkinson's disease will not be affected. The most common symptoms are as follows:

[Trembling] The most common symptom of Parkinson's disease is involuntary trembling of one or both arms. In addition, legs, feet or chin will shake. A slight movement of the trembling part will reduce the degree of trembling, and usually there will be no trembling during sleep.

[Limb stiffness or muscle contracture] Because the relaxation information sent by the brain cannot reach the muscle tissue. Muscle stiffness can cause muscle pain or inability to straighten.

Slow movement is another common symptom. Common actions such as getting on and off the bed, standing or sitting down all require some effort. When walking, you can't do it in one step, you can only make small steps. Parkinson's patients sometimes feel "frozen stiff", that is, they can't move autonomously. Involuntary behaviors such as blinking, facial expression changes, and swinging your arms when walking will be slower than normal people.

Lack of balance often causes patients to fall.

[Other symptoms] Abnormal slow speech speed, dull tone, etc. When you write, your hands will tremble and your words will get smaller and smaller; Food is inedible, etc. In addition, constipation is one of the common symptoms of Parkinson's disease.

Diagnosis of Parkinson's disease

An epidemiological study of Parkinson's disease in China shows that the total number of people suffering from Parkinson's disease in China has reached 654.38+07200, and the prevalence rate of Parkinson's disease in people over 55 years old is nearly 654.38+0%. However, patients with Parkinson's disease confuse some early symptoms of Parkinson's disease with normal aging of body function, thus delaying the treatment opportunity.

1, diagnostic criteria of Parkinson's disease

(1) Clinical manifestations: Most patients with Parkinson's disease started after 60 years old, and occasionally patients in their twenties. The onset is mostly occult, developing slowly and getting worse gradually. The main manifestations are tremor (often the first symptom), myotonia, bradykinesia, abnormal posture and gait, and dyskinesia of mouth, pharynx and palate muscles.

(2) Auxiliary examination: The decrease of HVA (homovanillic acid) content in cerebrospinal fluid and urine can be detected by high performance liquid chromatography. Brain CT may have widened sulcus and enlarged ventricle.

(3) Exclude Parkinson's syndrome caused by encephalitis, cerebrovascular disease, poisoning and trauma, and differentiate it from hysteria, nervousness and senile tremor.

Diagnosis is mainly based on typical symptoms, and sometimes it is difficult to distinguish with the help of auxiliary examination. return

2. Differential diagnosis

It is mainly differentiated from Parkinson's syndrome, essential tremor and benign tremor.

(1) Parkinson's syndrome after encephalitis;

The so-called Parkinson's syndrome caused by lethargic encephalitis has not been reported in recent 70 years, so the Parkinson's syndrome caused by this encephalitis has disappeared. In recent years, it has been reported that patients with viral encephalitis may have Parkinson-like symptoms, but the disease has obvious infection symptoms, which may be accompanied by neurological damage symptoms such as cranial nerve paralysis, limb paralysis, convulsion and coma. Cerebrospinal fluid may have mild to moderate increase of cell number, increase of protein, decrease of sugar, etc. Parkinson-like symptoms are relieved after remission and can be distinguished from Parkinson's disease.

(2) Hepatolenticular degeneration:

Recessive hereditary disease, about 1/3, has a family history, and adolescents have symptoms such as increased limb muscle tension, tremor, facial masking, torsion spasm and so on. It is characterized by liver damage, corneal K-F ring and decreased serum ceruloplasmin. It can be distinguished from Parkinson's disease.

(3) Essential tremor:

This is a dominant genetic disease, characterized by involuntary tremor of the head, jaw and limbs. The frequency of tremor can be high or low, and the high frequency is very similar to hyperthyroidism. The low frequency is very similar to Parkinson's tremor. The disease has no decreased exercise, increased muscle tone and postural reflex disorder, and disappears after drinking. Propranolol is effective and can be distinguished from primary Parkinson's disease.

(4) Progressive supranuclear paralysis:

The disease is also common in middle-aged and elderly people, and its clinical symptoms may include extrapyramidal symptoms such as myotonia and tremor. However, this disease has prominent eyeball fixation disorder, myotonia is concentrated in the trunk, limb muscles are slightly involved and limb flexibility is maintained well, and neck hyperextension caused by increased tension of neck extensor muscles is obviously different from neck flexion of Parkinson's disease, which can be distinguished from Parkinson's disease.

(5)Shy_Drager syndrome:

Clinically, extrapyramidal symptoms often appear, but due to the prominent autonomic symptoms, such as syncope, orthostatic hypotension, sexual dysfunction, bladder dysfunction, etc., it can be distinguished from Parkinson's disease, and levodopa preparation is ineffective.

(6) Parkinson's syndrome induced by drugs:

Excessive use of antidepressants such as reserpine, chlorpromazine and haloperidol can cause extrapyramidal symptoms, which can be distinguished because of obvious medication history and remission after stopping taking drugs.

(7) Benign tremor:

Refers to physiological tremor (imperceptible to the naked eye) and functional tremor without brain organic lesions. Functional tremor includes: 1. Physiological tremor is enhanced (visible to the naked eye), mostly postural tremor, which is related to the enhanced adrenergic regulation response; Also found in some endocrine diseases, such as pheochromocytoma, hypoglycemia, hyperthyroidism; 2. Cocaine and alcoholism and the side effects of some drugs. Hysterical tremor is caused by many cardiac factors, and distraction can relieve tremor. 3. Others: nervousness and tremors when doing fine movements. Benign tremor has no characteristic manifestations of Parkinson's disease, such as myotonia, decreased movement and abnormal posture.

Conventional treatment of Parkinson's disease

To treat this disease, we should first have a correct understanding of it:

First, it is a long-term illness. Generally speaking, it will not threaten the life of patients soon. To carry out this struggle for a long time, to make unremitting efforts for health care, and to cure this disease for a long time, we must have long-term thinking.

Second, the real cause of Parkinson's disease is not clear in treatment, so there is no really effective means to completely solve it. Parkinson's patients confuse some early symptoms of Parkinson's disease with the normal aging of body function, thus delaying the treatment opportunity. At present, the medical community is constantly trying to explore. At present, the treatment of Parkinson's disease mainly adopts various methods to prevent or delay its occurrence and development, and the effect is still relatively good.

1, principles of western medicine treatment of Parkinson's disease

Parkinson's disease is caused by the decrease of substantia nigra cells in the brain. The substantia nigra cells can produce dopamine like a processing factory. If the factory is destroyed, the dopamine in the brain will decrease, and the globus pallidus, another part of the brain, will be extremely active, which will lead to the three major symptoms of Parkinson's disease.

Then if the patient is given dopamine drugs, the content of dopamine in the brain can be increased, thus reducing the excessive activity of globus pallidus and relieving the symptoms of the patient. At present, drugs such as madopa are substitutes for dopamine. When we can't produce dopamine ourselves, we can meet the normal needs of the body and maintain the normal function of the body through external compensation. Of course, there are other kinds of drugs, such as amantadine and monoamine oxidase inhibitors, which can relieve symptoms by indirectly promoting the production of dopamine or reducing the decomposition of dopamine, but there are many side effects in drug treatment and the shortcomings of drug efficacy attenuation after long-term application.

Stereotactic surgery mainly aims at the abnormal activity of globus pallidus, and reduces the excitability of globus pallidus with abnormal activity through surgery to achieve the purpose of relieving symptoms. At present, deep electrode stimulation, also known as deep brain nucleus stimulation (DBS), can also be used, that is, using an electrode to stimulate the remaining nerve cells to accelerate the production of dopamine, which can also make up for its functional deficiency. Recently, another method, neural stem cell transplantation, has emerged and is still in the research stage.

2. Specific treatment measures

The treatment of Parkinson's disease mainly includes drug treatment and surgical treatment, both of which can achieve the purpose of relieving symptoms.

(1) drug therapy: in the early stage of the disease, drugs can improve the symptoms very well. The most commonly used and effective drug is levodopa preparation (trade name Madopar or Xi Ning), which has been used in clinical treatment since the 1960s and has been the core drug in clinic. This medicine must be taken for a long time, and once the treatment is stopped, the disease will recur. In the first few years, the effect of drug treatment is the best. Although most patients are still effective after long-term use, after long-term use, patients will feel that the effective time of the drug is shortened, and some patients will have fluctuations of "drug powder" and "intermittent". Drug therapy has certain limitations. Usually after 3-5 years of treatment, the disease will become uncontrollable, and the side effects of drugs will offset the advantages and disadvantages of its curative effect, so patients feel that their daily living ability is greatly limited.

2) Surgical treatment: There are two main methods: cell destruction surgery (cell knife) and electrical stimulation surgery, both of which are aimed at inhibiting abnormal activity of brain cells and improving symptoms. The former is to create a lesion with a diameter of about 3 mm on the extremely active nerve nucleus, and the latter is to implant a stimulator to achieve a similar lesion effect through high-frequency electrical stimulation. There is not much difference in surgical techniques between the two. Both electrodes are placed on specific targets in the brain nucleus, and then stimulated or destroyed.

Because the root of brain lesions in Parkinson's patients is the decline of nerve cell function, theoretically speaking, the transplantation technology of neural stem cells (which can replace the declining brain cells of patients) has a good development prospect, but it is still in the experimental stage and needs more detailed research before clinical application. We expect that it will take more than ten years.

The surgical treatment of Parkinson's disease should be timely. All patients with primary Parkinson's disease diagnosed clearly are suitable for surgical treatment, especially levodopa (Madopar or Xi Ning) is effective or effective in the past, but after long-term use, the curative effect decreases, and there are "on-off" fluctuations, dyskinesia and "drug powder" deterioration effects. However, other chronic brain diseases will also show symptoms similar to Parkinson's disease, so early patients are not easy to be diagnosed. We should find an experienced neurologist for a period of clinical observation, combine the necessary examination means (such as magnetic resonance imaging) and drug treatment, make a clear diagnosis, rule out other diseases, and find out the main reasons of patients' dysfunction. Because Parkinson's disease usually progresses slowly and is not a fatal emergency, it is very important to observe the development of the disease and will not delay the treatment of patients. Only a clear preoperative diagnosis can ensure the effect of the operation.

Because of the slow progress of Parkinson's disease, there is no absolute time limit for surgery. When to have surgery depends largely on the patient's own requirements for quality of life. Generally speaking, patients with early Parkinson's disease should receive medical treatment first. After 3 ~ 5 years of drug treatment, the effect will decline, and there will be "on-off" fluctuation, abnormal behavior and "drug powder" deterioration effect, and the disease will become more difficult to control. Surgical treatment should be considered at this time. According to the clinical statistics of 1600 cases of Parkinson's disease, more than 80% patients received surgical treatment during this period. Generally speaking, patients who are relatively young, have symptoms concentrated on one side of the body and have good general health have better surgical results. Advanced elderly patients are more likely to have hypertension, diabetes, arteriosclerosis and heart disease, and their general health status is often not very good, and there are relatively many postoperative complications.

3) Acupuncture treatment

Acupuncture treatment of this disease is mainly tremor and calming the wind. The commonly used acupoints for body acupuncture are Sishencong, Fengchi, Quchi, Hegu, Yanglingquan, Taichong and Taixi. Can be added or subtracted according to syndromes. The retention time is about 30 ~ 50 minutes, and the course of treatment is 10 ~ 15 days. Scalp acupuncture mainly takes dance tremor control area as stimulation area, and can cooperate with head acupuncture points such as motor area and sensory area according to symptoms. The course of this disease is long, so acupoint fatigue should be avoided, and two groups of prescriptions can be used alternately if necessary. Because of the obstinacy of the disease, electroacupuncture is often used in clinic, the frequency is between 100 ~ 180 times /min, and continuous waves are the main ones, and sometimes dense waves can be selected.

It is generally believed that the key mechanism of acupuncture in treating Parkinson's disease lies in the following aspects: ① Improving dopamine level in brain and other monoamine transmitters in basal ganglia may be related to the regulation of acupuncture on residual neurons in basal ganglia; ② Excluding the factors of nerve injury. Acupuncture can improve the activity of antioxidant enzymes in patients with Parkinson's disease and reduce the pathological increase of lipid peroxidation to normal level. The free radical scavenging system after restoring balance can effectively scavenge free radicals, protect the body from excessive reactive oxygen species, reduce brain tissue damage, and play a neuroprotective role in Parkinson's disease patients. ③ Attenuate the amplitude and frequency of tremor myoelectric potential, thus effectively improving the tremor signs of patients with Parkinson's disease; ④ The repair status of diseased brain tissue has been improved; It is observed that acupuncture can temporarily improve the blood supply to the brain and make this effect last. Whether acupuncture and moxibustion can improve the activity of anti-free radical enzymes or improve brain blood flow, it is beneficial to the repair of diseased tissues.

In addition, physical therapy and functional exercise can play an auxiliary role in treatment.

Nursing care of patients with Parkinson's disease

In the early stage of the disease, patients have the ability to live independently, and the nursing for them mainly lies in guiding and helping to solve the difficulties in life; The nursing task of bedridden patients in the later period is getting heavier and heavier. Nursing care of patients with Parkinson's disease should generally pay attention to the following issues:

(1) Pay attention to diet and nutrition:

① Sufficient total calories can be given according to the patient's age and activity. Pay attention to the supply of sugar and protein in the diet, mainly vegetable oil, and eat less animal fat. People receiving dopamine therapy should limit their intake of protein. Protein will affect the therapeutic effect of dopamine. Protein's intake is limited to less than 0.8 grams per kilogram of body weight per day, and the total daily intake is about 40-50 grams. Select high-quality protein such as milk, eggs, meat and bean products within a limited range. Eating seafood in moderation can provide high-quality protein and unsaturated fatty acids, which is beneficial to the prevention and treatment of atherosclerosis.

② The supply of inorganic salts, vitamins and dietary fiber should be sufficient. Eating more fresh vegetables and fruits can provide a variety of vitamins, promote intestinal peristalsis and prevent constipation. Patients sweat a lot, so pay attention to hydration.

③ Food preparation should be soft, easy to digest, chew and swallow, and be used as semi-liquid or soft food.

④ Diet should be light and less salt; Don't smoke, drink and stimulate food, such as coffee, pepper, mustard, curry, etc. Adequate water supply should be ensured.

(2) Guidance and help in life: Early patients with this disease have barrier-free motor function and can persist in certain labor. He should be instructed to participate in various forms of activities as much as possible and adhere to the functional exercise of all joints of his limbs. With the development of the disease, the motor function of patients is hindered to a certain extent, and the ability of self-care is obviously reduced. At this time, we should pay attention to the safety problems in patients' activities and help them walk with crutches. If the patient has difficulty squatting and standing in the toilet, he can sit on a high stool to defecate. If the patient is all thumbs and often makes many mistakes, be careful with the tableware when eating. If you can't eat, you should feed soup and rice. People who have difficulty in dressing, buttoning, tying belts and shoelaces need help.

(3) Strengthen physical exercise: In the early stage of this disease, we should adhere to certain physical activities, take the initiative to do physical exercise, and do the flexion, extension, rotation and other activities of all joints of limbs to the maximum extent to prevent the occurrence of limb contracture and joint stiffness. In the later stage, patients should do passive physical activities, massage muscles and joints, and promote blood circulation of limbs.

(4) Prevention of complications: Pay attention to the temperature, humidity, ventilation and lighting of the room. Change clothes according to season, climate, weather, etc. And decide the way and intensity of outdoor activities. All the above measures can effectively prevent colds. Late bedridden patients should turn over on time and take good care of their skin to prevent soaking in urine and urine and bedsore. It is of great significance to passively move limbs and strengthen muscle and joint massage to prevent and delay bone and joint complications. Combined with oral care, turn over and knock on the back to prevent aspiration pneumonia and falling pneumonia.

Prognosis of Parkinson's disease

Since 1988, the number of cases of stereotactic surgery has reached 3500, some of which are patients with Parkinson's disease, and the surgical effect should be said to be positive. Generally speaking, the short-term effect of surgery, that is, the immediate effect after surgery, can reach more than 90%.

Then there is another situation where everyone is very concerned about the safety of this operation. From the perspective of stereotactic surgery, its complications are only 1% ~ 2%, and the probability of serious complications is even smaller.

After suffering from Parkinson's disease, it is better to go to the relevant medical units in time and get the guidance of doctors for health care, so that these Parkinson's patients can live a more fulfilling life in their later years. The physical and psychological shock suffered by Parkinson's patients is beyond our comprehension. It should be said that sometimes, life is fragile in the face of disease, but what we need more is a strong life. We hope that patients with Parkinson's disease must strengthen their faith, cooperate with doctors to launch a new round of fighting against the disease, and finally defeat the disease. Some relatives and friends around Parkinson's disease, including the public, should also have a sympathetic, tolerant and caring attitude towards these patients and give them understanding and support, which is very important for them.

* * * Special tips * * *

1. Three symptoms of Parkinson's disease: bradykinesia; Tremor; Muscle stiffness.

2. Parkinson's disease is a slowly progressive disease, which generally does not threaten the life of patients quickly.

3. The sympathy, tolerance and caring attitude of relatives, friends and the whole society towards these patients, as well as their understanding and support, are very important for patients with Parkinson's disease.