Parkinson's syndrome

Parkinson's disease, also known as Parkinson's disease or tremor paralysis, commonly known as "shake disease", "lower case disease." It is a degenerative disease of the substantia nigra and substantia nigra neurons in the middle age, which is caused by a lack of dopamine in a specific part of the brain or by a protein called "PAEL" in the human body. Its main features are progressive movement, muscle rigidity and tremor, which begin to slow down and gradually increase. Previous investigations have found that the disease is more common in people over the age of 50, more men than women, the incidence of people over the age of 60 can account for 1%. However, the incidence of Parkinson's disease in China has risen very rapidly in recent years. Among them, there are population aging factors, but more are misdiagnosed. From this point, it can be explained that Parkinson's disease is easily missed and easily misdiagnosed as cerebrovascular disease, depression, etc. The rate of misdiagnosis is about 47.6% in major cities, so it is very important to find this disease early. So far, the cause of primary Parkinson's disease is still not fully understood. From the current research, it is closely related to ageing, family genetics, environmental pollution and electromagnetic radiation (but some studies believe that genetic factors are not play a major role). The risk of illness among siblings is 6.7 times that of the general population. Parents have Parkinson's disease, and their children are 3.2 times more likely to develop the disease than the general population. Exposure to toxic metals and pharmaceuticals, pesticides and hydrocarbon solvents (including halogens, various fragrances, resins, herbicides, acetates, etc.) is more likely to develop the disease. People who often take metoclopramide, reserpine, phenothiazines, antidepressants, and men with long-term constipation are also likely to cause symptoms similar to Parkinson's disease. The incidence of widows is four times that of non-widowed people. The incidence of military and political personnel is higher, while the number of domestic workers is the lowest. In recent years, people under the age of 40 have not seen the disease, the incidence rate accounts for about 20%, and more patients have found this disease in their 20s. The biggest harm of Parkinson's disease is that the patient's quality of life is seriously degraded, and life cannot be taken care of, which will lead to various complications. At present, it is difficult to cure this disease. Most of the treatments are mainly to reduce the pain, delay the development of the disease, and improve the quality of life of patients. Parkinson's disease belongs to the category of "senile sensation", "inside wind" or "vibration" in traditional Chinese medicine. Chinese medicine believes that this syndrome is mostly caused by the elderly, mostly due to lack of qi deficiency, blood is not nutritious, gas is not warm, and the muscles are dying; or because the enchantin is not clear in the later stage of the stroke, damage to blood, body fluid, or excessive anger , stagnation and fire, burning and yin blood, caused by dystrophy. In the treatment of syndrome differentiation, it is often divided into liver and kidney yin deficiency, qi and blood deficiency, spleen deficiency and dampness, blood stasis and phlegm and heat and wind. [Clinical manifestations] (1) Early manifestations: 1 tremor. Starting at the side of the body, it gradually spreads slowly to the ipsilateral lower limb, the contralateral upper limb, the bilateral limb, the head and neck, the lower jaw, the chin, the lip and the tongue. The amplitude is small, and the typical one is at the time of rest. "Action" can be temporarily controlled. A small number of people have large amplitudes and tremors in their movements. When the free movement is done, the tremor is reduced or disappeared, disappears after falling asleep, and is intensified when the mind is nervous and emotional. 2 stiff and strong. Almost all patients have a stiff and strong sense of the heart, the palm is not easy to bend back, the fingers are getting worse and finer movements, such as tying the laces, writing and scribbling and writing smaller, the continuous rotation often stops. Tonicity is also systemic. When doing joint passive activities, you will feel a uniform obstruction. Medical scientists call it "lead tube-like rigidity." If the patient is accompanied by tremor, the limbs feel a uniform resistance during passive movement and intermittent pauses, as if the gear is rotating. In particular, muscle rigidity is more pronounced when the neck muscles, elbows, wrists, shoulders, knees, and ankles are active. 3 movement disorders. It is difficult to start and slow down in sports, such as difficulty in starting, unable to walk, small step, slow walking, gait panic or rushing gait, difficulty in turning, repeated movement and fatigue, and inability to act independently a feeling of. It also manifests as a variety of motor deficits, such as lack of expression, less blinking, slower speech, food unable to swallow, constipation and "mask face". It also shows that it is difficult to change the posture of the movement. For example, when you are walking, you can't salute. When you answer the question, you can't buckle the button. It takes a little effort to get on the bed, stand or sit down. 4 balance obstacles. Walking is unstable and easy to fall. If one or two of the above symptoms are found in the lateral limb, it is necessary to consider that the disease may occur. (2) After the disease develops into the middle and late stages, the patient's speech is monotonous, the voice is low, there may be autonomic dysfunction such as urinary and bladder dysfunction, increased sweating, seborrhea and orthostatic hypotension, and may have mental symptoms and dementia. . [Diagnostic points] Parkinson's disease: 1. Mainly manifested as resting tremor, increased muscle tone, and retarded exercise. The first symptom is tremor with the most tremor. The typical manifestation is a static tremor with a rhythm of 4 to 6 Hz. The thumb and the flexed index finger show a "pill-like" action. When the movement is free, it is relieved or stopped. When the tension is increased, it becomes worse after going to sleep. Followed by walking disorders, muscle rigidity (lead tube-like tonic or gear-like rigidity) and exercise retardation (mask face, writing small signs, etc.). Symptoms often start from one upper limb, gradually affecting the ipsilateral lower limb, contralateral upper limb and lower limb, and some cases start from one lower limb, and both lower limbs are rare at the same time. 2. Dopamine transporter, dopamine receptor and DOPA function tests and SPECT, PET imaging can help early diagnosis of Parkinson's disease. 3. CT and MRI help to rule out Parkinson's disease syndrome similar to Parkinson's disease caused by other brain diseases. Secondary Parkinson's Syndrome: 1. Consult with long-term toxic contact, brain infection, stroke, head trauma and other medical history. 2. In addition to extrapyramidal signs, there are signs of cone system, cerebellum, brain stem damage and autonomic nervous system damage, which can be identified. 3. Use blood, urine, cerebrospinal fluid, and imaging to help identify. [Treatment points] 1. Drug treatment: For patients with early Parkinson's disease, neuroprotective treatment can be used first to delay the development of this disease. When the disease affects the life and work of the patient, different drugs can be selected according to the condition to control the symptoms. 2. Surgical treatment: indications are severe dyskinesias, and all medications do not improve quality of life. The surgical methods include globus pallidus destruction and deep brain microelectrode stimulation in the subthalamic nucleus. At present, it is more inclined to deep brain microelectrode stimulation. 3. Cell transplantation: Cell transplantation is mostly performed on allogeneic embryos. The transplantation of substantia nigra cells into the striatum of the patient can correct the lack of DA transmitter and improve the motor symptoms of Parkinson's disease. However, there are problems such as limited donor sources, long-term efficacy and immune rejection. Therefore, it has not been widely used in clinical practice. 4. Rehabilitation exercise: including speech and tone exercise, facial muscle exercise, hand, limb and torso exercise, relaxation of respiratory muscle exercise, gait and balance exercise, and posture recovery exercise. As an aid, it can also play a role in improving symptoms. Patients with advanced bed rest should strengthen their care and reduce the incidence of complications. 5. Others: Patients with Parkinson's syndrome should actively treat the primary disease at the same time as symptomatic treatment.