PARKINSONISM [by name English doctor Parkinson (J. Parkinson), 1755 — 1824] — slowly progressing syndrome which is characterized by the hypertension of muscles, a trembling hyperkinesia and a bradykinesia arising owing to defeats of extrapyramidal system (basal kernels and black substance), various on an etiology. Allocate P., to-ry can be a consequence of atherosclerosis (atherosclerotic P.), the postponed epidemic encephalitis (postencephalitic P.), injuries (posttraumatic P.), tumors of c. N of page; much less often it develops as a result of various toxic damages of a brain (toxic P.), in particular at poisonings with mercury, carbon monoxide gas, carbon sulfur, lead, manganese, etc. The special group is made by P. connected with intoxication at long use of neuroleptics — aminazine, Reserpinum, Triphtazinum (Stelazinum) and t. and.
P.'s emergence is connected with loss of function of black substance (see. Mesencephalon ) and control basal kernels (see) over reticular and spinal ways that increases time of a tonic delay of muscles. Permanent depolarization of a postsynaptic membrane of a myoneural (aksomyshechny) synapse and disturbance of regulation of a muscle tone generally through gamma neurons is observed. The item has a certain neurochemical basis and is connected with disturbance of kate-holaminovy exchange in a brain (see. Catecholamines ). At P. the content of dopamine in basal kernels considerably decreases and synthesis of melanin in black substance decreases. There are data on a role in a pathogeny of a syndrome of acetylcholine in this connection P. is represented as the complex process caused by balance upset of cholinergic and dofaminergichesky mediator systems.
Pathomorphologically defeat of black substance (loss of neurons, disappearance of a pigment, izoformny gliosis) and a pale sphere is characteristic of all forms P. (see. Basal kernels ); also various extent of changes of a striate body is found and reticular formation (see). At atherosclerotic parkinsonism against the background of changes of the vessels inherent to atherosclerosis, in a brain multiple focal defeats come to light (cysts, lacunas, hems, losses and dystrophy of neurons, proliferation of a glia). At postencephalitic P. in a brain perivascular accumulations of lymphoid cells, loss and dystrophy of neurons, the expressed gliosis are found; process has more local character in comparison with the atherosclerotic Item. At posttraumatic P. hydrocephaly, an atrophy of substance of a brain come to light, there are signs of hemorrhages in basal kernels. At toxic, naira, mercury, P. are noted considerable dystrophic changes of cells of basal kernels, front and side columns of a spinal cord, peripheral nerves; melkoochagovy necroses meet.
The most characteristic symptoms of P. are a muscular hypertension (see. Tone ) in the form of extrapyramidal rigidity (see. Extrapyramidal system ), a trembling hyperkinesia (see. Trembling ), hypokinesia (see) and an akineziya (see. Movements ). Quite often nek-ry of these symptoms on degree of manifestation prevail over others in this connection distinguish akinetic, and kinetiko-rigid, rigid and trembling and trembling forms P.
The akinetic form P. is characterized by the greatest extent of restriction of movements with decrease in the general physical activity and vyr and Zita in l nos to t and a zhestik of a lyation.
Very slow and tonichny are mimic movements; they are carried out hardly and are inclined to hardening. At patients the rare blinking (Mari's symptom), the silent, monotonous, fading, deprived of modulation speech is noted. During the walking consensual movements of hands are not observed (acheirokynesis), patients move small steps with bent to acceleration and with the phenomena of propulsion (impossibility at once to stop).
At and a kinetiko-rigid form P. along with an akineziya are noted muscle tension (a plastic hypertension). The phenomenon of a cogwheel which is observed at this form — the tolchkoobrazny resistance to passive bending and extension of extremities is connected with the raised muscle tone. Rigidity is noted in all muscles or has selective character. High degree of muscle tension causes fixing of the patient in a so-called pose of the applicant: the trunk is bent forward, the head is inclined to a breast, hands are slightly given to a trunk and bent in elbow joints, hands are in sog-N uty on a bed and pi.
For a rigid and trembling form P. the most characteristic, in addition to rigidity, is to a drozhata ii flax the hyperkinesia. Trembling has melkoritmichesky character, it is noted at rest (a tremor of rest), especially in upper extremities, and disappears at autokinesias. During the trembling typical reduction of a thumb of a brush is observed that reminds driving of pills. Sometimes trembling extends to separate muscles of the head and a neck.
The trembling form P. is shown by hl. obr. a trembling hyperkinesia while the akineziya and muscle tension are expressed more weakly.
For atherosclerotic P. dominance of akineti-to-rigid manifestations in combination with pseudobulbar and pyramidal symptoms, and also existence of symptoms of atherosclerosis is peculiar. Postencephalitic P. differs in the raised tone of muscles and an akineziya, a tremor of rest, and also symptoms, characteristic of encephalitis: weakness of convergence, disturbance of pupillary tests, spasms and oculogyric crisis, vegetative frustration (hypersalivation, greasiness of the person), changes of mentality (aspontannost, emotional prituplennost), etc. For toxic P. along with the expressed trembling hyperkinesia, especially in hands, svoystven a number of specific symptoms. So, at lead P. anemia, the phenomena of a polyneuritis, an alalia, epileptiform attacks are noted. Mercury P. is combined with the expressed mental disorders (hallucinations, fears, a condition of melancholy and alarm, the developing weak-mindedness, etc.), a polyneuralgia, radiculoneurites; neuritis of an elbow nerve, vegetative disturbances is most often noted.
Differential diagnosis carry out with trembling paralysis (see), for to-rogo the late beginning of a disease (at the age of 50 — 60 years), small trembling of the head, a pose of the applicant, senesthopathias and lack of vegetative frustration is most characteristic.
Treatment complex. The leader is medicinal therapy using L-dofa and the drugs (Madoparum, Sinemetum, a nakom) reducing a lack of dopamine of subcrustal nodes supporting her. Since deficit of dopamine is not the only origin of symptoms of P. resulting also from balance upset between dofaminergichesky and cholinergic systems, L-dofa usually combine with the cholinolytics (Cyclodolum, Norakinum, artany, etc.) suppressing the increased cholinergic activity. As additional resources use Midantanum (amantadin), ^-adrenoblockers ((((((((((anaprilin, Obsidanum), Muscle relaxants and fortifying means. There are data on successful use of Bromocriptinum, lergotril and other means which are directly stimulating dopamine receptors. In parallel with medicinal therapy apply to lay down. physical culture, massage, auto-training; positive impact is exerted by work therapy. Conservative treatment of sick P. provides, as a rule, long compensation of process and a possibility of active work.
In some cases operational treatment is shown, a cut it is the most effective at a rigid and trembling form P. In the 50th 20 century concerning P. performed direct operations of destruction of basal kernels of a brain, to-rye did not gain recognition in connection with a high postoperative lethality. Sovr, operational treatment of P. using stereotaxic operations on basal kernels (see. Stereotaxic neurosurgery ) it is shown at inefficiency of prolonged conservative treatment pharmakol, means or intolerance of these means and progressing of the Item. Absolute contraindications are the senile age of the patient, a mental disease, an idiopathic hypertensia with high raising of the ABP postponed a heavy myocardial infarction and disturbances of cerebral circulation, a disease of blood, a serious illness of a liver and kidneys, a diabetes mellitus. Relative contraindications: the expressed hydrocephaly, stenocardia, hron, diseases of lungs. In each case the issue of stereotaxic operation is resolved individually.
At essential dominance of manifestations of P. on one half of a body operation is made on basal kernels of the opposite side; at bilateral defeat (at right-handed persons) operation on the left basal kernels for the purpose of improvement of function of the right hand is preferable.
The combined destruction of two subcrustal structures which appeared the most effective — a ventrolateralny kernel of a thalamus and a subthalamic kernel by means of various methods — a cryolysis is applied (see. Cryosurgery ), high-frequency coagulation with thermocontrol, anode electrolysis and a method of induction heating.
According to many researchers, at 85 — 90% of sick P. after stereotaxic operation good results are observed: almost completely trembling and muscle tension of the corresponding extremities disappear, the akineziya decreases, gait improves, ability to write and service itself is recovered. The stereotaxic operation performed on one party does not prevent progressing of process on other side of a body. A recurrence after stereotaxic operation for P. is observed in 6 — 8% of cases.
Bibliography: Bogolepov N. K. Atherosclerotic parkinsonism, in book: Disturbances of cerebral circulation, under the editorship of Yu. M. Lopukhin, century 1, page 37, M., 1968; Kandel E. I. Parkinsonism and its surgical treatment, M., 1965, bibliogr.; Clinic of parkinsonism, the Current state of a problem, under the editorship of JI. S. Petelina, p.1 — 2, M., 1977; Petelinl.S.iatadzhanovm. A. Genetika of Parkinson's disease, Tashkent, 1977; Stolyarova L. G. of ides of river. Rehabilitation of patients with parkinsonism, M., 1979; Physiology and a pathophysiology of deep structures of a brain of the person, under the editorship of N. P. Bekhtereva, L. — M, 1967; B about and - N about in S. Sjvremenen ostjr Parkinsanums encephalitis, Sofia, 1975; In i r k m and at-e r W. u. a. Zweijahrige Erfahrungen mit einer Kombinationsbehandlung der Parkinson-Syndroms mit L-Dopa und dem Dekarboxylasehemmer Benserazid (R0 — 4 — — 4602), Wien. med. Wschr., S. 340, 1974; Hassler R., Mundinger F. Riechert T. Stereotaxic in Parkinson syndrome, B., 1979; Parkinson J. An essay on the shaking palsy, L., 1817; Proceedings third symposium on Parkinson’s disease, Edinburgh — L., 1969.
L. S. Petelin; E. I. Kandel (neyrokhir.).