What is Parkinson's disease?

Parkinson's syndrome is also called paralysis. A world-renowned scientist, Hawking, suffers from this disease. This disease is a common neurological disease among middle-aged and elderly people. Common symptoms of this disease include muscle stiffness, excessive saliva secretion, constant body tremors, etc. This disease has a great impact on life and the person basically loses the ability to take care of himself. Its treatment methods include drug therapy, cell transplantation, gene therapy, acupuncture therapy, psychotherapy, etc. This disease still has a chance of being cured in the early stages, so it should be treated promptly upon discovery, otherwise it will be difficult to treat in the later stages. The following is a detailed introduction.

Parkinson's disease (PD), also known as tremor paralysis, is a common neurodegenerative disease in middle-aged and elderly people. The main lesions are in the substantia nigra and striatum. Tremor, muscle rigidity and decreased movement are the main clinical features of this disease. Parkinson's disease is the fourth most common neurodegenerative disease among the elderly.

Conventional treatment

(1) After years of clinical practice, drug therapy has gradually accumulated and continuously summarized experience, and some preliminary principles of drug use have been formulated. However, some content is still highly controversial and will continue to be improved with the advancement of scientific research. The principle of drug treatment is to restore the balance of the two major neurotransmitter systems in the striatum, DA and ACH, but the drug cannot prevent the progression of the disease and needs to be taken for life. The principle is: start with a small dose, increase slowly, maintain at the minimum dose, choose the treatment plan based on age, symptom type, severity, contraindications, price and financial affordability, and reasonably choose the timing of combination medication.

2. Cell transplantation and gene therapy

In recent years, there have been successful cases of transplanting autologous adrenal medulla and allogeneic embryonic midbrain substantia nigra cells into the striatum, which can correct DA transmitter deficiency and improve motor symptoms. However, 50% of patients had symptom improvement, and the mortality and disability rate was 15%. In addition, there were problems such as limited donor sources, uncertain long-term efficacy, and immune rejection. Transplantation of gene-processed cells or direct vector-mediated gene transfection, as well as specific dopaminergic nerve growth factor, are the most effective methods for treating PD. The tyrosine hydroxylase gene (THCDNA) has been cloned, and types 1 and 2 of THCDNA have been transfected into fibroblasts or AtT-20 cells using retrovirus, and expression of tyrosine hydroxylase activity has been obtained. However, this method is still in the animal experiment stage, the technology is not mature and cannot be used clinically.

3. Select the best solution

Since PD treatment is lifelong, surgical treatment is not easily accepted by patients and their families in the early stages, so the choice of drugs is particularly important. At the same time, rehabilitation treatment should always accompany drug treatment, taking into account the progress of drug treatment in recent years.

(1) Interventional treatment for early-stage mild patients to prevent disease progression. MAO-B inhibitor + vitamin E (DATATOP regimen): oral selegiline + oral vitamin E.

(2) It is the preferred option for young patients with early-stage disease and no motor delay. Anticholinergics or amantadine:

① Start with a small dose of trihexyphenidyl and gradually increase to the dosage, but do not exceed 4 mg/day orally.

②Take benzhexol + amantadine orally.

(3) If the disease progresses and the above treatment is ineffective, a low-dose combination of L-Dopa + DA receptor agonist can be used: levodopa/carbidopa (Sinemet) (carbidopa 10 mg, levodopa 100 mg) + bromocriptine (Bromocriptine) taken orally for 3 to 4 years. Depending on the condition, the patient can be transitioned to L-Dopa controlled-release + DA receptor agonist to prevent movement disorders.

Prognosis

Parkinson's disease is a progressive degenerative disease. All drug treatments can only improve the patient's quality of life and work, but cannot prevent the progression of the disease, and the patient will eventually lose the ability to live. Judging from the symptoms, those with tremor as the main symptom have a better prognosis, while the elderly are mainly less active, so their prognosis is poorer. The main cause of death from Parkinson's disease is complications caused by lack of movement in the late stage of the disease, such as bedsores and sepsis, heart failure, lung infection and urinary tract infection, which account for 50%, 28%, 14% and 8% of the causes of death from Parkinson's disease respectively. Because of the weakening of parasympathetic nerve excitement and levodopa effect in the early morning, Parkinson's disease patients often die in the early morning.