What is parkinsonism, its signs and methods of treatment

Rigid-bradykinetic form is characterized by plastic-type muscular hypersthenia, worsening deceleration of active movements until immobility. Muscle contractures emerge. There is a typical “manikin posture” (“supplicant posture”).

Akinetic-rigid and tremor-dominant form is characterized by the tremor of the limbs, mainly of their distal segments accompanied by the stiffness of voluntary movements.

Tremor-dominant form is characterized by the presence of permanent or almost permanent medium-amplitude and coarse tremor of limbs, tongue, head, lower jaw. The muscle tone is normal or slightly elevated. The tempo of voluntary movements is preserved.

Secondary parkinsonism is a functional brain disorder characterized by the dopaminergic block of basal ganglia similarly to Parkinson’s disease (PD) caused by other reasons (for example, medications, cerebrovascular diseases, injury, postencephalitic residual effects). In compliance with the last agreements of the European Parkinson’s Disease Association, the parkinsonian syndrome is divided into four groups:

• idiopathic parkinsonism;
• genetic forms of parkinsonism, familial parkinsonian syndrome is a hereditary form that is defined by the localization of the gene (for example, PARK1);
• parkinsonism in terms of other neurodegenerative diseases (atypical forms of parkinsonism that are sometimes called “parkinsonian syndrome plus” because of additional symptoms);
• symptomatic parkinsonian syndromes, for example, the consequence of chronic administration of some medications (amphetamines, neuroleptic agents), injuries, tumors, effect of toxic substances, endocrine-metabolic disorders, inflammatory and infectious diseases (encephalitis, syphilis, influenza).

• to interview a patient attentively, including the obtaining of the information on his/her professional activity, drug administration, family history;
• to perform the assessment in order to detect neurological diminished symptoms caused by the diseases other than PD;
• to apply visualizing examinations of the nervous system in case of the presence of uncharacteristic factors (for example, falls at the onset of the disease, early cognitive impairments, ideomotor apraxia [inability to imitate gestures], hyperreflexia).

Destructive surgeries are thalamotomy and pallidotomy. Thalamotomy is indicated only in cases where the main symptom of the disease is tremor. To obtain a positive result of the surgery, patients must meet several criteria: PD is manifested by unilateral tremor; nonsurgical treatment is ineffective. Efficiency of the surgery is 96 %. Complications after thalamotomy are dysarthria, abulia, dysphasia, dyspraxia.

Pallidotomy can be indicated for patients with predominance of movement disorders, when nonsurgical treatment is ineffective. The procedure involves introducing a needle into the pallidum followed by its partial destruction. Pallidotomy is a relatively safe procedure. The effectiveness of pallidotomy is quite high: hypokinesia in the limbs opposite to the side of the surgery decreases in 82 % of cases.

With the development of radiosurgery, a new opportunity has emerged to destroy corresponding nervous structures without traumatizing surrounding structures and tissues.

Neurostimulation is a modern method of treatment, which is a minimally invasive neurosurgical operation. The essence of the method is as follows: the therapeutic effect is achieved due to stimulation of certain structures of the brain, which are responsible for control over body movements, with a precisely calculated small-amplitude electric current. For this purpose, thin electrodes are inserted into the patient’s brain, which are connected to a neurostimulator (similar to a pacemaker), which is implanted subcutaneously in the chest area under the collarbone.