Parkinson’s disease, also known as tremor palsy, is a degenerative disease of the central nervous system that occurs in middle and old age. The main lesions are in the substantia nigra and striatum. It is a disease characterized clinically by muscle tremor, rigidity, and reduced movement. For those with unknown etiology, it is called primary Parkinson’s disease or tremor palsy; similar clinical manifestations produced by encephalitis, cerebral arteriosclerosis, traumatic brain injury and poisoning are called Parkinson’s syndrome.
Diagnosis
(I) Clinical manifestations
1, medical history Parkinson’s disease mostly starts slowly and worsens progressively.
2. Tremor is caused by continuous rhythmic (4-6 times per second) contraction and relaxation of the agonist and antagonist muscles of the limb. The tremor first appears at the distal end of one limb, mostly starting from the distal end of one upper limb (fingers), and then gradually expanding to the upper and lower limbs of the same side. The rhythmic tremor of the fingers forms a so-called “pill-rolling movement. However, the symptoms disappear during sleep.
3.Sluggish movement Movement disorder, muscle stiffness, and posture, balance and reflexes, etc., resulting in a series of movement disorders. Patients are unable to do fine motor movements, manifesting as difficulty in writing, the smaller the writing, walking in broken steps and difficulty in speaking, and unable to take care of themselves. Facial muscle movement is reduced, forming a “mask face”.
4, stiffness The extrapyramidal limb muscle tone is increased, and the muscle tone of the extensor and flexor muscles are increased. Therefore, when the joint does passive movement, the increased muscle tone is always consistent, so that the examiner feels a uniform resistance, which is clinically called “leadpipe-like stiffness”. In the case of combined tremor, intermittent pauses are felt on the uniform resistance when extending and flexing the limb, which is also called “gear-like hypertonia” or “folding knife hypertonia”.
(II) Auxiliary tests
1.Laboratory tests
(1) Cerebrospinal fluid examination: the regular indexes are normal, only the metabolite of dopamine, homovanillic acid, and the metabolite of 5-hydroxytryptamine, 5-hydroxyindoleacetic acid, are decreased.
(2) Routine urinalysis: urinary dopamine and its metabolite, homovanillic acid, were reduced.
2, imaging examinations Non-specific changes such as brain atrophy can be seen on cranial CT and MRI. In addition PET examination shows a significant decrease in radioactive dopamine uptake in the basal ganglia region compared to normal.
Treatment
(i) Indications for surgery
For those who are ineffective in drug treatment or cannot tolerate drug treatment, less than 75 years old and without important organ dysfunction, brain stereotactic surgery is feasible with the consent of the patient and family.
(II) Pre-operative treatment
1. Routine preoperative examination and preparation, with special attention to the treatment of combined other geriatric diseases.
2. Discontinue the use of anti-tremor paralysis drugs before surgery.
(C) Surgical treatment
1.Radiofrequency destruction of basal ganglia nuclei.
2. Chronic buried electrical stimulation of deep brain nuclei.
(iv) Postoperative treatment
Maintain and adjust the frequency and voltage of electrical stimulation and assist the treatment with drugs after stereotactic surgery.
(V) Curative effect and assessment (combined with UPDRSIII score)
1.Cure Good recovery of the function of the limb contralateral to the surgery.
2.Significantly improved The function of the limb on the opposite side of the surgery improved by more than 75%.
3.Effective Improvement of the function of the limb on the opposite side of the surgery but less than 75%.
4.Invalid No improvement.