Five years ago, when I was a master's student at Xuanwu Hospital, I did a lot of research on Parkinson's disease with the team of Mr. Chen Biao, who is one of the leading experts on Parkinson's disease in China. At that time, I also attended outpatient clinics with the team and participated in some national and international conferences. So I have an in-depth understanding of Parkinson's disease.

"There are two types of Parkinson's disease and Parkinson's syndrome. In Parkinson's disease, there is a set of treatments; in Parkinson's syndrome, there can be a variety of causes, such as medications.

We will focus on Parkinson's disease. There are four main movement-related symptoms of this disease, including resting tremor (hands shake when you stay still and stop shaking when you move), increased muscle tone in the joints of the extremities, which are particularly stiff (the doctor examines the arms and sees that they are very hard to move), bradykinesia (slow walking, not being able to take a step at the beginning of the initiation of the step), and postural gait disturbances (leaning forward with a small, choppy gait).

The predominant pathological change in Parkinson's disease is the degenerative death of dopaminergic neurons in the substantia nigra of the midbrain, which simply means that there is less of one thing in the brain.

All currently applied treatments improve the symptoms but do not stop the progression of the disease. The main methods are the following:

I. Drug therapy

Medication is by far the mainstay of treatment. There are six main classes of drugs. Among them, levodopa preparations (direct dopamine supplementation) are still the most effective. The direct application of levodopa preparations is not recommended at the beginning of the disease in general, and dopamine agonists etc. are routinely applied first, then the dose is gradually increased according to the condition, and then dopa preparations are added if this is not feasible, and then the dosage is constantly adjusted. However, after some time, the drug will be slowly tolerated, the effect will be reduced, and some anisotropy will appear, which is not well controlled. Patients are very painful.

People with Parkinson's disease also have many non-motor symptoms that need to be managed symptomatically.

Secondly, when the effect of medication is poor at the later stage, surgical treatment can be chosen according to the situation. Surgical treatment has strict indications, many do not improve, and the cost is not small, about 200,000 or so. A small number of patients can relieve symptoms through surgery, but the effect will not be as good as imagined. It's not like appendicitis, where cutting out the appendix makes it better.

Third, rehabilitation, psychotherapy and good nursing care can also improve symptoms to some extent. I think any disease can benefit from these treatments. Good mood, proper rehabilitation and quality care can help the disease.

Parkinson's disease is also an age-related disease, the second most common neurodegenerative disease after Alzheimer's disease. The number of patients is also high, and in the later stages of the disease, the inability to take care of themselves puts a great burden on the patients and their families.

Mr. Chen Biao team, is the top team in the domestic research of Parkinson's disease, their group is doing a lot of scientific research, including a lot of clinical research studies, generally the follow-up of the disease as well as questionnaires or do nuclear magnetic, no harm to the human body, but also through the team to keep in touch with the convenience of medical treatment, free of the registration of the particular difficulties of the trouble. I used to be a member of the team, and there are still contacts there. If you need to contact me, you can contact me. Writing this paragraph is a bit like an advertising promotion. It really isn't. It's just the experience of doing research together in the past. I hope it will be helpful to you.

Parkinson's disease is a neurological disorder that is prevalent in middle-aged and older people, with seniors over the age of sixty being at high risk for Parkinson's.

So far, Parkinson's can be treated withMedication, surgery, rehabilitationthree ways to manage their symptoms.Delaying the progression of the disease can ease the burden on Parkinson's patients as well as their families.

01. Drug treatment

Once a definitive diagnosis has been made, early medication is recommended.Especially when the disease has already affected the patient's daily life and ability to work, proper medication can alleviate symptoms to varying degrees and prolong life by reducing complications.When an elderly person exhibits any of the following symptoms, he or she should be diagnosed by a neurologist:

• The trembling of hands and feet
• Move slowly.
• homeostatic dysfunction
• Muscle stiffness (soreness when moving arms or legs)

As a reminder, Parkinson's treatment is highly specialized and medication must be used under the guidance of an experienced neurologist to ensure safety and efficacy.

02. Surgical treatment

Clinical follow-up of surgical treatment and pharmacologic outcomes for patients with different disease durations (5, 8, 15, 20 and even 26 years of Parkinson's disease)The data show that the earlier a patient is treated surgically, theThe therapeutic effect is to be better, so it is recommended that although drugs are the treatment of choice, patients with a clear diagnosis of Parkinson's disease and indications for surgery should undergo surgical treatment as early as possible, especially if the effect of drugs has been poor and complications such as anisocoria, switch phenomenon, morning stiffness phenomenon, etc., are present.Surgery is combined with medication to achieve better results.

The surgical methods arestereotactic nucleus destruction和Deep Brain Stimulation (DBS). A common target for neuronal nucleus destruction is theVentral intermediate nucleus of the thalamus (Vim) and posterior ventral part of the pallidum (PVP).. The thalamic ventral intermediate nucleus was selected more often for patients with predominant tremor, and the ventral posterior part of the pallidum was selected as the target for those with predominant rigidity.

DBS is known for itsMinimally invasive, safe and highly controllableAnd as a primary option. New therapies using stem cell transplantation combined with gene therapy are being explored.

03. Rehabilitation

e.g.Physical Movement, Speech, Feeding, Daily LivingSuch training and instruction may improve the patient's quality of life and reduce developmental disorders.Psychological Counseling and Disease EducationIt is also an important integrative treatment measure for Parkinson's disease.

Parkinson's patients' physical strength and condition have declined, so they should not do strenuous exercise, and the exercise should focus on improving endurance, maintaining joint mobility, and avoiding bedsores. Usually, attention should be paid to dietary diversity, to meet the body's needs for various nutrients, to pay attention to the food is soft and easy to digest, conducive to chewing and swallowing, and actively prevent constipation.

Psychological care: create a good environment so that patients can obtain the best physical and mental state. For those who are suspicious and sensitive, pay attention to the patients' complaints and listen patiently to alleviate their fear and anxiety about the disease, and for those who are stubborn and have personality changes, their personality should be respected.

I'm Ren Jie, I'm in Kunming Sanbo Brain Hospital, if it helps you please click a like, welcome to add attention, if there is any problem can be commented below, see will be back, back will be fast, thank you for your support!

There are both hot and cold in any disease in the world, and there is probably only one type of so-called Parkinson's disease, and there will not be two.

The biggest manifestations of Parkinson's patients are symptoms such as low mood, severely lower intelligence than before, shaking hands and feet without instructions, and often involuntary clear drooling.

Modern medicine to study the disease, the conclusion that what nerves by what dopamine, etc., but always branch Wu Wu dare not say the cause of the origin of the disease, for fear of the blame of the Western interest groups. Therefore, modern medicine on the cause of the disease, no one dares to tell the truth, in order to maintain the interests of Western interest groups as the upper hand.

Parkinson's disease, for Chinese folk wild plant medicine, is not a difficult disease to treat.

Parkinson's disease, strictly speaking, is the body's heart blood vessels serious deficiency failure, the heart blood vessels to the body's organs and tissues of the long-term supply of blood and oxygen is not enough, depending on the occurrence of a unique disease, because the heart failure of people do not necessarily appear Parkinson's disease.

Treatment of Parkinson's disease, must know how to use the essence of Chinese medicine theory, flexible treatment, many Parkinson's patients can be restored to normal health, only a small number of Parkinson's disease patients, will be due to heart failure to the drug can not be reversed after the drug is no cure.

Overall, Parkinson's disease is easier to cure than many heart failure patients because of the Chinese folklore of the Lord's creation, the original wild plants special medicine, can easily cure Parkinson's disease. If you have any doubts, you can ask your patients to come and try it to know the effect.

　　Parkinson's disease is a common extrapyramidal disorder in middle-aged and elderly people. The first symptoms of the patient are, in descending order, tremor, tonicity or slow movement, loss of dexterity or dysgraphia, gait disorders, myalgia spasm and pain, often accompanied by vegetative nerve disorders and mental disorders. There is no effective way to prevent the disease, and the treatment of Parkinson's is comprehensive, with long-term medication as the main treatment, along with physiotherapy, hydrotherapy, medical sports and daily life adjustment and surgery.

　　Clinical treatment is based on medication, which needs to be personalized throughout the treatment process, and the dosage is the smallest dose that produces satisfactory efficacy and is standardized for long-term use. In addition must not be multiple varieties of anti-Parkinson's disease drugs used together, and should not be abruptly discontinued.

　　Drugs for Parkinson's disease are now in their third generation. The first generation was anticholinergic drugs such as Antan, Benztropine, Chemagun and Ankyl Spasm. The second generation was levodopa. The third generation are dopamine agonists and potentiators, which can be used in combination with levodopa to reduce the dose of levodopa. In addition, antihistamines such as diphenhydramine and ipratropium can be used concurrently depending on the patient's condition. The use of nutritive drugs such as methylcobalamin tablets, glutamine, etc., to reduce the symptoms of phytoneurological disorders and psychiatric disorders.

　　At present, stem cell transplantation therapy and gene-targeted therapy are in the research stage, and the main modes of stem cell transplantation therapy in the clinical trial stage are: cell suspension stereotactic injection; collagen matrix embedding method; intraventricular cell suspension input method; intracerebroventricular cell suspension injection, etc., but they have not yet been widely promoted by the clinic. In addition, gene-targeted therapy has also been a hot spot of research in recent years, and is a future direction of treatment for neurodegenerative diseases in the elderly.

Click on the bottom of the page [Learn More] to see more answers or ask the doctor a question for free!

Follow "Family Doctor Online" headline, more health Q&A easy to see~~~~

At the time of the U.S. election, Trump attacked Hillary with Parkinson's disease, and a series of Hillary's evidences about Parkinson's disease, especially some evidences of purchasing Parkinson's medication, have been revealed on WikiLeaks. Parkinson's disease is no longer confined to the elderly, but is also a favorable factor for people over 40 years of age, with stressful jobs and impatient brain workers.For Parkinson's disease, in the early days, medications were still the first priority, but now DBS surgery is becoming more popular as well.

First, what kind of patient is a candidate for DBS surgery?

For more specialized science, welcome to my Goku Q&A "Sin Sur"!

Prof. Wu Jingwen, director of the Department of Functional Neurology at Dongfang Hospital, Tongji University, said:

Cases of Parkinson's are actually difficult to cure at this point in time, but they can be treated effectively. Treatment is generally categorized into these types of therapies: there is medication, surgery, and cellular therapy. The first two methods are generally regarded as symptomatic treatments, that is, what symptoms appear, what methods are used to treat them. Only the latter type of cell therapy is a counterpart therapy. Why is it a counterpart therapy? Because it is a counterpart therapy that replenishes the dopamine-deficient cells, but it is still in the research stage.

medication

Patients with Parkinson's know all too well that medication is good and effective at first. Generally the medication is maintained for 3 to 5 years, beyond which the efficacy of the medication decreases. In order to increase the efficacy, will increase the use of drugs and the number of types of drugs, but after the increase of the side effects of this drug will come out, there may be a switch phenomenon: a moment of good and a moment of bad, as well as the end of the agent phenomenon, muscle twitching, dry stools, and sleep disorders will be further aggravated, so the side effects of the drug in the honeymoon period after the honeymoon period is very obvious, and also difficult for the patient to tolerate a state, why is it so? Because only 1% of the drugs we take are absorbed into the brain to replenish dopamine, or to promote dopamine secretion, about 99% are metabolized in the periphery, then it acts on the peripheral intestines, lungs, liver acceptance, then the side effects may affect a lot. So for those patients who have passed the honeymoon period, then there are other options to consider for guidance.

surgical treatment

As a result of the decrease in dopamine, this relative transmitter of acetylcholine is increased. Then some of the nuclei, including the thalamic nucleus, the pallidum, and even the ventral intermediate nucleus of the thalamus, become abnormally excited. These excitatory nuclei lead to dysfunction of the motor system. So by surgical means, we can target these three nuclei, reduce their excitability, and bring their motor disorders to a balance, so that we can have a therapeutic effect on the environment. So this is a basic principle of our surgical treatment.

Parkinson's disease PD, also known as tremor paralysis, is a neurodegenerative disease commonly seen in middle-aged and old-aged people, clinically characterized by resting tremor, bradykinesia, muscle tonus and postural balance disorders. Regarding the treatment of this disease, there are several Parkinson's treatment guidelines in different countries around the world. Based on the reference to the foreign treatment guidelines and the actual situation in China, the Chinese Parkinson's treatment methods developed by experts of China's Parkinson's Disease and Movement Disorders Group are as follows:

(i) Principles of treatment

1. Comprehensive treatment: Comprehensive treatment should be taken in combination with motor and non-motor symptoms of PD, including medication, surgery, rehabilitation, psychotherapy and nursing care. Drug treatment is the first choice and the main treatment means in the whole treatment process, while surgery is an effective supplement to drug treatment. Currently applied treatments, whether medication or surgery, can only improve the patient's symptoms, but not stop the progression of the disease, let alone cure it. Therefore, treatment should not only be based on the present, but also requires long-term management to achieve long-term benefits.

2. Principle of medication: to achieve effective improvement of symptoms, improve the life of the treatment as the goal. Adhere to the "dose titration", "the smallest dose to achieve satisfactory results", the treatment should follow the general principles, but also should emphasize the individual characteristics of different patients should be considered not only the characteristics of the disease, but also take into account the patient's age, employment status, economic and affordability. The selection of drugs for different patients should not only take into account the characteristics of the disease, but also the patient's age, employment status, and economic capacity.

(ii) Drug therapy

1, Protective therapy: At present, the main drugs used as protective therapy are monoamine oxidase B inhibitors (MAO-B), such as Silegilai.

2、 Symptomatic Treatment - Early Parkinson's Disease

1) Pre-elderly (<65 years old) patients, and not accompanied by mental retardation, may have the following choices: (1) non-ergot DR agonists; (2) MAO-B inhibitors, or the addition of vitamin E; (3) amantadine; (4) compound levodopa + catechol-oxygen-site-methyltransferase (COMT) inhibitor, i.e., Dariflunomide; and (5) compound levodopa: generally added when treatment with regimens (1), (2), and (3) is ineffective.

2) Elderly (≥65 years) patients, or with mental retardation: preferred compound levodopa, plus DR agonists, MAO-B inhibitors, or COMT inhibitors if necessary.

Therapeutic Drugs:

1) Anticholinergics: phenazopyridine

2) Amantadine: 50-100 mg 2-3 times/day, the last dose should be taken before 4 pm.

3) Compound levodopa (benserazide levodopa, carbidopa levodopa): it is still the most basic and effective drug for the treatment of this disease, and it has a better effect on tremor, tonus, and motor retardation.

4) DR agonists: Non-ergot DR agonists are mostly promoted as the drug of choice, including pramipexole and piribedil.

5) MAO-B inhibitors: silegiline, resagiline, etc.

6) Catechol-oxygen-site-methyltransferase (COMT) inhibitors: entacapone and tolcapone.

3. Symptomatic treatment-moderate to advanced Parkinson's disease

Symptoms often do not improve significantly in the middle and late stages, and the clinical presentation is more complex, with side effects of medications and factors involved in the progression of the disease itself. The treatment improves motor symptoms on the one hand, and on the other hand, it is necessary to deal with some concomitant motor complications and non-motor symptoms.

(iii) Surgery and stem cell therapy

Surgery can be considered for those who have shown significant results in early drug treatment, but whose efficacy has diminished significantly with long-term treatment, as well as for those who have developed anisocoria. It should be emphasized that surgery only improves the symptoms, but cannot cure the disease, and medication still needs to be applied after surgery, but the dose can be reduced. The main surgical methods are neuronal nucleus destruction and deep brain stimulation (DBS). In addition, the emerging stem cell transplantation combined with neurotrophic factor gene therapy is expected to overcome this obstacle, and is a more promising new treatment being explored.

(iv) Chinese medicine, rehabilitation and psychotherapy

Traditional Chinese medicine or acupuncture and rehabilitation therapy as an adjunct can also play a role in improving symptoms. Training and guidance for patients in speech, eating, walking and all kinds of daily life can improve the quality of life. Education and psychological counseling are also auxiliary measures that should not be ignored.

The disease is a chronic progressive disease that cannot be cured. The current treatments are those mentioned above. Most patients with this disease can continue to work in the first few years of the disease, but gradually lose the ability to work after a few years. In the late stages of the disease, due to the stiffness of the whole body and difficulty in movement, they are eventually unable to get out of bed, and eventually often die from various complications such as pneumonia.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Minor Parkinson's surgery for a major problem!

{!-- PGC_VIDEO:{'thumb_height': 354, 'thumb_url': 'a190000f271f90f28819', 'vname': '', 'vid': 'v02016530000bdhu8ulf1stetq0pbopg', 'thumb_width': 640, 'src_thumb_uri': '9f9f0011d01fa63ec1a3', 'sp': 'toutiao', 'update_thumb_type': 1, 'vposter': 'https://p3-sign.toutiaoimg.com/mosaic-legacy/a190000f271f90f28819~noop.image?x-expires=1971447113&x-signature=vLSUz4UKw3Wq2J%2BSo27cNm3fees%3D', 'video_size': {'high': {'duration': 52.64, 'h': 416, 'subjective_score': 0, 'w': 752, 'file_size': 4665610}, 'normal': {'duration': 52.64, 'h': 354, 'subjective_score': 0, 'w': 640, 'file_size': 3261667}}, 'md5': '5cf75679cb7a8f3603af9d8670c00c45', 'duration': 52.64, 'file_sign': '5cf75679cb7a8f3603af9d8670c00c45', 'thumb_uri': 'a190000f271f90f28819', 'vu': 'v02016530000bdhu8ulf1stetq0pbopg'} --}

With the development trend of population aging in China, the population is aging, and Parkinson's disease is a common central neurodegenerative disease in middle and old age. Parkinson's disease is also called tremor paralysis, which is characterized by resting tremor, bradykinesia, myotonia, and postural gait disorders. The current clinical treatment is aimed at reducing the symptoms and slowing down the progression of the disease, and the treatment includes medication, surgical treatment, rehabilitation therapy and psychotherapy, of which medication is the first choice of treatment, and is also the most important means of treatment.

Early treatment:In terms of drug selection, individualization needs to be followed in principle, and drugs should be started in small doses and increased slowly to achieve satisfactory efficacy with the smallest dose.

The drugs represented are the following:

1. Anticholinergic drugs, the mechanism of action is to prevent the uptake of Ach receptors and DA. The representative drugs are phenazopyridine, indications: tremor obvious, relatively young patients. And older patients should be used with caution, contraindications: closed-angle glaucoma, prostate hypertrophy.

2. Amantadine: the mechanism of action is to increase the synthesis and release of DA in the presynaptic membrane. Indications: it can improve hypokinesia, tonicity, tremor, hepatic and renal insufficiency, epilepsy, severe ulcers, contraindications: lactating women.

3. Compound levodopa, is the most basic and effective drug for the treatment of Parkinson's disease, mechanism of action: to increase the level of DA in the substantia nigra striata, active peptic ulcer patients should be used with caution, contraindications: angle-closure glaucoma, psychiatric disorders, due to long-term use of the drug will diminish the efficacy of the young patients to delay or minimize the dosage of the appropriate elderly patients should be from the beginning of a small dosage, according to the condition of the gradually increase

4. Dopamine agonists, mechanism of action: agonizing D1D2 receptors. Classification: one is ergot class, including bromocriptine, bequerel, ergot acetylcholine, and the second is non-ergot class, including pramipexole, piribedilol.

5. Monoamine oxidase A inhibitor, mechanism of action: to prevent the degradation of dopamine in the brain, increase the concentration of dopamine. Gastric ulcers should be used with caution, commonly used drugs are Silegilan

6. Catechol-oxygen-site-methyltransferase inhibitors, which inhibit the metabolism of levodopa and stabilize dopamine, the main drugs are entacapone and tolcapone.

Medium-term treatment:When early treatment with anticholinergic drugs such as dopamine agonists, amantadine, and monoamine oxidase B inhibitors does not result in significant improvement of symptoms, compound levodopa can be added to the treatment. If necessary, the dose of early therapeutic drugs can be increased according to the condition.

advanced treatment: 1. For the treatment of mental disorders, first gradually reduce the anti-Parkinsonian drugs, and if necessary, add antipsychotic drugs, such as clozapine, olanzapine, 2 for the treatment of sleep disorders: before going to bed, you can add the compound levodopamine controlled-release tablets.

Other treatments

1. Surgery and stem cell therapy: Surgery is suitable for those who have significantly reduced the efficacy of long-term treatment, or those who have developed anisotropy. It should be clear here that surgery only improves the symptoms, but not a cure, and medication is still needed after surgery. The main methods of surgical treatment: 1. neuronal nucleus destruction 2. deep brain electrical stimulation.

2. Chinese medicine, rehabilitation and psychotherapy: can be used as an adjunctive treatment to improve symptoms.

My father-in-law is 71 years old, diagnosed with Parkinson's disease, brain atrophy, cervical spine syndrome. The course of the disease has been 10 years, long-term use of methyldopa, the symptoms are worsening day by day. Wasting, vibration (more than 10 times a day), both feet tibialis anterior edema is black, dry mouth, tongue descending red without moss, the tongue becomes small vibration trespass, pulse string number. Traditional Chinese medicine identified as yin deficiency and wind-driven evidence, after applying Da Ding Feng Zhu plus and minus 7 doses, the symptoms improved significantly. I am still exploring ......