Parkinson's Disease and Other Degenerative Brain Syndromes

Parkinson's disease is characterized, at the anatomopathological level, by neuronal degeneration in the substantia nigra and other pigmented nuclei of the brainstem. It is a chronic, progressive, degenerative disease of the brain. It occurs when certain nerve cells in a part of the brain called the Substantia Nigra are damaged or die. Normally these neurons produce a chemical product known as dopamine, which helps coordinate the movement of the body's muscles. When about 80% of the dopamine-producing cells are damaged or die, symptoms of the disease appear.

It usually begins after the age of 60, but juvenile forms with onset before the age of 40 are also recognized.

Clinical Manifestations

Clinically, it manifests with the signs of parkinsonian syndrome:

• Resting tremor
• Rigidity
• Bradykinesia
• Postural disorders
• The "freezing" phenomenon

To be classified as a clear parkinsonian syndrome, at least two of these signs must be present, one of which must be tremor or bradykinesia.

A parkinsonian syndrome is considered suspected when there is one sign, which is either tremor or bradykinesia.

A parkinsonian syndrome is considered possible when the patient shows other signs besides tremor and bradykinesia.

In addition to the signs of parkinsonian syndrome, sleep disturbances, disorders of higher cognitive functions and skeletal muscle pain may also occur.

Other Degenerative Brain Syndromes

Besides Parkinson's disease, there are other degenerative brain syndromes, which include:

1. Morbus Parkinson (idiopathic).
2. Drug-induced parkinsonian syndrome (haloperidol, cinnarizine, lithium, flunarizine).
3. Post-traumatic parkinsonian syndrome.
4. Atypical parkinsonian syndromes (multiple system atrophy, progressive supranuclear palsy, striatonigral degeneration).
5. Neurodegenerative diseases (Huntington's chorea, mitochondrial disorders, hepatolenticular degeneration).

Staging of the Disease

Several scales are used to assess the progression of the disease and the effectiveness of therapy. The Hoehn and Yahr scale divides the disease into 5 stages:

1. Stage 1: Signs of parkinsonian syndrome are unilateral and functional impairment of the patient is minimal.
2. Stage 2: Signs are bilateral, and again there is no significant functional impairment.
3. Stage 3: Postural disorders appear.
4. Stage 4: The patient is nearly dependent on others but can perform some small tasks independently.
5. Stage 5: The patient is confined to a wheelchair or bed and is completely dependent on others.

Treatment and Rehabilitation

Treatment and rehabilitation depend on the stage of the disease. However, the basis of treatment is the administration of dopamine preparations in the form of their precursors, dopaminergic drugs, and anticholinergics.