Treatment of parkinsonism

Treatment and prognosis. In acute and recurrent stages of Parkinson's disease in need of treatment, used for acute encephalitis viral etiology (see Encephalitis). In the chronic stage is prescribed for intravenous infusion 40% solution of hexamethylenetetramine (+) and 5 ml of 40% glucose 10-20 ml showed plenty of introduction of ascorbic acid and other vitamins. Good action has nicotinic acid. It is recommended that long term use of antihistamine that reduces the permeability of the vascular wall and the phenomenon of brain edema. Symptomatic means that affect the immobility and stiffness of muscles is Arten (1 mg 4-5 times a day during meals). Recommended therapeutic exercises, massage, Hiking, hydrotherapy, in particular sulphur bath, inhalation or subcutaneous injection of oxygen. Applied and resolving therapy pyrogenal and other hyperthermic means. You must use the cortical mechanisms of compensation. With this purpose should be used drugs caffeine (low dose), ephedrine, zenadrine and psychotherapy.

Effective surgical treatment of Parkinson's disease has only been possible in recent years after the development and introduction in neurosurgical practice stereotaxic method (see). This method is a set of calculations and tricks using the coordinate system to determine the defined structure deep in the brain, and then to make its destruction.
Indications for surgery in parkinsonism arise in cases where long-term treatment medication has no effect, and the steady progression of the disease threatens the working ability of the patient or his self-service capabilities. Contraindications to surgery of the basal ganglia of the brain are the elderly (over 60 years), hypertensive disease, stenocardia, gross violations of the psyche, etc. should Not be operated when miotaticheskogo form of the disease.
Currently, the most effective operation in parkinsonism is stereotactic destruction intrauteralno kernel visual mound [Richert (So Riechert), Cooper (I. S. Cooper), 1961; E. I. Kandel, 1965]. Setting this kernel is the x-ray of the skull after preliminary contrasting ventricles of the brain. With this purpose a number of intracerebral landmarks - III ventricle, hole Monroe, front and back comissary etc. Cannula (electrode) to introduce in the above structure using stereotactic apparatus under radiological control. Electrostimulation subcortical structures, disposal of biopotentials and special functional tests are additional methods of control accuracy specified in the deep structure of the brain. Operation is performed under local anesthetic, which allows to estimate the effect of the intervention directly on the operating table.
. For local destruction of subcortical structures used several methods: introduction 96 degree alcohol, anode electrolysis, high-frequency electrocoagulation, freezing and other Local freezing using liquid nitrogen is currently the method of choice. For this purpose, designed a special device with vacuum insulation. At the end of the cannula this device creates a low temperature (up to-40C), able to turn into ice calculated in advance the amount of brain tissue. After thawing is formed strictly outlined hearth full of necrosis, which does not cause total or perifocal reactions of the brain. Freezing local easily tolerated.
Immediately after the destruction intrauteralno thalamic nuclei disappear (or sharply decrease) tremors and muscle rigidity in the contralateral (relative to the side operations) limbs, recover fast and free movement in them. Often there is some improvement on the side of the operation. When bilateral lesions operation is usually produced on the left (to restore the function of the right hand).
The frequency of postoperative complications does not exceed 5-6%. Of these, mention should be made of mental disorder, as well as the paralysis of the extremities, which usually disappear within 2-3 weeks. Postoperative mortality does not exceed 2-3%.
In 75-80% of patients are good or satisfactory long-term results. They are complete, or almost complete disappearance of the tremor, muscle rigidity, in reducing overall stiffness, improve gait, the disappearance of propulsive and muscle pain, and reduction of vegetative symptoms, improve speech. As a result of operation in many patients improved or restored the ability to self-service, and some of the patients returned to work.
For a complete functional recovery is often required a second operation (on the other side). However, the testimony to it is strictly individual and do a second operation should not earlier than in 3-4 months after the first. Only about 15% of patients over long periods of time after the operation, have weakened the obtained effect, however, the relapse symptoms of parkinsonism in full is not more than 6-8% of cases.