Advances in diagnosis and treatment of Parkinson's disease
Upload time：2017-02-22 Browse：
Author: Li Yanfeng
Key words: Parkinson's disease; diagnosis; treatment
CLC number: R742.5 document code: A article number: 1006-2963 (2017)
Parkinson's disease (PD) is one of the most common neurodegenerative diseases, and it is also one of the most common neurological diseases. With the development of basic and clinical research, the diagnosis and treatment of PD has made great progress. In recent years, the diagnosis and treatment of PD is introduced.
1 PD pathophysiology study
The main pathological changes of PD are the loss of dopamine neurons and the distribution of Louis's inclusion bodies. The main component of the inclusion body of the is alpha synuclein. The two pathological changes are still not conclusive. The recently proposed theory of prion protein may help to solve this problem, alpha synuclein formed inclusion bodies in the central nervous system and the mode of transmission is very similar to the prion protein , many studies around alpha synuclein is a prion protein and carry out.
2 PD diagnosis
At present, the diagnosis of PD is still empirical diagnosis, although domestic every year to the interpretation of PD guidelines for diagnosis, clinical manifestation, examination, but all of the response to dopaminergic drugs and later motor symptoms of volatility is still the basis for the diagnosis. In addition to motor symptoms, non motor symptoms of PD need to attract people's attention, non motor symptoms early in the disease can appear, parts of PD were classified according to inclusion body Louis Braak: phase I is a violation to the ventromedial nucleus of vagus nerve and olfactory tract, resulting in constipation and smell decline; II is involved blue spots and related structures and sleep and mood disorders; phase III is involved in the substantia nigra to produce motor symptoms; the fourth period involved cortex produce cognitive and psychiatric symptoms corresponding. Emphasis on the non motor symptoms of PD will help identify patients early and get the right treatment. This issue of neurodegenerative diseases in a number of articles related to the study of PD non motor symptoms, hoping to cause more attention.
3 PD treatment
Research progress in the treatment of PD rapidly, from the beginning of 1960s and entered the levodopa clinical benefit to patients after it appeared in the levodopa synergist, monoamine oxidase B inhibitor, dopamine receptor agonist. 80% of patients had a good response to levodopa, in order to reduce the symptoms of peripheral reactions and long-term medication fluctuations, in recent years, some new types of dopamine preparations such as patches, intestinal adhesive or long acting preparations are listed. As a supplement to drug therapy, the use of deep brain stimulation (DBS) has been more and more widely used. It has a very significant improvement in the tremor and movement of .
In addition to the treatment of symptoms, the treatment of PD etiology has not stopped. Nerve growth factor of glial cell line derived neurotrophic factor (GDNF) and neurotrophins etc. through the injection of different injected into the brain, but did not achieve the desired effect, so the proper selection of patients and what is very important for more effective or safe manner. Digital scientists from NsGene use a package of cells to produce GDNF stem cells that can be implanted into the brain and produce GDNF, which can be removed in time if there is a safety or other side effect. Gene technology can make GDNF production is higher, so as to play the role of nutritional black cells, the study if successful, will likely be a breakthrough in the treatment of PD.
Since 2004, some mutations of LRRK2 gene have been found to be related to PD, and the related target drug research has become a hot spot . Animal experiments have shown that the drug may lead to changes in lung tissue, recent studies have confirmed that these changes are reversible, once the withdrawal of this change will stop, so the drug safety measurement research needs to be carried out in depth. At present, about LRRK2 inhibitors in clinical application still has a large distance, there are too many factors that may affect the research process, such as whether the subjects had LRRK2 mutation, clinical stage, efficacy of drugs in patients with the characteristics of science.
In addition to the above treatment, other treatment may also be beneficial to patients, such as physical therapy, occupation therapy, music therapy, including Taijiquan therapy China get attention , Taijiquan in relaxation, psychosomatic, imagination, strength or balance training on the body, have certain curative effect. Also the special research reports on the effect of Taijiquan and Qigong therapy PD, expect to have China traditional sports research has been carried out more of the treatment of PD.
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(Editor: Autumn width)
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, China