Professor Chen Wei from the First Affiliated Hospital of Xi’an Jiaotong University: The characteristics and treatment methods of patients with Parkinson’s disease in different periods

Parkinson’s disease is a chronic progressive disease. The patient’s condition gradually deteriorates over time. Although it is not fatal, it seriously affects the quality of life of the patient. Parkinson’s disease The treatment of patients should be carried out according to the stages. The purpose of this is to prolong the honeymoon period as much as possible. Therefore, it is necessary to choose the correct treatment method and scientific treatment in different stages of Parkinson’s disease.

Early stage of Parkinson’s disease

This stage Parkinson’s disease The movement disorders of Kinson’s disease are mainly on one or both limbs, without balance problems, and without severe cognitive impairment, neuropsychiatric symptoms and other non-motor symptoms.

The treatment of early Parkinson’s disease focuses on factors such as Parkinson’s disease type, age and cognitive function.

Middle Stage of Parkinson’s Disease

At this stage, there are motor fluctuations, diminished efficacy, and end-of-dose phenomena, etc. There are midline motor symptoms but the balance disorder is not obvious, and there may be non-motor symptoms such as mild cognitive impairment .

The above manifestations suggest that Parkinson’s disease has entered the middle stage, and has also entered the so-called “progressive stage”. It is necessary to moderately increase the type, dose and frequency of drugs taken in the original “honeymoon period” to maintain the effect of improving motor function. This stage usually requires the combined application of two or more anti-Parkinson’s disease drugs.

Late stage of Parkinson’s disease

This stage has Definite balance impairment and frequent falls, need for a brace or support, dementia, severe cognitive impairment, and hallucinations.

There are many difficulties in the treatment of advanced Parkinson’s disease:

1. Motor symptoms worsen, frequent falls and other midline symptoms are dopa-resistant;

2. Motor fluctuations develop from predictable to unpredictable , reduced movement and abnormal chorea-like hyperkinesia coexist; 3, orthostatic hypotension, hallucinations and other symptoms may be exacerbated by increasing the application of compound dopa drugs and dopamine receptor agonists.

How to treat patients with Parkinson’s disease in different periods?

Due to the progressive nature of Parkinson’s disease, with the development of the disease, it will seriously affect the patient’s ability to live and quality of life. The method can cure or reverse the progression of the disease. In the early stage of the disease, when motor complications have not yet appeared, we can also use drug treatment to improve motor symptoms, so that normal life will not be affected as much as possible.

During the progressive stage of Parkinson’s disease, the patient’s physical activity and quality of life were severely impaired due to motor complications. At this time, the drug effect was found “Gradually getting worse”, the on-off phenomenon, the end-of-dose phenomenon, etc. gradually appear. At this time, the treatment goal should be to reduce the symptoms of Parkinson’s disease with drugs and surgery, improve motor complications, improve the quality of life of patients, reduce the dosage of drugs, and reduce the disability rate. Do not wait until the symptoms are severe to start drug treatment or consider brain pacemaker treatment until the drug treatment is ineffective. Early diagnosis and early treatment should be achieved.

In the late stage of Parkinson’s disease, even if the dosage is increased at this time, the symptoms will not be improved, and symptoms such as dyskinesia and non-motor symptoms will also appear It will be more serious, and the effect of brain pacemaker surgery on drug-induced dyskinesia complications is particularly prominent. 5 years after surgery, the improvement is 60%-83% compared with pre-operation, and the duration is shortened by 67%-100%; 9-10 years after surgery The annual improvement is basically the same as that of the previous five years. The equivalent daily dose of levodopa decreased by 43%-68% and 36%-40% at 5 years after operation and 8-10 years after operation, respectively.

It can be seen that the treatment of Parkinson’s disease cannot be achieved by a single department and treatment. Department of Psychology, Department of Rehabilitation, Department of Imaging, Department of Orthopedics and postoperative program control combined with a new (care + treatment + management) treatment model for Parkinson’s disease. Solve the limitations of medical treatment in the middle and advanced stages of Parkinson’s disease, improve the survival and quality of life of patients, and provide patients with the most professional help.