Parkinsonova bolest

Parkinsonova bolest (PB) je druga najčešća neurodegenerativna bolest. Srednja dob pojavnosti je 60 godina. Premda je uzrok nepoznat, utjecaj genetike i okoliša je važan za nastanak bolesti. Prema tome, postoje nenasljedni i nasljedni oblici bolesti. Geni kodiraju pojedine proteine za koje se vjeruje da su povezani s nastankom PB-a. Najbitniji su alfa-sinuklein i parkin. Što se tiče utjecaja okoliša, istraživanja su pokazala da izloženost pesticidima, ruralni život, povrede glave, srednji životna dob, pretilost, nedostatak vježbe, neke infekcije te konzumacija pitke vode iz bunara mogu utjecat na pojavnost PB. Patološka karakteristika bolesti je prisutnost Lewijevih tjelešaca u degeneriranim dopaminergičkim neuronima supstancije nigre. Simptomi se mogu podijeliti na primarne, sekundarne, one povezane s ponašanjem i one povezane s terapijom. Također, možemo ih podijeliti na motorne i ne-motorne. Dijagnoza se donosi na temelju kliničke slike koja uključuje prisutnost bradikineze i/ ili rigora, tremora, odsutnost atipičnih znakova i dva od sljedeća tri znaka: dobar odgovor na levodopu, levodopom inducirani nevoljni pokreti (diskinezija) i asimetričan početak simptoma. Liječenje je farmakološko , nefarmakološko i kirurško. Farmakološka terapija se sastoji od uporabe pet lijekova, a to su: dopaminergički (levodopa i agonisti dopamina), antikolinergički, MAO inhibitori, COMT inhibitori i amantadini. Neurokirurški postupci su palidotomija ili talamotomija, te DBS (duboka stimulacija mozga). Nefarmakološke metode predlažu da je najbitnije da pacijenti održavaju socijalne, fizičke i intelektualne aktivnosti u najvećoj mogućoj mjeri.Parkinson's disease (PD) is the second most common neurodegenerative disease. The mean age of onset is 60 years. Although the cause is unknown, the influence of genetics and environment is important for the development of the disease. Therefore, there are sporadic and hereditary forms of the disease. Genes encode certain proteins that are believed to be associated with the emergence of PB. The most important are alpha-synuclein and parkin. As for environmental impact, studies have shown that exposure to pesticides, rural life, head injury, middle age, obesity, lack of exercise, some infections and consumption of drinking water from wells can affect the incidence of PB. Pathological characteristics of the disease is the presence of Lewy bodies in degenerated dopaminergic neurons of the substantia nigra. The symptoms can be divided into primary, secondary, those associated with behavior and those associated with the therapy. Also, we can divide them into motor and non-motor. The diagnosis is made on the basis of clinical presentation that includes the presence of bradykinesia and/or rigidity, tremor,absence of atypical signs and two of the following three characters: a good response to levodopa, levodopa-induced involuntary movements (dyskinesia), and asymmetric onset of symptoms. The treatment is pharmacological, non-pharmacological and surgical. Pharmacological treatment consists of the use of five drugs, namely: dopaminergic (levodopa and dopamine agonists), anticholinergic, MAO inhibitors, COMT inhibitors and adamantanes. Neurosurgical procedures are pallidotomy or thalamotomy and DBS (deep brain stimulation). Non-pharmacological methods suggest that it's important for patients to maintain social, physical and intellectual activities to the extent possible