Low back pain is caused by Parkinson's disease? Understanding these early symptoms, "Pa" friends seek medical treatment and take fewer detours

When people think of Parkinson's disease, people's first reaction is "hand shaking", but many of the early symptoms of "Pa" disease do not stop there. Decreased sense of smell, insomnia and drowsiness, constipation, dermatitis, wasting... Non-motor symptoms caused by various Parkinson's diseases may come much earlier than "hand shaking", but they are often not identified. Parkinson's disease is diagnosed, how to treat it? When is a brain pacemaker suitable for installation? How do you care for Parkinson's patients on a daily basis?

On the 11th of this month, the 26th World Parkinson's Day will be ushered in, and the reporter invited Professor Zhang Shizhong, director of the Department of Functional Neurosurgery of Pearl River Hospital, Professor Xue Shan, deputy chief physician, and Professor Xie Huifang, deputy director of the Department of Neurology, to explain in detail the early detection of Parkinson's disease and comprehensive treatment and rehabilitation for patients.

Parkinson's disease is not just "shaky hands" these early symptoms should be taken seriously

Xie Huifang introduced that the clinical symptoms of Parkinson's disease are divided into two categories, one is motor symptoms, and the other is non-motor symptoms. Some people are sick and manifest as slow movements when doing fine movements every day, and some are the most commonly heard "hand shaking" - static tremor, shaking when not moving, but trembling when doing movements, generally based on hands and feet, less head. But there are many causes of hand shaking, not necessarily Parkinson's; more notably, sometimes it is not manifested as "shaking", but as a body balance disorder, walking easy to wrestle, forward thrust.

There are also many non-motor symptoms that are easily missed and misdiagnosed, such as loss of smell, loss of sense of smell, numbness and tingling, warmth and other abnormal sensations. Professor Zhang Shizhong has received a patient, because of low back pain to see the orthopedic department, diagnosed with disc herniation and underwent surgery, but the problem was not solved, until Parkinson's other symptoms came out one after another, only came to the neurology department, found that low back pain is also due to Parkinson's early caused by Parkinson's.

Zhang Shizhong said that it is not uncommon for patients who have taken such detours in the clinic. Because parkinson's disease may also have visual problems, anxiety and depression, sleep disorders (insomnia or drowsiness), orthostatic hypotension, constipation, urgency, thermoregulation disorders, seborrheic dermatitis, weight loss and many other symptoms in the early stage of Parkinson's disease, the manifestation varies greatly in different individuals, thereby increasing the difficulty of early detection. In fact, if you are in a neurology department, a series of diagnostic treatments can help detect problems early. Patients often wait until they have classic symptoms such as limb tremor and bradykinesis to go to the neurology department for diagnosis, which is already in the middle and advanced stages.

"Pa You" pays attention to avoiding the three major drug misunderstandings

Xie Huifang reminded that Parkinson's disease is a chronic disease that requires the whole process of multidisciplinary coordination such as neurology, functional neurosurgery, and rehabilitation, and is treated under the guidance of doctors for life. Like many other patients with chronic diseases, "Payou" daily medication is also prone to fall into misunderstandings.

The first is the fear of fluctuations in symptoms after taking the drug, and refusal to take the drug in the early stage of the disease. Clinically confirmed, patients who started taking drugs within 1 to 3 years after the onset of the disease were significantly better than those who started to take drugs 4 to 6 years after the onset of the disease. Early treatment can also reduce the cost of treatment by delaying the progression of the disease, because the cost of treatment for advanced parkinson's disease is much greater than the cost of early to medium term.

Secondly, can the drug be stopped after the symptoms improve? Xie Huifang stressed that Parkinson's disease is a degenerative disease of the nervous system caused by degenerative necrosis of dopamine neurons in the brain, which requires lifelong medication, and the improvement of symptoms only represents disease control. The sudden discontinuation of the drug may lead to the malignant withdrawal syndrome of Parkinson's disease, which can even be life-threatening! Treatment of Parkinson's disease should adhere to dose titration, unauthorized tapering or discontinuation may lead to worsening symptoms or serious side effects, and may affect the efficacy of subsequent treatment.

In addition, many patients believe that as long as the disease should be cured, they will also hope for health care products and folk remedies. But at present, there is no cure for Parkinson's disease in the world, Xie Huifang reminded that all drugs that boast of being able to "cure" Parkinson's disease are not credible, patients must not be misled, taking folk remedies, health care products, both delay the disease, but also waste money.

What patients are brain pacemakers suitable for?

Clinically, through the joint cooperation of drugs, surgery and rehabilitation, the disease can be controlled and the quality of life can be improved. In recent years, with the development of medical technology and the increasing coverage of social medical protection, many Payou have considered installing a brain pacemaker (DBS) to improve their symptoms. DBS surgery is a minimally invasive surgical procedure in which electrodes are implanted at specific locations in the brain nerves, connected through subcutaneous tunnels to stimulators embedded in the chest, which transmit weak high-frequency electrical impulses to the electrodes deep in the brain to inhibit abnormal electrical activity of neurons and improve symptoms. In August 2021, Guangdong Province has included DBS treatment of Parkinson's disease in medical insurance, and insured persons in Guangzhou can also superimpose the "Sui Shi Kang" commercial supplementary insurance to obtain greater protection.

So, what kind of "Payou" is suitable for installing a brain pacemaker (DBS)?

Zhang Shizhong said that in general, patients with a course of more than 5 years and confirmed primary Parkinson's disease, if the symptoms are mainly tremor, the improvement through standardized drug treatment is not ideal, and the tremor seriously affects the quality of life can consider the installation of DBS, and strongly requires early surgery to improve symptoms, after evaluation, the course of the disease can be relaxed to more than 3 years.

In terms of appropriate age, DBS can generally not be installed until the age of 75, and the age limit can be relaxed to about 80 years old after an individualized assessment of benefits and risks in elderly patients, and the age limit can also be appropriately relaxed for elderly patients with severe tremor.

Doctors also evaluate the patient's medication use, and consider installing DBS if the compound levodopa has been good for the patient but can no longer satisfactorily control symptoms, the efficacy is significantly reduced or there are intractable movement fluctuations or dyskinesia, or the drug is intolerant.

In addition, many people think that the installation of DBS can be "once and for all", Zhang Shizhong stressed that DBS is only one of the comprehensive treatment methods, in fact, after the installation of DBS, patients still have to adhere to the doctor's guidance to dynamically adjust the medication, and the parameters of DBS also need to be adjusted regularly.

Daily diet attention "four more and one less"

Diet management is one of the adjunctive treatments for Parkinson's disease, which aims to maintain better nutrition and physical condition in patients and to achieve better results through dietary adjustments. Xue Shan suggested that Pa You's daily diet should pay attention to "four more and one less":

More grains: usually eat 300 to 500 grams of cereals a day, such as rice, noodles, grains, etc.; from cereals, you can mainly get carbohydrates, protein, dietary fiber and vitamin B and other nutrients, and can get the energy needed by the body and do not affect the medicinal effect of levodopa.

Vegetables and fruits: eat about 300 grams of vegetables or melons per day, 1 to 2 medium-sized fruits, from which vitamins A, B, C, a variety of minerals and dietary fiber are obtained. Some special vegetables such as broad beans can be eaten regularly. In addition, melon seeds, almonds, black sesame seeds, etc. are rich in tyrosine, which may promote levodopa synthesis and be beneficial to patients.

Protein: Milk is rich in calcium, for Parkinson's patients who are prone to osteoporosis and fractures, drinking 1 cup of milk or yogurt a day is an excellent way to supplement the body's calcium, and eating soy products such as tofu and dried tofu can also supplement calcium.

It should be noted that since the protein components in milk may have a certain effect on the efficacy of levodopa drugs, in order to avoid affecting the effect of medication during the day, it is recommended to drink milk arranged at night before going to bed.

Drink more water: ingesting sufficient water is beneficial to the body's metabolism, can make the body excrete more urine, reduce the chance of bacterial infection of the bladder and urethra, can make feces soften, easy to excrete, and prevent the occurrence of constipation. If you have symptoms of dry mouth, thirst, and dry eyes, you can try to drink half a cup of water every day than the previous day, and gradually increase the amount of water you drink to 6 to 8 cups per day.

Less fat: It is recommended to cook foods with vegetable oil and not eat fatty meat, meat oil and animal offal, which helps prevent the adverse effects of excessive intake of saturated fat and cholesterol on the body.

How does Payeo exercise and rehabilitation?

Rehabilitation exercise is an important intervention for "Payou" to improve the quality of life, and proper exercise in daily life is also beneficial to control and alleviate the disease. Professor Xue Shan suggested that patients maintain a small number of skeletal muscle exercises every day, which helps to reduce bone calcium loss, which can start from simple exercises such as walking, from simple to difficult, and the exercise dose also starts from a short period of small exercise, step by step. "Payou" with a good overall state can choose tai chi, baduanjin, yoga and other sports that integrate coordination, balance ability and muscle strength. Usually, you can give priority to choosing your favorite sports within the scope of your ability, improve the fun of exercise, and help improve cardiopulmonary function.

Xue Shan said that many long-term patients will form a posture of arched back, pelvic back tilt, knee bending, and difficulty lifting legs. In fact, after combining drugs and surgical treatment, patients can "learn" to use their own bodies and limbs again through rehabilitation exercises. Usually, there is a simple way to train at home in a posture: back against a wall, try to stand on the back of the head, hips, heels close to the wall, try to bring the shoulder blades close to the wall, if you stand unsteadily, you can hold the armrests of the appropriate height, such as tabletops, chair backs, etc. This exercise, which lasts 5 minutes at a time, can help patients regain their upright posture, "and you will find that walking upright is not as difficult as you think."

Text/Guangzhou Daily, New Flower City Reporter: Zhou Jieying

Guangzhou Daily New Flower City Editor: Wu Wanhong