A decrease in the number of movements (oligokinesia) is a typical manifestation of various forms of parkinsonism: primary or symptomatic, parkinsonism-plus. It occurs in temporal lobe epilepsy, some encephalopathies and mental disorders. The cause is established on the basis of complaints, anamnesis data, results of a neurological examination and additional diagnostic procedures. Treatment includes dopaminomimetics, symptomatic agents. Surgical interventions are carried out according to indications.
Oligokinesia and bradykinesia are two symptoms on the basis of which hypokinesia is formed, which is one of the main signs of primary and secondary parkinsonism. A decrease in the range of motion develops against the background of the following disorders:
Oligokinesia in combination with bradykinesia cause impoverishment of facial expressions, a decrease in the volume of the voice, a change in handwriting, a shuffling gait and the absence of normal hand movements during walking, and difficulty in moving from a sitting to a standing position.
At a certain stage, they are found in almost all patients with Parkinson's disease and secondary lesions of extrapyramidal structures. Often they become the main cause of disability in patients. A decrease in the number of movements in other pathologies has more variable symptoms, depending on the nature of the process.
Parkinson's disease develops under the influence of several factors, including hereditary predisposition. Manifests in the elderly, rarely middle age. Oligokinesia increases gradually, at first it is detected only during special tests, subsequently it makes everyday activities difficult, becomes the cause of impoverishment of facial expressions and gestures, and changes in walking. The hallmarks are asymmetry of symptoms and resting tremor.
Juvenile parkinsonism is inherited, debuting before the age of 25. The number of movements decreases already at the initial stage, interferes with children's games, makes self-service difficult. The stage of hemiparkinsonism is absent, the disorders are symmetrical from the very beginning. Resting tremor is possible, but a more typical variant is statokinetic tremor (during movements, muscle tension).
It develops against the background of injuries, intoxications, some diseases. It is characterized by the rapid formation and progression of the clinical picture, the symmetry of manifestations. There are the following variants of symptomatic parkinsonism:
It develops with degenerative lesions of the central nervous system, which are predominantly not hereditary in nature (some cases of occurrence in several generations are possible). It is found in the following pathologies:
Pathologies are inherited, in most cases, genetic transmission mechanisms have been identified. The group includes:
The number of movements may decrease with the following pathologies:
The manifestations of oligokinesia often differ from those in parkinsonism. More often, the usual impoverishment of movements is noted without the disappearance of synkinesis, the “cog wheel” symptom, changes in handwriting, and problems when standing up.
Determining the cause of a decrease in the number of motor acts is the responsibility of neurologists. Patients with mental disorders are referred for consultation with a psychiatrist. At the initial stage of the examination, the doctor finds out when oligokinesia first appeared, how it was expressed, how the symptom changed over time.
Based on complaints and anamnesis, the specialist forms a general idea of the clinical picture and the dynamics of the disease. According to the neurological examination, it reveals extrapyramidal and cerebellar disorders, pyramidal signs, and other characteristic symptoms. Based on the data obtained, it differentiates Parkinson's disease and various variants of secondary parkinsonism. Taking into account the results, it draws up a survey program, which may include methods such as:
If necessary, an EEG is performed, functional techniques are used. Patients with visual loss are referred for consultation with an ophthalmologist.
Exercise therapy for oligokinesia
With parkinsonian manifestations of any genesis, dopaminomimetics are indicated. The drug is selected individually, taking into account the etiology of oligokinesia and the stage of the disease. Despite the effectiveness of levodopa in Parkinson's disease, they try to delay the appointment of this drug, since with prolonged use its effectiveness decreases, drug-induced dyskinesias occur.
The drug is chosen individually, taking into account age, concomitant diseases, personal characteristics, professional status and other factors. As a rule, monotherapy is used. With insufficient effect, a combination of drugs is selected. The time of initiation of therapy with levodopa is also determined individually, if possible trying to postpone this moment until the age of 60-7 years.
In secondary parkinsonism, levodopa is usually ineffective. Preference is given to selective irreversible MAO inhibitors and dopamine receptor agonists. In symptomatic forms, etiopathogenetic treatment is carried out, which in some cases eliminates or significantly reduces the severity of symptoms. In case of vascular pathology, vascular therapy is prescribed, in case of toxic effects, detoxification is carried out, etc.
Specific treatment for many "plus" syndromes has not been developed. They use vitamins, neurometabolites, nootropics. In dementia with Lewy bodies, cholinesterase inhibitors and NMDA antagonists are used. With severe psychotic problems, antipsychotics may be indicated. In patients with myoclonus and severe tremor due to corticobasal degeneration, beta-blockers are recommended.
With encephalopathies against the background of hematological and somatic diseases, treatment is carried out aimed at normalizing the blood count, restoring the functions of internal organs, and eliminating endogenous intoxication. Anticonvulsants are effective in temporal lobe epilepsy. Patients with psychiatric disorders are prescribed antipsychotics
With the ineffectiveness of conservative therapy for Parkinson's disease, it is possible to conduct electrical stimulation of the pale ball, cryotalamotomy, pallidotomy, deep brain stimulation. Patients with hydrocephalus undergo bypass surgery. In chronic ischemia against the background of damage to large cerebral vessels, reconstructive operations (stenting) are indicated.