Propulsion is seen in parkinsonism and Parkinson's disease. It is combined with hypokinesia, freezing when walking, weakening of facial expressions, tremor, rigidity, increased muscle tone, micrography, increased postural tone, lack of hand movements during walking. The cause of propulsion is established on the basis of anamnesis, data from an objective and neurological examination, rheoencephalography, echoencephalography, CT, MRI. Treatment includes levodopa preparations, etiopathogenetic therapy of secondary parkinsonism, exercise therapy, massage, and surgical interventions.
Propulsion - the inability of the patient to maintain balance when pushed forward. A similar phenomenon, revealed when pushing back, is called retropulsion. When giving even a slight external acceleration, the patient begins to move uncontrollably. Restoring balance takes a lot of effort. Due to the shift in the center of gravity and the inability to stop, falls are possible.
The same picture is observed when stumbling, the sudden disappearance of obstacles (for example, an unexpectedly opened door). Sometimes propulsion occurs without external stimulation when walking at a steady pace on a flat surface. The symptom is an unfavorable prognostic sign, indicating a high probability of rapid progression of clinical manifestations and possible resistance to therapy.
The most obvious symptom is a resting tremor, which is detected early in the disease. May be accompanied by intentional and postural trembling. The severity of muscle rigidity in the initial stages varies significantly, sometimes the manifestation is confirmed only during special tests. An important feature that allows differentiating Parkinson's disease and secondary parkinsonism is the asymmetry of muscle tone in the limbs.
Pathology is accompanied by increasing hypokinesia, which is first noted when performing small movements, subsequently progresses, becomes pronounced. Propulsion occurs at the stage of maladjustment, combined with postural disorders. May be accompanied by dysarthria, dysphagia, salivation, sleep disturbance, depressive disorders. Some patients develop dementia.
It is the second most common after Parkinson's disease. Most often provoked by neuroleptics. Other drugs associated with this pathology include sympatholytics, calcium antagonists, metoclopramide, and anticonvulsants. Patients are dominated by the elderly. In 90% of cases, the disease manifests itself within three months from the moment the drug was prescribed, sometimes the first symptoms appear after a few days.
The likelihood of propulsion formation depends on the severity of drug-induced parkinsonism. The clinical picture varies depending on the drug that caused the pathology. The most common symptom is hypokinesia. Propulsions and postural instability are more common in neuroleptic and cinnarizine variants of the disease.
Parkinson's disease
It develops as a result of damage to subcortical structures in chronic cerebral ischemia, hemorrhagic and ischemic stroke. The course is often subacute. Muscle rigidity and hypokinesia are more pronounced in the lower extremities. Characterized by the early appearance of postural instability and propulsion, a progressive decline in intelligence. Resting tremor is rare. Other symptoms are determined by the prevalence and localization of the pathological focus.
Unlike other forms of parkinsonism, young people suffer. The first signs appear before the age of 20-25. First, fine motor skills are impaired. Then the manifestations of hypokinesia progress. The patient moves in small steps. The gait is shuffling, the arms are bent and pressed to the body. Possible propulsion and stiffness when walking. Cognitive impairment is not typical. A distinctive feature of juvenile parkinsonism is diurnal fluctuations - a decrease in the severity of symptoms after sleep and an increase in the evening hours.
Along with the listed varieties of pathology, propulsion can be observed in post-traumatic, post-infectious, toxic and post-hypoxic secondary parkinsonism. In some patients, intracerebral neoplasms, frequent attacks of hypoglycemia, or hydrocephalus become the cause of the symptom. Sometimes propulsions are detected in people with signs of parkinsonism due to degenerative diseases of the central nervous system: multiple sclerosis, Wilson's disease, supranuclear palsy.
Secondary parkinsonism is characterized by the absence of asymmetry in muscle tone, a more rapid progression of symptoms than in Parkinson's disease. The clinical picture and the likelihood of propulsion are quite variable, determined by the cause of development and the severity of the pathology. In some cases, regression of symptoms is possible after treatment of the underlying disease.
The determination of the cause of propulsion is carried out by a neurologist. An important task is to distinguish between Parkinson's disease and secondary parkinsonism, and to establish the etiofactor in secondary disorders. When interviewed, the specialist pays attention to the rate of progression of symptoms, the time of occurrence of propulsions and the effectiveness of therapy with levodopa drugs.
Indicative differential signs detected during an objective examination are rest tremor, asymmetry of muscle tone, the presence and severity of postural disorders. To clarify the diagnosis, the following diagnostic methods are used:
Physical rehabilitation
The plan of therapeutic measures is determined taking into account the causes of parkinsonism, the severity of propulsion and other manifestations. With a medicinal variety of the disease, a replacement or cancellation of the drug that provoked the appearance of the symptom is required. With toxic effects, detoxification therapy is necessary. Patients who have undergone hypoxia are shown neurometabolic agents in combination with oxygen therapy.
Patients with propulsion against the background of vascular disorders are recommended medications to improve the rheological properties of blood, vasoactive agents, and nicotinic acid preparations. In post-infectious and post-traumatic parkinsonism, neurometabolic therapy is prescribed using B vitamins, lipoic acid, pyritinol, piracetam.
Since propulsions tend to appear late in the disease, treatment with levodopa drugs comes to the fore. Dopaminergic agents are used to reduce the dose of levodopa. Other ways to increase the effectiveness of therapy and avoid the development of the "on-off" phenomenon are to reduce the time intervals between medications and the appointment of combined medications.
An important part of the fight against propulsion, hypokinesia and muscle rigidity is exercise therapy. Specially designed sets of exercises allow you to extend the period of active functioning, maintain the ability to move and self-service. To reduce muscle rigidity, massage, thermal procedures are used. In the presence of mental disorders, the participation of a psychiatrist is required. Some patients are shown antidepressants and sedatives.
Parkinson's disease with propulsions and severe akinetic-rigid syndrome is an indication for pallidotomy. With trembling, rigid, trembling-rigid and rigid-trembling variants of parkinsonism, cryotalamotomy is performed. In severe disabling disorders, electrical stimulation of the subthalamic nucleus and globus pallidus is performed.
Patients with propulsion due to hydrocephalus may be recommended endoscopic ventriculostomy, various options for shunting (with diversion of cerebrospinal fluid into the abdominal cavity or right atrium). In vascular pathologies, thrombolysis is performed, reconstructive operations are performed, and vascular anastomoses are formed.