Gruppo Italcliniche



Parkinson's disease is a neurodegenerative disease that primarily affects the basal ganglia, and whose incidence is growing in western countries. There has also been a gradual reduction in the average age of the disease's onset, which affects an ever more frequent age group of people still actively employed and working. In recent years the drug therapy has changed, giving patients with Parkinson's disease a life expectancy that is only slightly below the general population's. Unfortunately what drug therapy hasn't changed is the quality of life of Parkinson's patients, at the time one of the worst among those of patients with neurological diseases.
The low incidence of drug therapy on Parkinson's patients' quality of life is correlated with the type of drugs available. They are in fact drugs that act only on dopaminergic transmission, which despite being the most affected symptom in Parkinson's disease, is also not the only one involved. In fact Parkinsonian patients have cholinergic and noradrenergic alterations in addition to problems in other important anatomical structures such as the cerebellum and the frontal lobe. What is the consequence of all this? Some symptoms such as altered gait and balance and posture disorders do not respond to drug therapies that are available, and therefore lead to a rapid deterioration in the patient's living conditions. In addition, the progressive increase of drugs that is usually prescribed to try to counter the clinical worsening, as well as not confirming any benefits, are responsible for the development of additional symptoms such as dyskinesias and freezing. In these cases, in addition to being ineffective, the drugs can also cause damage.
The consequence of all this is that the patient must resort to expensive treatments such as a brain stimulator implant linked to to the subthalamic nucleus of Luys, or a PEG implant for the administration of Duodopa. Even these systems, however, have major side effects or complications (cerebral hemorrhage, implant infection, deadly polyneuropathy) and are therefore reserved for very selected cases.
Since 1950, rehabilitation has been proposed as a therapeutic alternative.
At Moriggia Pelascini Hospital, Prof. Frazzitta developed an intensive rehabilitation program aimed primarily at patients who present all those problems that do not respond to drug therapy: gait disturbances, freezing, posture disorders, balance disorders with falling episodes, dyskinesias, and dystonias.
The multidisciplinary program includes the participation of neurologists, physiatrists, physical therapists, speech therapists, neuropsychologists, and nurses in order to better address the various issues related to this widespread neurodegenerative disease. In particular, the path includes one hour of front-to-front treatment with expert physiotherapists in order to improve body function and motor performance; an hour of treatment with the most modern and specific rehabilitation equipment; finally, a third treatment with exercises to improve hand function and independence in daily activities. In addition, patients with speech and swallowing disorders follow a group speech therapy-rehabilitation program. An individualized rehabilitation program is instead used for patients with Parkinsonism (multiple-system atrophy and progressive supranuclear palsy).
The protocol was tested in a population of patients in the intermediate stage of Parkinson's disease and an objective assesment measurement was used that is based on energy consumption. At the end of the rehabilitation treatment, in addition to presenting significant clinical improvement, patients also demonstrated an optimization in calorie consumption, which is an index of objective improvement in centrally based muscle activation.
A 12-month follow-up (the first to ever have been planned) compared a group of patients in the intermediate stage of the disease who had undergone intensive rehabilitation treatment and a group who was completely lacking rehabilitation treatment; it showed that there is a significant difference in the clinical evaluation parameters and all the advantages were in the rehabilitated group. And even more interesting, the group subjected to rehabilitation had been able to reduce their drug dosages, while the control group required further increases in drug dosages without any benefit.

  • Dott. Frazzitta Gravedona Hospital

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