Cancer Types

The differences in treatment methods have been observed in clinical practice for many years. The results show that different treatment behaviors have significant differences in the condition of Parkinson's disease patients: 1. The vast majority of patients who start receiving reasonable treatment in the early stages of the disease can delay the development of the disease, the condition is relatively stable, and they can basically take care of themselves. Although treated, most patients who are often interrupted cannot control their condition well, and their condition may recur and worsen to varying degrees. 3. Patients who only begin treatment in the late stages often have severe conditions, and existing treatment methods are also limited in improving the condition. Patients often experience significant disabilities. Early treatment of Parkinson's disease with Western medicine can compensate for the presence of DA neurons in the substantia nigra striatum system, which can increase DA synthesis. It is recommended to use physical therapy (massage, hydrotherapy) and physical therapy (joint activity, walking, balance and language exercise, facial expression muscle exercise) to seek the cooperation of patients' families, encourage patients to exercise more actively, and try to postpone drug treatment time. If the disease affects the patient's daily life and work, medication treatment is required. At present, drug therapy for PD is mainly focused on restoring the balance between DA and Ach neurotransmitter systems in the striatum, using anticholinergic and DA neurotransmitter functional drugs to improve symptoms, but cannot prevent the progression of the condition. Medication principle: ① Starting from a small dose, gradually increasing, and try to use a smaller dose to achieve satisfactory therapeutic effects; ② Individualization of treatment plans, selecting medication based on patient age, symptom type and degree, employment situation, drug price, and economic affordability; ③ Drugs should not be blindly added or suddenly stopped, and should be taken for life; ④ The treatment of PD with drugs is complex. In recent years, adjuvant drugs such as DR agonists, MAO-B inhibitors, catechol-oxymethyltransferase (COMT) have been introduced. When combined with compound dopamine, it can enhance efficacy, reduce symptom fluctuations, and reduce the dosage of compound dopamine. However, the efficacy of single use is not ideal. Therefore, it is necessary to balance the advantages and disadvantages and choose appropriate combination medication. Some scholars advocate the use of this type of drug in combination with vitamin E, known as the DATA-TOP regimen (depronyl and tocopherol-antioxidation therapy of Parkinson's disease), as a neuroprotective agent for early mild patients, which may delay disease progression. Vitamin E is a natural free radical scavenger with antioxidant effects. Early use of vitamin E, especially in untreated patients with PD, may slow down the degeneration of substantia nigra cells and delay disease progression. In recent years, some people abroad have advocated for the oral administration of 2.5mg of propargyl amphetamine, once a day, gradually increasing to 2.5mg, twice a day, and then increasing to 5mg, twice a day; Simultaneously take 2000U of vitamin E once a day. However, there is still controversy over this plan and further observation and evaluation are needed. Surgical treatment of PD with stereotactic surgery began in the 1940s. In recent years, with the development of microelectrode guided stereotactic technology, microelectrodes are used to record and analyze cell discharge characteristics, which can accurately locate neurons that cause tremor and myotonia, achieving cellular functional localization and significantly improving surgical efficacy and safety. Surgery can correct the excessive inhibitory output of the basal ganglia, with indications for patients who have failed drug treatment, are unable to tolerate it, or have motor disorders (dyskinesia). Patients who are younger, have symptoms such as tremor and rigidity, and are biased towards one side have better results, and still require medication after surgery. (1) Pallidotomy: In recent years, with the development of microelectrode guided orientation technology, the accuracy of localization has reached 0.1mm, reaching the cellular level to achieve accurate functional localization. It is helpful to determine the relationship between the electrode and various structures of the pallidus, as well as adjacent optic tracts and inner capsules, and to search for neurons that cause tremors and increased muscle tone. By using this method to determine the target, the surgical effect is good, improving the motor symptoms of PD, especially with delayed movement and few complications such as visual impairment. (2) Hypothalamic lesion surgery: It involves the use of stereotactic surgery to destroy one side of the ventrolateral nucleus, lenticular loop, and subthalamic nucleus of the thalamus. It has a good therapeutic effect on tremor in PD, and the best indication is unilateral severe tremor. Unilateral thalamus ablation has fewer complications, while bilateral ablation can cause complications such as speech disorders, swallowing difficulties, and mental disorders, and is not recommended. (3) Deep brain stimulation therapy (DBS): It involves implanting high-frequency microelectrode stimulation devices into surgical targets of PD patients. The voltage and frequency generated by high-frequency electrical stimulation are higher than those generated by diseased neurons, thereby exerting inhibitory effects. The advantages of DBS are accurate positioning, small damage range, fewer complications, high safety, and long-lasting efficacy, while the disadvantage is high cost. The US FDA has approved the clinical application of DBS for the treatment of PD. (4) Stereotactic radiation therapy（ γ- Knife (X-knife): Utilizing the principle of stereotactic orientation and using a computer to accurately calculate the target, a large dose of narrow beam high-energy rays can accurately focus and destroy the target, and the dose to normal tissues outside the target is minimal. The radiation includes 60 cobalt (60CO) generated γ- Ray（ γ- X-rays generated by knives and linear accelerators. The indications are the same as stereotactic lesion surgery, but the efficacy is not as good as the latter, with more side effects, and is currently not recommended for use. Cell transplantation and gene therapy cell transplantation are the transplantation of autologous adrenal medulla or allogeneic embryonic midbrain nigra cells into the patient's striatum to correct DA transmitter deficiency and improve PD motor symptoms. Gene therapy with tyrosine hydroxylase (TH) and neurotrophic factors is currently being explored as promising new therapies. The exogenous TH gene is introduced into the brain of animals or patients through the exvivo or vivo pathway, and the imported gene is transcribed and translated into TH, promoting the formation of DA. At present, there are problems such as difficulty in donor sources, uncertain long-term efficacy, and immune rejection. Rehabilitation therapy is crucial for improving patients' quality of life by providing language, eating, walking, and various daily life training and guidance. Late bedridden patients should strengthen nursing care to reduce the occurrence of complications. Rehabilitation includes voice and intonation training, facial muscle exercises, hand, limb, and trunk exercises, relaxation breathing muscle exercises, gait and balance exercises, posture recovery exercises, etc. Physical therapy is important for patients to maintain various activities as much as possible. In the early stages of the disease, patients should try their best to complete various daily activities. As motor dysfunction worsens, regular physical therapy and physical therapy can help maintain or rebuild the body's ability to adjust, enabling patients to learn some adaptive strategies. Due to the disease itself, treatment medication and reduced activity can cause constipation, Patients should maintain a high fiber diet and eat adequately. The use of psyllium and moisturizing laxatives (such as sodium docurate) can help. The clinical manifestations of traditional Chinese medicine in treating this disease are similar to the descriptions of symptoms such as "tremor syndrome", "tremor", "vibration loss", "internal wind", and "spasms" in traditional Chinese medicine. The book "Su Wen. Zhi Zhen Yao Da Lun" states that "all wind and dizziness belong to the liver," which is an early understanding of this disease. Among them, "falling" means "trembling". The "Huashi Zhongzang Jing. On the Obstruction of the Tendon, Chapter 37" states: "When walking in a hurry, evil spirits harm the liver, and the liver loses its qi... it makes people's tendons urgent and unable to walk comfortably." The so-called "walking in a hurry, unable to relax," is just like the panic gait of Parkinson's disease. Sui Chaoyuan Fang wrote the "Treatise on the Origin of Various Diseases", which further explained the pathogenesis of ankylosis and postural disorders in the "wind limb contracture unable to bend and extend syndrome" and "five finger tendon contracture unable to bend and extend syndrome". Tang and Sun Simiao recorded in their "Prescription for Preparing for Urgent Thousand Gold" that "Golden Tooth Wine" treats diseases such as "eight winds and five spasms accumulated over the years, holding up the body and dragging cicadas, unable to turn, walking with limp and frowning, and unable to retract". These characteristics are very similar to the slow movements and gait disorders seen in Parkinson's disease. Jin Yuan According to the medical record, an elderly male with unknown etiology, such as chronic progressive tremor accompanied by random movement disorders and melancholic symptoms, is considered to have the highest risk of Parkinson's disease. By the Ming Dynasty, the understanding of tremor syndrome was further deepened, and many doctors during this period had a systematic discussion on the disease name, etiology, pathogenesis, differentiation and treatment of tremor syndrome. Zhang Jingyue's "Classics: Disease Category (1)" notes: "Falling, shaking... Wind actively shakes, and wood transforms, so it belongs to the liver." Lou Ying's "Medical Compendium" proposes that evil is actually a disease, and wind, fire, and phlegm cause disease. Sun Yikui is particularly outstanding. In his book "The Mysterious Pearl of Red Water", he first uniformly named tremor as the main clinical manifestation of the disease "tremor syndrome", emphasizing that tremor cannot be controlled at will. He pointed out that "tremors are caused by the shaking of hands and feet, as if they are shaking, and the muscles and veins cannot be restrained. However, there are also scientific judgments on the age of onset and prognosis of tremor, This disease is rare in the prime of life, but it occurs after middle age, especially in old age. In old age, there is insufficient yin and blood, and lack of water cannot control kidney fire, making it extremely difficult to treat. "Wang Kentang summarized a set of formulas for treating tremor that are tailored to individual needs in his" Criterion for Syndrome and Treatment ". The representative formulas are Dingzhen Pills (Gastrodia elata, Gentiana macrophylla, Scorpion, Asarum, Rehmannia glutinosa, Rehmannia glutinosa glutinosa, Angelica sinensis, Chuanxiong, Paeonia lactiflora, Fangfeng, Jingmustard, Atractylodes macrocephala, Astragalus membranaceus, and Weilingxian) for treating elderly tremors. Until the Qing Dynasty, Zhang Lu's "Zhang Shi Yi Tong" systematically summarized the experience of predecessors and combined with personal clinical practice, pointing out that this syndrome was mainly caused by wind, fire, phlegm, and deficiency. At the same time, it also provided a detailed discussion on the corresponding pulse conditions of tremor syndrome. Gao Gufeng's "Yi Zong Ji Ren Bian. Zhan Zhen" states: "In general, both qi and blood are deficient, and cannot nourish muscles and bones, so it can be shaken and cannot be controlled." It emphasizes that qi and blood deficiency is an important cause of Zhan syndrome and creates a method of nourishing qi and blood to treat Zhan syndrome. It points out that "it is necessary to greatly supplement qi and blood, and ginseng nourishing Rong soup or modified ginseng nourishing Rong soup is the main method." This method has been used to this day and is still one of the effective methods for treating Zhan syndrome. From literature reports over the past 20 years, it can be seen that traditional Chinese medicine scholars have not yet unified their understanding of this disease. In November 1991, at the Third Academic Symposium on Geriatric Encephalopathy of the All China Society of Traditional Chinese Medicine, a trial draft of the "Diagnosis and Efficacy Evaluation Standards for Geriatric Fibrillation Syndrome in Traditional Chinese Medicine" was discussed, demonstrated, and approved, and a unified disease name was determined as Geriatric Fibrillation Syndrome, which further advanced the research of this disease towards objectivity.