Program of Attention to Parkinsonisms
MEDICAL REHABILITATION PROGRAM FOR PATIENTS WITH PARKINSON
The best knowledge of the physiopathology of the main syndromes affecting motor control, the development of effective and reliable therapeutic technologies and methods, and the existence of drugs with therapeutic capacity for symptomatic control and / or neuroprotection have allowed the development of combined treatments. that allow, by enhancing their effects by the simultaneous and harmonic use, optimize the control of symptoms and the evolutionary complications of most neurological diseases characterized by manifestations of parkinsonian stock.
A comprehensive evaluation that includes confirmation or modification of the diagnosis with evaluation of the aggravating factors and the evolutive profile together with the individualization of the functional commitment of the patient allows to design a more effective and tolerable therapeutic strategy of restoration or neurological rehabilitation, which usually includes modification of the pharmacological scheme, hygienic-dietetic measures, specialized and multidisciplinary motor training. When surgical treatment is required by stereotactic functional surgery techniques allow a high degree of recovery of the motor skills and functional independence of the individual.
The proper development of these restoration or neurological rehabilitation methods and technologies and the controlled introduction of other neurological restoration or rehabilitation therapeutic agents have allowed the conception and validation of this comprehensive care program, applied by a qualified work team at CIREN, neurological restoration or rehabilitation center for more than 10 years, achieving high recovery rates and a significant improvement in the quality of life in more than 90% of the more than 1000 patients treated with this technology.
Composition and Duration of the Program:
The program includes a week of evaluation during which a set of exams is performed in the specialized clinic of Parkinson's syndrome, which consists of a general clinical evaluation of the patient's health status, a quantification by international scales to measure neurological condition, motor capacity , functional capacity and quality of life, neurophysiological studies specialized in exploration of the motor system and perceptual motor integration, structural and functional imaging studies by Computed Axial Tomography, Nuclear Magnetic Resonance, Simple Photonic Emission or Ultrasound techniques that correlate with the clinical findings and the intensity of the motor commitment.
This evaluation is complemented with a functional evaluation of movement and gait kinetics, spirometric, stabilometric, neuropsychological studies and the application of international instruments to determine the degree of disability or objectify the neurological defect to be modified.
The information obtained by this comprehensive evaluation is analyzed collectively by specialists from various disciplines and a unique program of Neurological Restoration or Rehabilitation is designed in stages, with specific objectives that are set according to the patient's possibilities and the previously accumulated experience.
The Neurological Restoration or Rehabilitation program is executed by therapeutic cycles of 4 weeks (28 days) that includes hygienic-dietetic measures to improve the general condition, pharmacokinetic disorders and the nutritional status of the patient, pharmacological adjustment to control fluctuations of mobility and other evolving motor and non-motor complications using as a tool a daily schedule designed in our clinic to optimize the doses and frequency of administration of drugs to be prescribed and its periodic adjustment until sufficient symptomatic control and stability of the motor condition are achieved throughout the day. Parallel sleep disorders, appetite, blood pressure and other autonomic or mental disorders that usually coexist with the progression of the disease or as a side effect of some drugs are controlled.
An integral Neurological Restoration or Rehabilitation program is also developed that includes posture, gait and balance training, manipulative skills training with language training and learning techniques, using feedback methods, specific motor learning, strengthening techniques and / or stretching and training systems for specific purposes more efficient to stimulate neuroplastic abilities with the integral objective of adapting the pattern of motor behavior and increase the motor skills of the individual especially for the execution of daily tasks.
In the presence of refractory symptoms or manifestations, severe gait disorders with blockages, freezing or falls, the presence of disabling and annoying dyskinesias or the need for high doses of drugs, which cause significant adverse effects for the control of the cardinal symptoms of the disease may suggest the possibility of surgical treatment using stereotactic functional surgery techniques, in which case the surgical procedure will first be carried out with the prior written informed consent of the patient and then the other therapeutic measures will be carried out.
In case of surgery a minimum of 10 days is required after the evaluation for the execution of the procedure and control of the result.
If the comprehensive care program is applied, as many cycles of four weeks will be required as the evaluation determines, the most common being the application of one or two therapeutic cycles annually.
Results that are Treated with the Treatment:
It has been determined in an open clinical trial that the effectiveness of the Comprehensive Neurological Restoration or Rehabilitation program is 93% and the improvement rates obtained for motor capacity are approximately 20% and for the functional capacity of approximately 35% . In more than 1000 patients treated to date there have been no complications, accidents or adverse events that compromise life or leave sequelae. The rate of adverse effects or transient complications is less than 5%.
Surgical treatment has variable efficacy and specific indications. The Vim Talamotomy induces more than 90% suppression of tremor in the contralateral limbs without residivas and approximately 20% overall improvement in parkinsonism.
The posteroventral pallidotomy induces a suppression of the contralateral dyskinesias in more than 95% of the patients and an overall improvement of 35 and 40%. The bilateral lesion of the subthalamic nucleus resolves the blockages and other gait disorders in more than 90% of the operated patients, with an overall improvement of approximately 60%. The effects of surgery are maintained with little modification until at least 5 years in most patients.