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Parkinson

O que é? Qual é o tratamento?

O mal de Parkinson é uma doença neurológica progressiva crônica, afeta as células nervosas (neurônios) em uma área do cérebro perto do pescoço, conhecida como “substância negra”. Estas células normalmente produzem dopamina, um componente químico (neurotransmissor) que transmite sinais entre as áreas do cérebro.

Quais são as causas?

Existem cada vez mais provas que demonstram que o mal de Parkinson pode ser hereditário. Os homens com mais de 60 anos (idade média para o aparecimento dos sintomas) têm mais probabilidades de desenvolver esta doença do que as mulheres. 10% dos pacientes recebem um diagnóstico de mal de Parkinson antes dos 40 anos.

Quais são os sintomas?

Os mais comuns são: tremor, movimento que começa em uma parte do corpo, por exemplo, a mão ou o pé. O tremor pode se propagar na medida em que a doença avançar e se agravar com o estresse. O tremor raramente incapacita um paciente e, geralmente, desaparece durante o sono e quando o braço ou a perna se mexem.

Entre os principais sintomas estão: o endurecimento muscular (rigidez), tremores, bradicinesia (lentidão dos movimentos e perda gradual de atividade espontânea), mudanças no padrão de deslocamento e na postura, mudanças na fala e na escrita e perda de equilíbrio, o que gera uma maior quantidade de quedas. Além disso, também aparecem estes sintomas: menos expressões faciais, mudanças na fala e na escrita, problemas urinários, prisão de ventre, problemas na pele e problemas para dormir.

Os sintomas do mal de Parkinson podem variar significativamente entre os pacientes, e, na verdade, 25% dos casos recebe um diagnóstico errôneo.

Ao identificar esses sintomas, consulte seu médico.

Como é realizado o diagnóstico?

Às vezes é complicado diagnosticá-lo, pois as primeiras características podem ser difíceis de avaliar, e podem ser semelhantes a outras doenças. Por exemplo, o tremor pode não ser evidente se uma pessoa estiver sentada descansando, ou as mudanças posturais podem ser consideradas como resultado da osteoporose ou simplesmente como um sinal de envelhecimento.

Na atualidade, não existem análises de laboratório ou de sangue sofisticados que permitam diagnosticar a doença. Por isso, o médico talvez deva observar o paciente durante um tempo para reconhecer os sintomas de tremor e rigidez, e compará-los com outros sintomas característicos. Também compilará todos os antecedentes dos sintomas do paciente, atividades, remédios, outros problemas médicos e a exposição a substâncias químicas tóxicas. Depois, realizará um exame físico das funções do cérebro e do sistema nervoso, avaliando reflexos, coordenação, força muscular e função mental do paciente.

Em que consiste o tratamento?
Existem diversas opções:

  • Remédios: existem fármacos que imitam o papel da dopamina, e funcionam estimulando determinadas partes do cérebro e do sistema nervoso. Mas, para tratar os sintomas da doença de Parkinson, são utilizados outros tipos de fármacos que bloqueiam uma enzima que destrói a levodopa e a dopamina.
  • Cirúrgicas: as cirurgias mais antigas requeriam da destruição intencional de partes do cérebro, e apresentavam um maior risco de sofrer complicações. Hoje, esse tipo de cirurgia é pouco frequente.

Em geral, a cirurgia é considerada apenas quando os remédios não podem fornecer um controle apropriado. Dentro das novas opções, a estimulação cerebral profunda oferece várias vantagens significativas. Esta técnica consiste em colocar permanentemente um eletrodo em um lugar profundo do cérebro. O eletrodo é posteriormente conectado a um tipo de marcapasso implantado debaixo da pele, no peito. Quando é ativado, o dispositivo envia pulsos elétricos contínuos para os lugares específicos, bloqueando as pulsações que causam o tremor.

Esta opção não requer a destruição intencional de uma parte do cérebro e, portanto, apresenta poucas complicações. Além do mais, é regulável e pode ser trocado na medida em que a doença ou a resposta do paciente aos remédios mudem. E se a estimulação cerebral profunda gerar uma quantidade excessiva de efeitos colaterais, é possível desligar o estimulador e reverter os efeitos.

Prevenção  

Não há maneira de prevenir esta doença, mas sim existem várias maneiras de atendê-la. Por isso, recomenda-se ir imediatamente a um médico especialista em doenças de movimento, caso perceber algum dos sintomas característicos.