For a long time apply anticholinergics to treatment of parkinsonism. In 1874 the famous French doctor Sharko used a belladonna for reduction of the strengthened sialosis observed in parkinsonism, at the same time also reduction of a tremor was noted. Further as antiparkinsonichesky means began to use not only galenovy drugs of a belladonna, but also individual alkaloids - atropine and also Scopolaminum, and with the advent of synthetic cholinolytic means - a number of drugs of this group.
Originally use of all these means had empirical character as the role of neurochemical processes in pathogenesis of parkinsonism was not known.
Now it is known that in pathogenesis of Parkinson's disease and the phenomena of parkinsonism an important role is played by disturbances of neuromediator processes in the estrapyramidal system of a brain. Defeats of subcrustal nodes, especially globus pallidus and substantia nigra which are observed in this pathology are followed by significant shifts in cholinergic and dofaminergichesky processes, namely increase in cholinergic activity of the dopamine which is one of the main transmitters of nervous excitement in subcrustal formations (in particular, in basal gangliya). It is established that in parkinsonism the content of dopamines in basal gangliya is reduced.
Thus, the efficiency of anticholinergic substances finds an explanation <<выравнивании>c> neuromediator interactions. Same the efficiency of the means which found recently broad application in parkinsonism stimulating functions of dofaminergichesky systems of a brain speaks (L-dofa, midaitan, etc.)
Use of cholinolytics and dofaminergichesky means is, thus, pathogenetic impact on disease process.
Along with use in the medical purposes of drugs of these groups their combined use is separately possible. It is important that on the available data, the central cholinolytics can not only affect cholinergic structures, but also strengthen effects of dopamine, oppressing process of its inactivation (by slowing down of its return capture by presynaptic nerve terminations).
Thus, the main modern protivoparkinsonichesky drugs are divided into 2 groups: A. The means influencing the cholinergic systems of a brain; B. The means influencing the dofaminergichesky systems of a brain.
From cholinolytic means now synthetic drugs have the main use. The belladonna drugs appointed earlier in parkinsonism especially strongly affect peripheral holinoretseptor less on - brain holinoretseptor. The therapeutic effectiveness of these drugs in parkinsonism is rather small, at the same time they cause various by-effects: dryness in a mouth, accommodation disturbance, an ischuria, the general weakness, dizziness, etc. In this regard the used earlier protivoparkinsonichesky drug of this group - a tablet<<Корбелла>>, containing dry extract of a root of a belladonna, is excluded from the nomenclature of medicines recently. Limited use has foreign complex drug Bellazonum which part the sum of alkaloids of a belladonna is.
Modern synthetic protivoparkinsonichesky drugs are characterized by more selective central cholinolytic effect. In experimental conditions these connections weaken or the tremor and spasms caused in animals by nicotine (N - cholinolytic action) and arecoline warn (m - cholinolytic action). Cyclodolum, Tropacinum, Dinezinum, etc. belong to these drugs. They have broad use (as the proofreader) at treatment of estrapyramidal diseases and also neurologic complications (parkinsonism phenomena) caused by antipsychotic drugs.
In parkinsonism also other drugs, obladayushchiyecentralny cholinolytic activity can be effective (amizyl, Dimedrol, etc.). In literature there are data on quite high activity of amizyl in parkinsonism.
The levodopa (L-dofa), Midantanum, Gludantanum and other medicines having dofaminergichesky activity belong to drugs of the second group.
Important approach to increase in antiparkinsonichesky efficiency of dofaminergichesky substances is the prmeneniye of the connections inhibiting the enzymes inactivating L-dofa and dopamine and promoting increase in concentration of dopamine in a brain and to strengthening of its interaction with dofaminergichesky receptors (see Madopar, NAC, Deprenil).