Prodromal stage in Parkinson’s disease

Beware of small signs that do not deceive… Everyone knows the classic Parkinsonian triad (rest tremor, rigidity and bradykinesia). Remember that when the clinical signs of the disease appear and are identified by the patient and the doctor, the dopaminergic population was destroyed more than 50% at the level of the basal ganglia. Many years ago seemingly innocuous clinical symptoms appeared but were neglected:
  • apathy (lack of motivation), in everyday life often taken for a depressive state,
  • genito-sphincter disorders evolving at low noise and which do not seem worrying (overactive bladder or frequent urge to urinate often confused in men from the fifties with a prostate problem, constipation …),
  • a discreet instability in everyday life that makes running more difficult with sometimes episodes of tension fluctuations,
  • attention and concentration disorders related to a beginner dysexecutive syndrome,
  • hyper-emotionality,
  • oral facial apraxia with greater difficulty in singing or whistling than before,
  • a progressive loss of smell or anosmia,
  • sleep disorders with a tendency to live waking dreams (motor behavior disorders in REM sleep),
  • a feeling of “inner vibration” reported by some patients especially at the level of a limb segment or even a hemibody and which may precede the appearance of a real rest tremor.
All this reflects the implication of a fairly wide dysfunction of the central nervous system (cortical and subcortical) but also of the vegetative nervous system “the great forgotten” of medicine. Composed of two systems that antagonize the sympathetic and para-sympathetic systems, it ensures the functioning of our vegetative, visceral and glandular functions in short of things essential to our existence. One accelerates the transit while the other slows it down. One raises blood pressure while the other lowers it.. A fragile balance that can be jeopardized. Understanding the role of the vegetative nervous system (which has vegetative only the name because it is on the contrary very active in our daily lives) is to better understand the small dysfunctions of everyday life that we must know how to observe before the extra-pyramidal storm occurs.