PARKINSON’S DISEASE

 

PARKINSONISM

Progressive neurological disorder of muscle movement as a clinical syndrome consist of 4 cardinal features

§  Slowness of movement ( Bradykinesia )

§  Increased tone/ stiffness ( Rigidity )

§  Tremor

§  loss of postural reflexes

Most common parkinsonism is idiopathic (no known cause ) Parkinson's disease

PARKINSON’S DISEASE

• Parkinson's disease is a slowly progressive degenerative disease of nervous system associated with destruction of brain cells , which produce dopamine.

EPIDEMIOLOGY

• PD accounts for more than 80% of all parkinsonism.
• The prevalence shows a gradual increase after the age of 50 yrs and a steeper increase after age 60 yrs.
• Disease onset before age of 30 suggest a hereditary form of parkinsonism.

PATHO-PHYSIOLOGY

• Dopamine and acetylecholine are present in corpus striatum.
• Due to some unknown cause,
• There will be degeneration of dopaminergic neurons.
• Cause imbalance between dopamine and acetylcholine.

Cause for dopamine depletion is not found , so idiopathic Parkinson's disease

CAUSES

• Parkinson's disease occurs due to lack of dopamine.
• Caused by the damage of basal ganglia.
• It is mostly due to the destruction of substantia nigra and the nigrostriatal pathway, which has dopaminergic fibers.

Cause of idiopathic parkinsons disease ;

• Cigarette smoking
• Coffee drinking
• MPTP (methylphenyltetrahydropyridine)
• Pesticides/herbicides
• Heavy metal (iron, manganese)
• Hydrocarbon solvents
• Diet
• Genetic factors

CLASSICAL CLINICAL FEATURES

·         Resting Tremor

·         Cogwheel Rigidity

·         Bradykinesia

·         Postural Instability

Other clinical Features

·         Masked face expression

·         Dysphagia

·         Dysphonia

·         Akinesia

·         Hypokinesia

·         Dementia

·         Urinary retention

·         Constipation

DIAGNOSIS

• Parkinson's disease remains a clinical diagnosis.
• Routine laboratories are not helpful
• CT , MRI

TREATMENT

• 6 type of medications are available for symptomatic treatment; (help you manage problems with walking, movement and tremor)
• Anticholinergics
• Amanatide
• L-dopa
• Monoamineoxidase inhibitors
• Catechol-o-methyltransferace inhibitors
• Dopamine agonists

OTHER MEDICINES

• Dopamine promoter

Stimulates dopamine receptors in the brain.

• Antidepressant

Prevents or relieves depression and elevates mood.

• Cognition-enhancing medication

Improves mental function, lowers blood pressure and may balance mood.

• Anti-Tremor

Helps control tremor, shaking and unsteadiness.

SELF-CARE

• Physical exercise

Aerobic activity for 20–30 minutes 5 days a week

SURGICAL TREATMENT

• Deep brain stimulation

Deep brain stimulation involves implanting an electrode deep within your brain. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your chest. A wire that travels under your skin connects the device to the electrode.

• Implantation of cellular sourses of dopamine
• Degenerative process like ; gene therapy as well as cellular transplantation
• some of the symptoms of Parkinson's disease such as tremor are abolished by surgical destruction of basal ganglia or thalamic nuclei.

DIFFERENTIAL DIAGNOSIS

• Drug induced parkinsonism
• Parkinson plus syndrome