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Parkinson’s disease

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  • 1. PARKINSON’S DISEASE
  • 2. Parkinson’s Disease Parkinson’s disease , is named after James Parkinson who in 1817 wrote a classic “shaking palsy”a disease for which the reason is still unknown .
  • 3.  Definition :It is a chronic degenerative disorder that primarily affects the neurons of the basal ganglia. It is a syndrome that consists of slowing down in the initiation and execution of movement (brady kinesia), increased muscle tone (rigidity), tremor and impaired postural reflexes
  • 4. The famous internationally known boxer Mr. Mohammed Ali suffered from this disease. incidence: Occurs in the age group of 60s. Mostly men are affected than women.
  • 5. Classifiation  Post encephalitic parkinsonism , which occured after the large epidemic of encephalitisin 1919.  Drug induced parkinsonism, occuring after long term use of phenothiazines .  Toxin induced parkinsonism , sometimesresulting from carbon monoxide, mercury, or manganese exposure.
  • 6.  Exposure to agricultural herbicides and pesticides  Trauma or injury to the midbrain.
  • 7. Etiology  Heredity  Antipsychotic drugs (or neuroleptic agents)  Encephalitis infection in response to brain trauma, tumors, hydrocephalus or ischaemia  Arteriosclerosis  Neurotoxins such as cyanide, manganese and carbon monoxide  Drugs like reserpine (hydropress), meyhyl dopa (aldomet), haloperidol (haldol) and phenothiazine (thorazine)
  • 8. Pathophysiology Antipsychotic drugs , encephalitis and other causes ↓ Affects the substantia nigra ↓ Destuction of dopamine producing neurons within the basal ganglia ↓ Reduces the amount of available straital dopamine ( inhibitory effects )
  • 9. There is increase in acetylcholine (excitatory effects ) ↓ Excitatory activity of Ach is inadequately balanced ↓ Difficulty in controlling and initiating voluntary movements
  • 10. Clinical manifestations In the beginning stages • Mild tremor • Slight limp • Decreased arm swing Later • Shuffling, propulsive gait with arms flexed • Loss of postural reflexes • Slight change in speech pattern
  • 11. Classic clinical manifestations 1.Tremor  First sign affects hand writing  Non intentional, present at rest but usually not during sleep  Movement of thumb across the palm gives a “pill rolling” character  Tremor also seen in limbs, jaw, lips, lower facial muscles and head
  • 12. 2. Rigidity • Increased resistance to passive motion when the limbs are moved through their range of motion • Muscles feel stiff and required increased effort to move • Discomfort or pain may be percieved in muscle when rigidity is severe • “Cog wheel” rigidity refer to rachet – like rhythmic contractions of the muscle that occur when the limbs are passively stretched
  • 13. 3. Bradykinesia (akinesia) • Slowness of active movement • Difficulty in initiating movement • Often the most disabling symptom: interferes with ADK and predisposes patient to complication related to constipation , circulatory stasis, skin breakdown and related complications of immobility .
  • 14. 4.Postural instability • i) Changes in gait • Tendency to walk forward on the toes with small shuffling steps • Once initiated, movement may accelerate almost to trot • Festination may occur, which propels the patient either forward or backward propulsively until falling is inevitable.
  • 15. ii) Changes in balance • Stooped- over posture when erect • Arms are semi flexed and do not swing with walking • Difficulty in maintaining balance and sitting erect • Cannot ‘right’ or brace self to prevent falling ,when balance is lost
  • 16. Secondary manifestations 1)Facial appearance • Expressionless • Eyes store straight ahead • Blinking is much less frequent than normal 2) Speech problems • Low volume • Slurred and muffled • Monotone • Difficulty with starting speech and word finding
  • 17. 3) Visual problems • Blurred vision • Impaired upward gaze • Blepharospasm- involuntary prolonged closing of the eyelids
  • 18. 4) Fine motor function • Microphagia- handwriting progressively decreases in size • Decreased manual dexterity • Clumsiness and decreased co-ordination • Decreased capacity to complete ADL. • Freezing- sudden involuntary inability to initiate movement can occur during movement or inactivity
  • 19. 5) Autonomic disturbances • Constipation- hypomotility and prolonged gastric emptying • Urinary frequency or hesitency • Orthoststic hypotension(dizziness, fainting and syncope) • Dysphagia( neuro muscular in co-ordination ) • Drooling( results from decreased swallowing ) • Oily skin • Excessive perspiration
  • 20. 6)Cognitive / behavioral • Depression • Slowed responsiveness • Memory deficit • Visual-spacial deficit • Dementia
  • 21. Pharmacological management  Anti- cholinergics  Anti- histaminics  Dopaminergics  Dopamin agonists  MAO inhibitors
  • 22. Surgical treatment  Thalamotomy  Pallidotomy  Fetal tissue transplantation( no cases resulted in complete reversal of parkinsonian symptoms)  Transplantation of genetically engineering cell lines or vector mediated gene transfection.