Parkinson’s disease is a progressive
neurodegenerative disorder that results in
deterioration of neurons in basal ganglia.
0.2 / 1000
1.5 / 1000
The incidence and prevalence both increase
Sex incidence is almost equal.
It is less common in smokers.
Typical Age of Onset
Average age of onset is 60 yrs.
5-10% of cases occur under the age of 40.
Referred to as Young-Onset Parkinson
Rarely seen under age 30.
Famous Faces of Parkinson
Michael J. Fox
Mao Tse Tung
Pope John Paul II
Parkinson’s disease is referred to as
idiopathic (unknown cause).
Genetic link is seen in a small number of
Larger genetic link is found in youngonset Parkinsons disease.
MPTP cause severe parkinsonism in
young drug users
Positive family history
Exposure to pesticide
Consumption of well water
Factors which decrease incidence of
Use of NSAIDS
Estrogen replacement in postmenopausal
Lower body Parkinsonism
It may represent a form of vascular
Parkinsonism plus syndrome
Features of parkinsonism associated with
complex clinical presentation
Failure to respond to treatment
Examples include :
1. Shy Dragger syndrome
2. Steel Richardson syndrome
3. Parkinsonism-dementia plus
There is depletion of pigmented
dopaminergic neurons in the substantia
nigra, atrophic changes in substantia nigra
and depletion of neurons in locus
Reduced dopaminergic output from the
substantia nigra to globus pallidus leads to
reduced inhibitory effect on subthalamic
nucleus, neurons of which become more
active in inhibiting activation of cortex
resulting in bradykinesia.
Akinesia / Bradykinesia
Head bent forward
Tremors of head
Maslike facial expression
Loss of postural
Expressionless face (mask like)
Soft rapid indistinct speech, monotonous
Glabellar tap sign / Myersons sign
Impaired postural reflexes
Slow to start walking
Rapid small steps tendency to turn en bloc
Reduced arm swing
Impaired balance on turning
mostly in upper limbs
Plastic / lead-pipe:
mostly in lower limbs
Slowness in initiation or repeating
Impaired fine movements
Hoehn & Yahr Scale
Stage I: Unilateral involvement only, usually with
minimal or no function impairment.
Stage II: Bilateral or midline involvement w/o
impairment of balance.
Stage III: 1st signs of righting reflex impairment;
functionally restricted in his/her activities but can
lead independent life. Disability mild/moderate.
Stage IV: Severely disabled. Able to walk &
stand unaided but is markedly handicapped.
Stage V: Confined to bed.
There is no specific medical test used to
diagnose Parkinson disease.
However, MRIs and blood tests are used
to rule out other possible conditions that
have similar symptoms to Parkinson
It is the oldest and most effective treatment of
Brain enzymes modify the drug to create dopamine.
It reduces slowness and stiffness of muscles.
Given in combination with peripheral decarboxylase
inhibitors, carbidopa & benserazide.
Combinations are called Sinemet & Madopar
Nausea, vomiting, hypotension,orofacial
dyskinesias, dystonias, hallucinations.
Two important phenomenon associated
with levodopa use are:
1) end- of- dose deterioration
2) on-off phenomenon
Useful effects on tremors & rigidity but
do not help bradykinesia.
Adverse effects :
Dry mouth , blurred vision , difficult
urination , constipation, confusion,
Useful in controlling dyskinesia produced
by dopaminergic treatment later in the
livedo reticularis , peripheral edema,
confusion , seizures
Surgical procedures are now available for
specific patients who no longer respond to
It is a neurosurgical procedure that can
reduce many of the symptoms of Parkinson
Performed by a neurosurgeon, who inserts a
hallow probe into the globus pallidus and then
liquid nitrogen is circulated in the probe.
The probe destroys part of the globus
pallidus by creating a scar .
The patient is awake during the procedure
which takes about 6 hours.
It can permanently eliminate
Reduces tremor, rigidity, bradykinesia
and shuffling gait.
It is not a cure.
Deep Brain Stimulation
An electrode is placed in one of several parts
of the brain (thalamus, globus palladus, or
The electrode is attached to a computerized
pulse-generator which is put under this skin in
Symptoms are relieved through the regulation
of electrical impulses from those three areas
of the brain.
Neural grafting, or transplantation of nerve
cells, is an experimental technique
proposed for treating the disease.
Investigators have shown in animal
models that implanting fetal brain tissue
from the substantia nigra into a
parkinsonian brain causes damaged nerve
cells to regenerate.
General Treatment Strategies
Develop routine for self care
Help family/care partner, along with patient,
create ideas for adapting home environment to
meet the patient’s needs.
Full bathroom and bedroom on first floor
Remove rugs/carpet/furniture that could be
easily tripped over
Important to encourage continued
involvement in activities important to their
Participation in activities which are not
Introduce techniques for enhancing voice
Depends upon the age of onset
If symptom starting in middle life ,the
disease is usually progressive & likely to
After 70 is unlikely to shorten life or