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Parkinson's Disease
 

Parkinson's Disease

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    Parkinson's Disease Parkinson's Disease Presentation Transcript

    • Presented byJessica Faye Manansala
    •  Is a slowly progressing neurologic movement disorder that eventually leads to disability. Symptoms 1st appear in 50th decade of life Parkinson’s disease may be diagnosed at the aged of 30 PD is the 4th most common neurodegenerative disease. It affects men more frequently than women.Most cause was unknown
    •  Genetic Atheriosclerosis Head trauma Chronic antipsychotic meds Excessive accumulation of O2 Viral infection And some environmental exposure
    • THREE CARDINAL SIGNS1. Tremor2. Rigidity3. Bradykinesia (abnormally slow movement)Other signs Hypokinesia Gait disturbances Postural instability
    •  Tremor – rhythmic , slow turning motion of the forearm & hand and a motion of the thumb against the finger as if a rolling pill.- Present while the pt. is at rest- Tremor increase when the pt. is walking, concentrating or feeling anxious. Rigidity – resistance to passive limb movement “cogwheeling” passive movement- Stiffness of the neck, trunk & shoulder is common.- The pt. may complain shoulder pain (early signs). Bradykinesia - abnormally slow movementHypokinesia (abnormally diminished movement) – common appear after tremor
    •  Micrographia – shrinking, slow hand writing Dysphonia – soft, slurred, low pitched, and less audible speech. Shuffling gait – the pt. may walk faster and faster, trying to move the feet forward under the body’s center of gravity.Other manifestations Excessive & uncontrolled sweating Proxysmal flushing Gastric & urinary retention Orthhostatic hypothension Constipation Dementia Depression
    •  PET (Positron emission tomography)scanning – used in evaluating levodopa (precursor of dopamine) uptake and conversion to dopamine. Patients history Presence of 2 or 3 cardinal signs
    •  Antiparkinsonian medications – levodopa (dopar, larodopa) with the combination of carbidopa (sinemet)- Budipine – non-dopaminergic, atiparkinsonian medication (it reduces akinesia, rigidity and tremor) Anticholinergic therapy – (trihexyphenidyl, cycrimine, procyclidine, biperiden and benztropine mesylate) effective for controlling tremor and rigidity. Antiviral therapy – amantadine hydrochloride (symmetrel)- It release dopamine from neuronal sites it has also a low incidence of side effect
    •  Dopamine agonist – bromocriptine mesylate (parlodel) and pergolide (permax). Ergot derivatives- This are dopamine receptor agonist and are useful in postponing the initiation of carbidopa or levodopa therapy. MAO inhibitors – selegiline (eldepryl)- It inhibits dopamine breakdown and is thought to slow the progression of the disease.- Selegiline used w/ the combination of dopamine agonist to delay the use carbidopa or levodopa therapy. COMT inhibitor (catecol-O-methyltransferase) – comtess and tasmar- COMT block the enzyme that metabolizes levodopa, amking more levodopa more available for conversion to dopamine in the brain.
    •  Antidepressant – tricyclic antidepressant may be prescribe to alleviate the depression that is so common in parkinson’s disease. Antihistamine – benadryl, banflex, neo-synephrine have mild central anticholinergic and sedative effects and may reduce tremors.SURGICAL MANAGEMENT Stereotactic procedures – thalamotomy and pallidotomy are effective in relieving PD symptoms- pt. with dimentia and atypical parkinson disease are usually not considered for this procedure- Thalamotomy and pallidotomy is to interrupt the nerve pathways and thereby alleviate tremor or ridigity.
    •  Neural transplantation – surgical implantation of adrenal medulary tissue into the corpus striatum to reestablish normal dopamine release. Deep brain stimulation – pacemaker like brain implant- An electrode is placed in the thalamus and connected to a pulse generator implanted in a subcutaneous subclavicular or abdominal pouch. The battery powered pulse generator send high frequency electrical impulses through a wire placed under the skin to a lead anchored to skull- The electrode blocks nerve pathways in the brain that cause tremors.
    • THE END 