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
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.