Parkinson’s Disease            -Paralysis agitans; Shaking palsy                            Presented by: Tenzin Dolma    ...
General Introduction:• It is one among the disease affecting the basal  ganglia( basal nuclei) and the brain stem( mid  br...
Basal Nuclei/ Basal Ganglia     (Controls Voluntary Movement)                                                Caudate      ...
Production, Release, reuptake and inactivation of          monoamine neurotransmitters                                    ...
Dopaminergic pathway in Brain:                                               Nigrostraital                                ...
The Motor CircuitGlutamate(excitatory)                                                         GABA                       ...
Parkinsonism:.    Diminished expression in the face•   Slowness of voluntary movement, Rigid or stiff muscles, often begin...
Causes/Etiology..     The exact cause of the disease is not known.•   Genetic factor plays a role but it varies from perso...
Pathogenesis and Molecular geneticsInheritedA .dominantJuvenileA. recessive Inherited    PD               Pathology presen...
MPTP• Destruction of neurons in Substantia Nigra          Exposure to MPTP( 1-           Exposure to MPTP( 1-          met...
Morphologic changes• Neurons of the substantia nigra show severe morphological  changes in Parkinsons disease. There is pa...
Diagnosis• The symptoms can be difficult to assess, particularly in the  elderly. They become more clear as the illness ge...
Microscopic PathologyThis is an example of a normal substantia nigra at medium power.                 Pathology presentati...
This is the substantia nigra of the current case taken at the same magnification.Note the extensive loss of pigmented neur...
At high power we can see that this surviving neuron contains a Lewy body (arrow). Thesewere seen in many of the surviving ...
How Treatment Works?•   There is no known cure for Parkinsons disease. The goal of treatment is to    control symptoms.•  ...
Treatment• Drugs                                        • Surgeries1. Levodopa (L-dopa), Sinemet,                1. Stereo...
Terminologies to Look For• Lewy Bodies  - Single or multiple cytoplasmic, eosinophilic, round to elongated inclusions with...
References• Robbins and Cotrans, Pathologic Basis of  Disease, 7th edition, Elsevier and Saunders• Struat Ira Fox, Human P...
Help Old People in their later years..                               ThankYou!!!      Pathology presentation@ Tenzin Dolma
Upcoming SlideShare
Loading in …5
×

Parkinsons

908 views

Published on

Brief outline of Parkinsons.

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
908
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
28
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Pathology presentation@ Tenzin Dolma
  • Symptoms may be mild at first such as a mild tremor or a slight feeling that one leg or foot is stiff and dragging. It may affect one or both sides of the body, and can include Pathology presentation@ Tenzin Dolma
  • Parkinsons

    1. 1. Parkinson’s Disease -Paralysis agitans; Shaking palsy Presented by: Tenzin Dolma Biomedical Science 2nd year Shaheed Rajguru College,DUPathology presentation @ Tenzin Dolma
    2. 2. General Introduction:• It is one among the disease affecting the basal ganglia( basal nuclei) and the brain stem( mid brain+ Medulla oblongata+ Pons).There is degeneration of dopaminergic neuron.• There is either reduction of voluntary movement or abundance of involuntary movements• It is the second most common disorder next to Alzheimer’s disease Pathology presentation@ Tenzin Dolma
    3. 3. Basal Nuclei/ Basal Ganglia (Controls Voluntary Movement) Caudate Caudate Nucleus Nucleus Putamen Putamen Lentiform Lentiform Nucleus Nucleus Globus Globus Pallidus Pallidus Pathology presentation@ Tenzin Dolma
    4. 4. Production, Release, reuptake and inactivation of monoamine neurotransmitters Trp Trp TT YY RR OO SS II NN EE Pathology presentation@ Tenzin Dolma
    5. 5. Dopaminergic pathway in Brain: Nigrostraital Nigrostraital pathway pathway Degeneration Degeneration cause Parkinson cause Parkinson symptoms. symptoms. Degeneration Degeneration cause Chorea cause Chorea Mesolimbic Mesolimbic pathway pathway Pathology presentation@ Tenzin Dolma
    6. 6. The Motor CircuitGlutamate(excitatory) GABA (inhibi tory)Dopamine( Excitatory) Pathology presentation@ Tenzin Dolma
    7. 7. Parkinsonism:. Diminished expression in the face• Slowness of voluntary movement, Rigid or stiff muscles, often beginning in the legs – Difficulty starting movement, such as starting to walk or getting out of a chair – Slowed movements and loss of fine movements• Shaking, called tremors – Usually occurs in the limbs at rest, or when the arm or leg is held out – Goes away when you move – Eventually may be seen in the head, lips, tongue, and feet – May be worse when tired, excited, or stressed – Finger-thumb rubbing (pill-rolling tremor) may be present• Slowed, quieter speech and monotone voice• Stooped position• Anxiety, stress, and tension• Other symptoms for PD:• Confusion• Dementia• Depression• Fainting• Hallucinations• Memory loss Pathology presentation@ Tenzin Dolma
    8. 8. Causes/Etiology.. The exact cause of the disease is not known.• Genetic factor plays a role but it varies from person to person. It can be autosomal dominant or recessive too. (> 10%)• Sporadic/ Idiopathic• The effect of aging ; 13% decrease in dopamine level per decade but syndrome seen at 80% fall.• Toxins such as Pesticides and other endogenous and exogenous factors• Oxidative free radical toxicity,• Impaired mitochondrial function, which may shift the balance regulating apoptotic cell death. Pathology presentation@ Tenzin Dolma
    9. 9. Pathogenesis and Molecular geneticsInheritedA .dominantJuvenileA. recessive Inherited PD Pathology presentation@ Tenzin Dolma
    10. 10. MPTP• Destruction of neurons in Substantia Nigra Exposure to MPTP( 1- Exposure to MPTP( 1- methyl-4- phenyl-1,2,3,6 methyl-4- phenyl-1,2,3,6 tetrahydropyridine) tetrahydropyridine) ( tox Monoamine oxidase B icity)• (During synthesis of psychoactive meperidine)• Toxicity of MPTP was used in experimental experimental study of PD involving transplantation. Pathology presentation@ Tenzin Dolma
    11. 11. Morphologic changes• Neurons of the substantia nigra show severe morphological changes in Parkinsons disease. There is pallor and local ceruleus.• Decrease of dendritic length, loss of dendritic spines and several types of dendritic varicosities were found only in the melanin-containing pars compacta neurons. Surviving cells contain eosinophilic inclusions Lewy bodies.• Lewy body in basal nucleus of Meynert . Pathology presentation@ Tenzin Dolma
    12. 12. Diagnosis• The symptoms can be difficult to assess, particularly in the elderly. They become more clear as the illness gets worse.• A doctors examination may show:• Difficulty starting or finishing voluntary movements• Jerky, stiff movements• Muscle atrophy• Shaking (tremors)• Changes in your heart rate• Reflexes should be normal.• Symptomatic response to L-DOPA therapy supports PD diagnosis.• Tools: PET and SPET Pathology presentation@ Tenzin Dolma
    13. 13. Microscopic PathologyThis is an example of a normal substantia nigra at medium power. Pathology presentation@ Tenzin Dolma
    14. 14. This is the substantia nigra of the current case taken at the same magnification.Note the extensive loss of pigmented neurons, corresponding to the lack ofpigment seen grossly.All types of Parkinsonism have a minimum 80% loss of neurons in the substantianigra Pathology presentation@ Tenzin Dolma
    15. 15. At high power we can see that this surviving neuron contains a Lewy body (arrow). Thesewere seen in many of the surviving neurons in this case.Lewy bodies are cytoplasmic eosinophilic masses made up of alpha synuclein and otherproteins.In Parkinsons disease they can be found not only in the substantia nigra, but also in thelocus coeruleus, sympathetic ganglia, basal nucleus of Meynert and cerebral cortex. Pathology presentation@ Tenzin Dolma
    16. 16. How Treatment Works?• There is no known cure for Parkinsons disease. The goal of treatment is to control symptoms.• Medications control symptoms, mostly by increasing the levels of dopamine in the brain. At certain points during the day, the helpful effects of the medication often wears off, and symptoms can return. If this happens to you, your health care provider may need to change the: medicine is taken.Sugeries reduce the symptoms.• Work closely with your doctors and therapists to find a treatment program that works best for you. Never change or stop taking any medications without talking with your doctor.• Many medications can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. Monitoring and follow-up by the health care provider is important.• Eventually, symptoms such as stooped posture, frozen movements, and speech difficulties may not respond very well to drug treatment. Pathology presentation@ Tenzin Dolma
    17. 17. Treatment• Drugs • Surgeries1. Levodopa (L-dopa), Sinemet, 1. Stereotactic implants of fetal levodopa and carbidopa (Atamet) mesencephalic tissue into stratium2. MAO inhibitors(Selegiline and 2. Involves placing electrical stimulators in Rasagiline) specific areas of the brain that control3. Anticholinergic medications to movement. Deep brain stimulation. reduce early or mild tremors 3. placement of lesion to compensate loss of nigrostraital pathway 4. Stem cell transplant and other clinical trials are currently ongoing in the USA. Pathology presentation@ Tenzin Dolma
    18. 18. Terminologies to Look For• Lewy Bodies - Single or multiple cytoplasmic, eosinophilic, round to elongated inclusions with a dense core.• Dementia - It is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.• Parkin -protein is a component of a multiprotein E3 ubiquitin ligase complex which in turn is part of the ubiquitin-proteasome system that mediates the targeting of proteins for degradation• Ubiquitin - a small regulatory protein that has been found in almost all tissues ( ubiquitously) of eukaryotic organisms. It directs proteins to compartments in the cell, including the proteasome which destroys and recycles proteins.• α- synuclein ( abundant lipid binding protein)• Chorea: Hyperkinetic disorder with rapid, uncontrolled, jerky movements. Pathology presentation@ Tenzin Dolma
    19. 19. References• Robbins and Cotrans, Pathologic Basis of Disease, 7th edition, Elsevier and Saunders• Struat Ira Fox, Human Physiology, 11th edition, McGraw Hill international Edition• FOYE’S Principle Of Medicinal Chemistry, 6th Edition, Wolters Kluwel/Lippincot Williams and Wilkins Pathology presentation@ Tenzin Dolma
    20. 20. Help Old People in their later years.. ThankYou!!! Pathology presentation@ Tenzin Dolma

    ×