Parkinson’s disease


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Parkinson’s disease

  2. 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. 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. 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. 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. 6.  Exposure to agricultural herbicides and pesticides  Trauma or injury to the midbrain.
  7. 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. 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. 9. There is increase in acetylcholine (excitatory effects ) ↓ Excitatory activity of Ach is inadequately balanced ↓ Difficulty in controlling and initiating voluntary movements
  10. 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. 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. 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. 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. 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. 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. 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. 17. 3) Visual problems • Blurred vision • Impaired upward gaze • Blepharospasm- involuntary prolonged closing of the eyelids
  18. 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. 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. 20. 6)Cognitive / behavioral • Depression • Slowed responsiveness • Memory deficit • Visual-spacial deficit • Dementia
  21. 21. Pharmacological management  Anti- cholinergics  Anti- histaminics  Dopaminergics  Dopamin agonists  MAO inhibitors
  22. 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.