A brief overview of Parkinson's disease. Dr. Amin Mohammadzadeh https://www.linkedin.com/in/amin-mohammadzadeh-26283660?lipi=urn%3Ali%3Apage%3Ad_flagship3_profile_view_base_contact_details%3BBBeVf3VNSO61bsqvs1fLkw%3D%3D amin60m@gmail.com

1. Parkinson‘s Disease
MOVEMENT DISORDERS
Dr.Amin Mohammadzadeh

2. Content:
1. Parkinson‘s Disease
2. Epidemiology
3. Classification
4. Cardinal Symptoms
5. EssentialTremor
6. EssentialTremorVS Parkinson‘s Disease
7. Neuroanatomy
8. Neuromodulation
9. Boston Scientific Portfolio

3. Parkinson‘s Disease
• First described in 1817 by James Parkinson
• Parkinsonism is a clinical syndrome of Rigidity,
Bradykinesia, RestingTremor, and Postural
Instability (loss of postural reflexes).
• Parkinson disease is a progressive brain disorder
characterized by the loss of neurons in an area of
the midbrain known as the substantia nigra.

4. Parkinson‘s Disease
• These neurons use dopamine as a neurotransmitter and
project their axons to the thalamus and the caudate and
putamen areas of the basal ganglia.
• Parkinsonism refers to any disease that alters
dopaminergic pathways connecting the substantia nigra
to the basal ganglia.

5. Famous Parkinson's Disease Patients
• Alan Alda
• MuhammadAli
• George H.W. Bush
• RobinWilliams
• Neil Diamond
• Michael J. Fox
• Pope John Paul II
• Brian Grant

6. Epidimiology
• Estimated prevalence: 500,000–1 million patients in
United States
• Incidence: 40,000–60,000 new cases per year in USA.
• Affects up to 0.3% of general population, but 1–3% of
those >65 y/o.
• PD is largely a disease of older adults: only 5–10% of
patients have symptoms before 40 y/o (young-onset
PD).

7. Epidemiology
• Occurs between 45 and 65 years of age:
• Distribution is equal in men and women.
• Most cases are sporadic, but some cases are familial.

8. Classification
o Idiopathic Parkinson‘s Disease (~75% all patients)
o Familial Parkinson‘s Disease
• Genetic inheritable forms are rare, named after respectve mutated locus (e.g.
PARK1)
o Secondary Parkinsonism
• Drug inducsed (e.g. neuroleptics)
• Post-traumatic (e.g. Boxers Encephalopathy)
o Atypical Parkinsonism (they have a different neurodegenerative disease)
• Multiple System Atrophy (MSA)
• Progressive Supernuclear Palsy (PSP)

9. Cardinal Symptoms
o RestingTremor (Frequency ~ 4-6 Hz)
o Bradykinesia = Slowness of movement
o Rigidity = Increased muscle tone, resistance to
passive movements
o Postural Instability = Loss of balance

11. Basal Ganglia Disruption

13. Dopamine Replacement Therapy
• L-Dopa Preperations
• L-Dopa in comboniation with Decarboxylase inibitor (Carbidopa,
Benserazid)
• Dopamine Agonist
• Ergot alkaloids = Dopamine agonists (Bromocriptin, Caberoglin,
Dihydroergocryptin,…)
• Selective D2-Receptr agonists = Non-Ergoline Dopamine agonists
(Apomorphin, Piribedil, Parmipexol, Ropinirol, Rotigotin)

14. Essential Tremor
EssentialTremor is…

15. Essential Tremor
• One of the most common movement disorders
• Prevalence of 3-4 per 1000
• 2-4% among over 40
• 3-6% among over 60
• 20% among over 95*
• Annual incidence of 23.7 per 100,000
• Slightly higher prevalence among men (1.08 : 1)
• Genetic Component

16. ET Tremor VS PD Tremor
ET
• IntentionTremor
• Faster (4-12 Hz)
• Variable Amplitude
• Primary Symptom
• Often Familial
• Alcohol Improves
• Onset anytime
PD
• RestingTremor
• Slower (4-6 Hz)
• Moderate Amplitude
• Constellation of Symptoms
• Infrequently Familial
• Alcohol has no effect
• Late onset

18. Neuroanatomy - Gross Functions
Frontal lobe:
Thinking,
behavior and
movement
Occipital lobe:
Sight
Temporal lobe:
Hearing, learning,
memory
Parietal lobe:
Language,
touch
Cerebellum:
Balance,
movement
coordination
Brainstem:
Breathing,
heart rate,
temperature

21. Ventral intermediate nucleus (VIM):
EssentialTremor, Parkinson’sTremor
Subthalamic nucleus (STN):
Parkinson‘s disease
Globus pallidus internus (GPi):
Dystonia, (Parkinson’s disease)

23. Neuromodulation

24. Neuromodulation
• The International Neuromodulation Society defines therapeutic
neuromodulation as “the alteration of nerve activity through
targeted delivery of a stimulus, such as electrical stimulation or
chemical agents, to specific neurological sites in the body.”

25. 10 Things to Know About Neuromodulation
1. Neuromodulation improves the quality of life for patients
in pain.
2. Neuromodulation can be applied through different
techniques.
3. Neuromodulation is FDA approved and has been used in
practice for more than a quarter century.
4. Potential neuromodulation patients can “test drive” the
modality.
5. Neuromodulation implants can be removed.

26. 10 Things to Know About Neuromodulation
6. Neuromodulation alleviates or lessens pain without
putting patients into a “drug fog.”
7. There are neuromodulation specialists in your area.
8. Neuromodulation procedures are covered by most medical
insurance and Medicare programs.
9. Patient care is of the utmost importance to
neuromodulation specialists.
10.Neuromodulation is NOT SCIENCE FICTION.

35. Dr.Amin Mohammadzadeh