The document discusses Parkinson's disease, including its causes, symptoms, stages, diagnosis, treatment, and prevention. Some key points: - Parkinson's is a progressive nervous system disorder caused by loss of dopamine-producing brain cells. Symptoms include tremors, rigidity, and impaired movement. - It is staged from 1 to 5 based on severity, from mild symptoms on one side of the body to requiring 24/7 care. Diagnosis is based on symptoms and medical history. - Treatment focuses on managing symptoms through medications like levodopa and carbidopa that aim to replace dopamine. Surgery like deep brain stimulation may also help in severe cases. - Risk can be reduced through diet high in omega

1. By- Vijaiy. S & Shreedevi. R
RVS COLLEGE OF PHARMACY, SULUR, COIMBATORE,
TAMILNADU.

2. INTRODUCTION
• It is a slowly progressive degenerative disease of nervous system
associated with damage to basal ganglia followed by destruction of
substantia nigra.
• This causes decrease in dopamine level causing parkinsons diseases.
• It was discovered by English physician James Parkinson in 1817.
• It is also called as Parkinsonism/Paralysis agitans.
• It is found to be 14th major cause for death in US.

4. PATHOPHYSIOLOGY

5. SYMPTOMS
• Mild noticeable tremor in one hand.
• Bradykinesia
• Rigid muscles.
• Poverty of movements-Loss of activties
including blinking,smiling etc.
• Gait
• Emotional changes.
• Dementia.
• And due to stages

6. CAUSES
• Encephalitis
• Cerebral arteriosclerosis
• Drugs - Prolonged use of Antihpertensive drugs (Eg:Reserpine)
• Low levels of dopamine and norepinephrine, a substance that
regulates dopamine, have been linked with Parkinson’s.

7. • Research has identified groups of people who are more likely to develop
the condition. These include:
• Sex: Men are one and a half times more likely to get Parkinson’s than
women.
• Race: Whites are more likely to get Parkinson’s than African Americans
or Asians.
• Age: Parkinson’s usually appears between the ages of 50 and 60. It
only occurs before the age of 40 in 5-10 percent of cases.
• Family history: People who have close family members with
Parkinson’s disease are more likely to develop Parkinson’s disease, too.
• Toxins: Exposure to certain toxins may increase the risk of Parkinson’s
disease.
• Head injury: People who experience head injuries may be more likely
to develop Parkinson’s disease.

8. STAGES OF PARKINSON’S DISEASE

9. Stage one of Parkinson’s disease
• The symptoms of PD are mild and only seen on one
side of the body (unilateral involvement), and there is
usually minimal or no functional impairment
• Symptoms at stage one may include tremor, such as
intermittent tremor of one hand, rigidity, or one hand
or leg may feel more clumsy than another, or one side
of the face may be affected, impacting the expression.
• This stage is very difficult to diagnose and a physician
may wait to see if the symptoms get worse over time
before making a formal diagnosis

10. Stage two of Parkinson’s disease
• It is characterized by symptoms on both sides of the body
(bilateral involvement) or at the midline without impairment to
balance.
• Stage two may develop months or years after stage one.
Symptoms of PD in stage two may include the loss of facial
expression on both sides of the face, decreased
blinking, speech abnormalities, soft voice, monotone voice,
fading volume after starting to speak loudly, slurring speech,
stiffness or rigidity of the muscles in the trunk that may result
in neck or back pain, stooped posture, stooped posture, and
general slowness in all activities of daily living.
• Diagnosis may be easy at this stage if the patient has a
tremor.

11. Stage three of Parkinson’s disease
• It is considered mid-stage and is characterized by loss
of balance and slowness of movement.
• Balance is compromised by the inability to make the rapid,
automatic and involuntary adjustments necessary to
prevent falling, and falls are common at this stage.
• All other symptoms of PD are also present at this stage,
and generally diagnosis is not in doubt at stage three.
• Often a physician will diagnose impairments in reflexes at
this stage by standing behind the patient and gently pulling
the shoulders to determine if the patient has trouble
maintaining balance and falls backward (the physician of
course will not let the patient fall).

12. Stage four of Parkinson’s disease
• Patients with stage four PD may be able to walk and
stand unassisted, but they are noticeably
incapacitated. Many use a walker to help them.
• At this stage, the patient is unable to live an
independent life and needs assistance with some
activities of daily living. The necessity for help with
daily living defines this stage. If the patient is still able
to live alone, it is still defined as stage three.

13. Stage five of Parkinson’s disease
• It is characterized by an inability to rise from a chair
or get out of bed without help, they may have a
tendency to fall when standing or turning, and they
may freeze or stumble when walking.
• Around-the-clock assistance is required at this stage
to reduce the risk of falling and help the patient with
all daily activities. At stage five, the patient may also
experience hallucinations or delusions.

14. DIAGNOSIS
• There’s no specific test for diagnosing Parkinson’s.
Diagnosis is made based on health history, a physical and
neurological exam, as well as a review of signs and
symptoms.
• Imaging tests, such as a CAT scan or MRI, may be used to
rule out other conditions. A dopamine transporter
(DAT) scan may also be used. While these tests don’t
confirm Parkinson’s, they can help rule out other
conditions and support the doctor’s diagnosis.

15. MRI & CT SCAN
A. Normal
B. Stage 1
C. Stage 2
D. Stage 3
E. Stage 4
F. Stage 5

18. TREATMENT
• Medications can control the symptoms of Parkinson's diseases.
• Following are the drugs used in the treatment:
• Levodopa-Dopamine precursor.
• Carbidopa-Peripheral decarboxylase inhibitor.
• Bromocriptine-Dopaminergic agonist.
• Selegilne
• Amantadine-Dopamine facilitator.
• Biperiden-Anticholinergics.

19. • Carbidopa +Levodopa (sinmet) is the 1st choice of drug.On
combination with carbidopa many common side effects of
levodopa, such as nausea, vomiting, and irregular heart
rhythms can be prevented.
• Tolcapone and entacapone. When you take levodopa, a
chemical in your body called COMT makes part of the drug
useless. The drugs tolcapone (Tasmar) and entacapone
(Comtan) block COMT, so the brain can use levodopa more
effectively, which eases Parkinson's symptoms.
• Levodopa is said to be "Gold standard treatment".

20. Mechanism of
Action

21. PARKINSON’S SURGERY
• Surgical interventions are reserved for people who don’t respond
to medication, therapy, and lifestyle changes.
• Two primary types of surgery are used to treat Parkinson’s:
1. Deep BrainStimulation
2. Pump- Delivered Therapy
• Deep brain stimulation
• During deep brain stimulation (DBS), surgeons implant electrodes in
specific parts of the brain. A generator connected to the electrodes
sends out pulses to help reduce symptoms.

22. • Pump-delivered therapy
• In January 2015, the U.S. Food and Drug Administration (FDA)
approved a pump-delivered therapy called Duopa.
• The pump delivers a combination of levodopa and carbidopa. In
order to use the pump, your doctor will have to perform a surgical
procedure to place the pump near the small intestine.

23. DBS

24. PARKINSON’S PROGNOSIS
• Complications from Parkinson’s can greatly reduce quality of life and
prognosis. For example, individuals with Parkinson’s can experience
dangerous falls, as well as blood clots in the lungs and legs. These
complications can be fatal.
• Proper treatment improves your prognosis, and it increases life
expectancy.
• It may not be possible to slow the progression of Parkinson’s, but you
can work to overcome the obstacles and complications to have a better
quality of life for as long as possible.

26. PREVENTION AND DIET
• Go Organic (and Local)
• Eat fresh raw vegetables.
• Incorporate Omega-3 Fatty Acids IntoYour Diet.
• Drink green tea.
• Do regular aerobic exercise.
• Intake of sufficient quantity of CoQ10 enzyme can prevent
or slow down the chances of Parkinson's diseases.Avoid
stress.

27. Reference : Parkinson disease
https://www.healthline.com/health/parkinsons
https://en.m.wikipedia.org/wiki/Parkinson%27s_disease
https://www.parkinson.org/understanding-parkinsons/what-is-parkinsons

28. Thank you