Parkinson's disease is a neurodegenerative disorder that causes motor symptoms like tremors, rigidity, and slowed movement. It results from the loss of dopamine-producing neurons in an area of the brain called the substantia nigra. As dopamine levels decrease, communication between the substantia nigra and striatum is disrupted, impairing motor control. Early symptoms often include tremors at rest that subside with movement. Later, symptoms like stiffness, slowness, balance problems, and freezing develop. While medication can help replace dopamine levels, the disease continues to progress over time.

1. Parkinson Disease
Aditya Johan Romadhon, Sst.Ft, M.Fis

2. Introduction
James Parkinson wrote a 66 page treatise entitled
An Essay on the Shaking Palsy
He believed that he had identified a new ‘medical
species’ that had ‘not yet obtained a place in the
classification of nosologists’ (Parkinson, 1817)
Parkinson’s disease (PD) is a complex and
progressive disorder characterized by various
motor and non-motor symptoms.
Parkinson disease is a neurodegenerative disorder
that mostly presents in later life with generalized
slowing of movements (bradykinesia) and at least
one other symptom of resting tremor or rigidity
Other associated features are a loss of smell, sleep
dysfunction, mood disorders, excess salivation,
constipation, and excessive periodic limb
movements in sleep

3. The disorder has a slow
onset but is progressive
Tremor is often the first
symptom and later can be
associated with
bradykinesia and rigidity
Postural instability is
usually seen late in the
disease and can seriously
impact the quality of life
Cardinal motor features
include rest tremor,
rigidity, bradykinesia,
postural instability and an
altered walking pattern,
including freezing of gait

4. Clinical Manifestation
An earlier feature of PD is tremor, typically unilateral
and present at rest
After using the hands, such as to pick up a book, the
tremor may vanish for some minutes, only to return
when the patient is distracted and resting once again
Slowness, or bradykinesia, on the other hand, is a core
feature of PD, patients will notice it takes them longer
to do simple tasks
In the clinic, patients demonstrate an inability to tap
their index finger and thumb rapidly, tap their foot
rhythmically on the floor, or walk steadily
Rigidity is the third prominent feature on examination
On checking muscle tone, lead pipe and cogwheel
rigidity can be appreciated

5. A combination of bradykinesia and rigidity
leads to some other characteristic features of
PD, such as micrographia
The fourth prominent feature of PD is gait
disturbance, although this is typically a late
manifestation
Patients will have trouble rising from a chair
without support
They take small, slow steps, they are unable to
stop themselves from falling if pushed lightly
They cannot turn around without taking several
small steps
And tend to freeze when faced with certain
stimuli such as a doorframe or a passer-by

6. Pathophysiology
▪ In 1919, it was first recognized that loss of pigmentation in the substantia nigra of the midbrain
is a feature of the post-mortem brain examination of patients with PD
▪ In the 1950s, it was further understood that the pigmented neurons that are lost in the
substantia nigra are dopaminergic, and it is the loss of dopamine in subcortical motor circuitry
that is implicated in the mechanism of the movement disorder in PD

7. Dopamine Regulation of Striatal Output
In normal conditions, the direct pathway facilitates
while the indirect pathway inhibits movement
Thus, the direct and indirect pathways act in concert
to regulate motor control handled by the basal ganglia
Dopamine (DA) release from the substantia nigra pars
compacta (SNc) causes an excitation in the direct
pathway via activation of DA (D)-1 receptors and an
inhibition in the indirect pathway via D2 receptors
Therefore, DA is required for movement to occur
The loss of DA in Parkinson’s disease causes
hyperactivity in the motor inhibitory D2 indirect
pathway and decreased activity in the facilitatory D1
direct pathway
This imbalance results in an inhibition of voluntary
movement.

8. Basal Nuclei Output Disorder

9. Medication
At present, replacement therapy with a precursor of
dopamine (DA)
L-DOPA, is the most effective therapeutic approach
in treating the symptoms of PD
This treatment effectively restores terminal DA
levels in the striatum and re-establishes the balance
between activation of the direct pathway and the
indirect pathway
Thus, L-DOPA pharmacotherapy is highly effective
in reducing symptoms of PD on a short-term basis
Nonetheless, after three to five years of treatment,
motor fluctuations, loss of efficacy, and
development of involuntary movements

10. Parkinsons Stage

11. Physiotherapy Related to Disease
Progression

12. THANKS