Parkinsonism is a neurological syndrome characterized by tremors, slowed movement, rigidity, and impaired posture and balance. It is caused by degeneration of dopamine-producing neurons in the substantia nigra region of the brain. Parkinsonism occurs in Parkinson's disease but can be caused by other neurological conditions and toxins as well. Symptoms are treated with levodopa/carbidopa to increase dopamine levels or dopamine agonists, though these drugs can cause side effects like nausea, dizziness, and hallucinations. Diagnosis involves neurological exams and tests like MRI and bloodwork to evaluate motor and non-motor symptoms.

1. PARKINSOINISM
Presented By-
Shreya yadav
Nursing Tutor

2. PARKINSONISM
• A disorder of the central nervous
system that affects movement, often
including tremors.
• Parkinsonism is a
clinical syndrome characterized
by tremor, bradykinesia, rigidity,
and postural instability. Parkinsonism
is found in Parkinson's disease (after
which it is named), however a wide
range of other causes may lead to this
set of symptoms, including
some toxins, a few metabolic
diseases, and a handful of
neurological conditions other than
Parkinson's disease.

3. Parkinsons Disease Vs Parkinsonism:
• Parkinson's disease (PD) is a long-term degenerative disorder of the central
nervous system that mainly affects the motor system. The symptoms generally
come on slowly over time. Early in the disease, the most obvious are shaking,
rigidity, slowness of movement, and difficulty with walking. Thinking and
behavioural problems may also occur. Dementia becomes common in the
advanced stages of the disease. Depression and anxiety are also common
occurring in more than a one third of people with PD. Other symptoms include
sensory, sleep, and emotional problems. The main motor symptoms are
collectively called "parkinsonism", or a "parkinsonian syndrome"

4. Clinicalfeatures
• Resting tremor
• Writing smaller; harder to do buttons
• Slowness, “weakness”, limb not
working well
• Stiff or achy limb
• Stoop, shuffle-walk, “dragging” leg(s)
• Trouble getting out of chairs or turning
in bed
• Low or soft voice
• Non-motor: anosmia, dream
enactment, constipation, anxiety,
depression, “passiveness”

5. Symptoms:
Bradykinesia
Tremor
Rigidity
Postutal Changes
Depletion of pigmented
dopaminergic neurons in SN
Reduced
dopaminergic
output from SN
Inclusion bodies
(Lewy bodies)
develop in nigral
cells
Neurons in subthalamic nucleus become more active
than usual in inhibiting activation of the cortex
Bradykinesia
Degeneration in
other basal
ganglia nuclei
MECHANISM OF ACTION:

6. Diagnosis
-History Of Present Illness
Patient was apparently alright 15 days back, then
developed sudden giddiness, which is progressive
in nature, aggregate on working, relieved on rest.
C/O generalized weakness since 15 days.
-Physical examination
-Neurological examination

7. Investigation-
 MRI – Brain & whole spine
 CBC
 Urine R
 RBC
 Sr. Electrolytes
 ECG
 CXR
 RVD
 HBA1C
 FBS

8. Levodopa
• Most effective overall for motor symptoms
• A fine option for initial therapy of PD
• By mid to late disease it is almost always needed
• Non-motor side effects include nausea, orthostasis, sleepiness, hallucinations;
but not as much as other PD drugs
How levodopa works
• Levodopa works by being converted to dopamine, a chemical messenger that
is needed to control the movement through transmission of signals in the
brain.
Common side effects of levodopa
• Nausea, Vomiting, Dizziness, Loss of appetite, Orthostatic hypotension
(sudden lowering of blood pressure on standing), Movement disorder

9. Treatment

10. CARBIDOPA
Carbidopa uses
• Carbidopa is used in the treatment of parkinson's disease.
How carbidopa works
• Carbidopa is always given with levodopa. It works by preventing levodopa from
being broken down before it reaches the brain. This allows for a lower dose of
levodopa, which causes less nausea and vomiting.
Common side effects of carbidopa
• Nausea, Neuroleptic malignant syndrome, Panic attacks, Altered behaviour,
Mood changes, Altered sleep, Burning sensation of tongue, Confusion,
Convulsion, Dizziness, Drowsiness, Fever, Frequent dreams, Hallucination,
Increased sweating, Tachycardia, Irregular heart rate, Tremor, Vomiting,
Worsening of tremor, Muscle stiffness

11. Dopamine agonists
(ropinirole, pramipexole,rotigotine)
• Can be monotherapy in early disease; need L-dopa in mid to late disease
• Can add to L-dopa to reduce OFF time
• Frequent side effects! Nausea, sleep attacks, hypotension, compulsive
behaviors, LE edema 
• More prone than L-dopa to causing hallucinations and confusion. Caution in
older or demented patients! 