by Krishnapriya, S8, 2017 MBBS Azeezia Institute of Medical Sciences and Research

1. PARKINSONISM

2. PARKINSONISM
• 2nd commonest neurodegenerative disorder
• Clinical syndrome characterised by
>Bradykinesia
>Rigidity
>Tremor
>Loss of postural reflexes

3. PARKINSONISM
• Incidence increases with age-Avg. age =60 yrs
• MC cause  Parkinson’s Disease
• Genetic  first degree relatives with PD  2-3 times more risk
• Progressive
• Incurable

4. CAUSES
• Idiopathic PD-80% cases
• Cerebrovascular disease
• Drugs and toxins
• Other degenerative diseases
• Genetic
• Anoxic brain injury

5. CAUSES-Drugs and toxins
>Atypical antipsychotics >Na valproate
>Metoclopramide >Lithium
>Prochlorperazine >Manganese
>Tetrabenazine >MPTP

6. CAUSES-Degenerative diseases
• Dementia with Lewy bodies
• Progressive supranuclear palsy
• Multiple system atrophy
• Corticobasal degeneration
• Alzheimer’s disease

7. CAUSES-Genetic
• Huntington’s disease
• Fragile X tremor ataxia syndrome
• Multiple system atrophy
• Dopa-responsive dystonia
• Spinocerebellar ataxia
• Wilson’s disease

8. DD FOR PARKINSONISM

9. PATHOPHYSIOLOGY
• Depletion of the pigmented dopaminergic neurons in the SNr.
• Imbalance b/n dopaminergic/inhibitory system and
cholinergic/excitatory system in the striatum.
• Presence of α-synuclein and other protein inclusions in nigral
cells(LEWY BODIES).

10. PATHOPHYSIOLOGY
Normally,
Output of basal ganglia-GPi and SNr  inhibitory tone to thalamic and
brainstem neurons  cerebral cortex and spinal cord  regulate
motor function
In PD,
Dopamine denervation  increased firing of neurons in STN and Gpi 
excessive inhibition of thalamus reduced activation of cortex and
motor systems development of parkinsonian features

11. PATHOPHYSIOLOGY

12. PATHOPHYSIOLOGY

13. CLINICAL FEATURES
Cardinal features Motor features Non-motor features
Bradykinesia Micrographia Anosmia
Rest tremor Masked facies/hypomimia Sensory disturbances
Gait disturbance or
Postural instability
Reduced eye blink Mood disorders
Rigidity Soft voice/hypophonia Sleep disturbances
Dysphagia Cognitive impairment
Freezing Autonomic disturbances
Orthostatic hypotension
GIT,GUT disturbances
Sexual dysfunction

14. PHYSICAL SIGNS IN
PARKINSONISM

15. INVESTIGATIONS
• Mainly clinical diagnosis
• Functional dopaminergic imaging
• Specific investiagtions for the cause .eg:exclusion of Huntington’s or
Wilson’s disease

16. IMAGING IN PD

17. MANAGEMENT
• Drug therapy- Symptomatic
• Surgery
• Physiotherapy , Occupational therapy , Speech therapy

18. MANAGEMENT-Drug therapy

19. DRUG THERAPY-LEVODOPA
• Precursor of dopamine--Most effective treatment available
• Given in combination with Carbidopa/Benserazide
Plasma t1/2 is prolonged and dose reduced to 1/4th.
Systemic side effects minimised.
• Adverse effects:-
postural hypotension,vomiting,trigger hallucinations,
abnormal LD seeking behaviour/dopamine dysregulation syndrome.

20. DRUG THERAPY

21. DRUG THERAPY-DOPAMINE AGONISTS
• Oral/transdermal/subcutaneous
• Rotigotine-Transdermal patch
• Apomorphine-Subcutaneous

22. MANAGEMENT-Surgery
• For medically refractive cases  Deep Brain Stimulation
• Targets  thalamus, globus pallidus, subthalamic nucleus

23. THANK YOU