Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

1. PARKINSON’S
DISEASE
Prepared by
Swaliha C K
Assistant Professor
Senghundhar College of Pharmacy

2. Parkinson’s
Disease
Parkinson’s disease , is named after James
Parkinson who in 1817 wrote a classic
“shaking palsy”a disease for which the
reason is still unknown .

3. DEFINITION :-
• It is a chronic degenerative disorder that primarily affects
the neurons of the basal ganglia.
• It is a syndrome that consists of slowing down in the
initiation and execution of movement (brady kinesia),
increased muscle tone (rigidity), tremor and impaired
postural reflexes

5. Parkinson’s disease is a chronic progressive degenerative
disorder of the CNS caused by an imbalance b/w
dopaminergic and cholinergic activity in the brain due to
degeneration of dopaminergic neurons resulting in depleted
level of dopamine in the brain leading to motor function
disorder and various other extrapyramidal symptoms

7. The famous internationally known boxer Mr.
Mohammed Ali suffered from this disease.
Occurs in the age group of 60s. Mostly men
are affected than women.

9. CLASSIFICATION
1.Primary /idiopathic parkinsonism
2. secondary/drug induced parkinsonism
1.Primary parkinsonism
•Cause is unknown
•Predominantly affecting individuals over60 years of age
•Over the years the dopaminergic neurons degenerate due to
H2O2 and free radicals such as superoxide and peroxynitrite

10. 2.Secondary /drug induced parkinsonism
There is no degenaration as seen in above case but the decrease
in dopamine is drug induced
•Drugs that deplete the central stores of dopamine.eg
methyldopa, reserpine
•Drugs that antagonize D receptor .eg: phenothiazine,
butyrophenone
•Infections like viral encephalitis
•Toxins like 1-methyl 4-phenyl 1,2,3,6 tetrahydropyridine
(MPTP)

11. Etiology
• Heredity
• Antipsychotic drugs (or neuroleptic agents)
• Encephalitis infection in response to brain trauma,
tumors, hydrocephalus or ischaemia
• Arteriosclerosis
• Neurotoxins such as cyanide, manganese and
carbon monoxide
• Drugs like reserpine (hydropress), meyhyl dopa
(aldomet), haloperidol (haldol) and phenothiazine
(thorazine)

12. Pathophysiology
Antipsychotic drugs , encephalitis and other
causes
↓
Affects the substantia nigra
↓
Destuction of dopamine producing neurons
within the basal ganglia
↓
Reduces the amount of available straital
dopamine ( inhibitory effects )

13. There is increase in acetylcholine
(excitatory effects )
↓
Excitatory activity of Ach is inadequately
balanced
↓
Difficulty in controlling and initiating
voluntary movements

15. Clinical manifestations
In the beginning stages
•
•
•
•Mild tremor
•Slight limp
•Decreased arm swing
Later
•Shuffling, propulsive gait with arms flexed
Loss of postural reflexes
•Slight change in speech pattern

16. Classic clinical manifestations
1.Tremor
First sign affects hand writing
Non intentional, present at rest but usually not during
sleep
Movement of thumb across the palm gives a “pill
rolling” character
Tremor also seen in limbs, jaw, lips, lower facial
muscles and head

17. 2. Rigidity
•
•
•
• Increased resistance to passive motion when the limbs
are moved through their range of motion
• Muscles feel stiff and required increased effort to
move
• Discomfort or pain may be percieved in muscle when
rigidity is severe
• “Cog wheel” rigidity refer to rachet – like rhythmic
contractions of the muscle that occur when the limbs
are passively stretched

18. 3. Bradykinesia (akinesia)
•
•
•
•Slowness of active movement
•Difficulty in initiating movement
Often the most disabling symptom:
•interferes with ADK and predisposes patient to
complication related to constipation , circulatory
stasis, skin breakdown and related complications
of immobility .

19. 4.Postural instability
•
•
•
•
i) Changes in gait
•Tendency to walk forward on the toes with small
shuffling steps
•Once initiated, movement may accelerate almost to
trot
•Festination may occur, which propels the patient
either forward or backward propulsively until falling
is inevitable.

20. ii) Changes in balance
•
•
•
•
•Stooped- over posture when erect
•Arms are semi flexed and do not swing with
walking
•Difficultyin maintaining balance and sitting
erect
•Cannot ‘right’ or brace self to prevent falling
,when balance is lost

21. Secondary manifestations
1)Facial appearance
•
•
•
•Expressionless
•Eyes store straight ahead
•Blinking is much less frequent than normal
2) Speech problems
•
•
•
•
•Low volume
•Monotone
•Difficulty with starting speech and word finding

22. 3) Visual problems
• Blurred vision
• Impaired upward gaze
• Blepharospasm- involuntary prolonged closing
of the eyelids

23. 4) Fine motor function
•
•
•
•
• Microphagia- handwriting progressively
decreases in size
• Decreased manual dexterity
• Clumsiness and decreased co-ordination
Decreased capacity to complete ADL.
• Freezing- sudden involuntary inability to initiate
movement can occur during movement or
inactivity

24. 5) Autonomic disturbances
Constipation- hypomotility and prolonged
gastric emptying
Urinary frequency or hesitency
Orthoststic hypotension(dizziness, fainting and
syncope)
Dysphagia( neuro muscular in co-ordination )
Drooling( results from decreased swallowing )
Oily skin
Excessive perspiration

25. 6)Cognitive / behavioral
•
•
•
•
•
•Depression
•Slowed responsiveness
•Memory deficit
•Visual-spacial deficit Dementia

26. DIAGNOSIS
•Physical examination
•Neurological examination
•Autopsy of brain to find lewy body
•Computed tomography scan (CT scan)
•Dopamine transporter imaging inspection test

27. MANAGEMENT

28. NON- PHARMACOLOGICAL
•Education
•Nutrition
•Psychiatric counseling
•Exercise
•Speech therapy
•Occupational therapy

29. Pharmacological management
 Dopamine agonist
 Anti- cholinergics
 Anti- histaminics
 MAO inhibitors
 COMT inhibitors

30. Dopamine agonist
•Levodopa
•Carbidopa
Anti-cholinergics
•Benztropine
•Trihexyphenidyl
Anti-histamines
•Diphenhydramine
•Promethazine
MAO- B inhibitors
•Selegeline
•Phenelzine
COMT inhibitors
•Entacapone
•Tolcapone