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Parkinson disease
Dr Bhupendra Shah
Assistant Professor
B.P.koirala Institute of Health Sciences
Difference in life?
Man behind Parkinson disease
Epidemiology of Parkinson diseases
• Second commonest degenerative disease of
CNS
• Mean age of onset:60 years
• More common in male
• 85-90% occur sporadically
Patho-physiology
LEWY
BODY
Parkinsonism
Bradykinesia
Resting
tremor
Rigidity
Parkinsons disease is degenerative disease diagnosed if fulfilled 2 out of
3 cardinal features.
Clinical features of Parkinson disease
Other non motor features
• Micrographia
• Soft voice
• Masked facies
Non motor featues
• Mood disorders
• Sleep disorders
• Autonomic disturbances
Atypical Parkinsonism disease
• more widespread neurodegeneration
• Early speech ,gait impairment and no
response to levodopa.
• Eg:multisystem atrophy, progressive
supranuclear palsy.
Secondary parkinsonism
• Post-infectious
• Drugs
Management
Anti –Parkinsonian drugs:how they
work?
• Levodopa--dopadecaboxylase----dopamine…MAO-
B/COMT……….3OMD/HVA
Levodopa
• Converted to dopamine by dopa decarboxylase
Side effects
• Acute: nausea , vomiting, postural hypotension
• Chronic : dyskinesia, behavioral effects, wearing
off effect.
Classification of antiparkisonian drugs
• Pramipexole
• Ropinirole
Dopamine
agonist
• Seligilline
• Rasagilline
MAO-B
inhibitor
• Tolcapone
• Entacapone
COMT
inhibitor
Anti-Parkinsonian drugs
PARKINSON’S DISEASE
NON PHARMACOLOGICAL PHARMACOLOGICAL
NEUROPROTECTION;RASAGILINE
FUNCTIONAL DISABILITY
NOYES
LEVODOPADOPAMINE AGONIST
COMBINATION THERAPY
SURGERY /CDS
Surgical treatment
• Pallidotomy
• Deep brain stimulation
Deep brain stimulation
Newer experimental therapy
Take home message
• is a progressive neurodegenerative disease
involving extrapyramidal system.
• Resting tremor,rigidity and
hypokinesia:classical symptoms
• Levodopa is a drug of choice .
Thank you

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