PARKINSON'S DISEASE

1. SUBHAM SOURAJIT
M.PHARM (PHARMACOLOGY)
ASST. PROFESSOR
JEYPORE COLLEGE OF
PHARMACY

2. Parkinson's disease is a long term degenerative
disorder of CNS that mainly affects the motor system
characterized by tremors, rigidity and hypokinesia. This
occurs generally at the age of 60 years or more. Males show
more susceptibility for this disease.
Dr. James Parkinson describe this disease completely
first in 1817. The symptoms of this disease developed
slowly. (other symptoms are also occurred in PD like
rigidity, slowness of movement, difficulty in walking,
dementia, depression etc. these symptoms are collectively
called as "parkinsonism" or a "parkinsonian syndrome" in
which patient does not get suffered from PD but shows
similar symptoms like PD.)
The peoples who are having habit of taking coffee, tea
or smoking shows more resistance to this disease.

3.  In basal ganglia there is presence of dopaminergic neuron. These
neurons are basically involve in the smooth movement of body and co-
ordination of posture during various activities. The neurotransmitters
involve in movement are dopamine, 5 - hydroxyl tryptamine (5HT),
noradrenaline, acetylcholine.
 These dopaminergic nerves get degenerated leading to reduction in
dopamine transmission. So, the movements of body get slower. When
60-70% of dopaminergic neurons get degenerated then patient
generally start to show the symptoms of Parkinson's disease.
 So, there is a death of dopaminergic neurons in basal ganglia causing
PD.
 Drug addict persons consuming heroin substitute containing methyl
phenyl tetra hydro pyridine (MPTP) get suffered from PD, as MPTP
get converted to toxic metabolite MPP which selectively taken up by
dopaminergic neurons in brain (nigrostriatum) causing neuronal
destruction i.e. PD.

4. 1)Tremors--It generally starts unilaterally then progresses to bilateral. Eg.
Adduction-Abduction at thumb, flexion- extension of fingures. These
tremors affect jaw, tongue, forehead and eyelids as the disease
progresses.
2) Rigidity--It is resistance to passive movement of limb which may be
unilateral initially (movement of hands while walking). With progress of
disease the speech becomes more identifiable.
3)Hypokinesia--As name indicates it is a slowness of movement or also called
as bradykinesia. Patient expressionless feels difficulty in motor movements.
It also involves muscle pain, easy fatigue,
4) Other symptoms
Impaired posture and balance-- Posture may become stooped, or patient may
have balance problems as a result of Parkinson's disease.
Loss of automatic movements-- Patient may show decreased ability to
perform
Speech Changes– More soft speech, slur or hesitate before talking.
Writing changes– It may become hard to write, and writing may appear small
(micrographia).

5. In Parkinson's disease, neurons in the brain gradually gets degenerate or die. The
Parkinson's disease is considered as idiopathic but some factors have been
involved in the development of PD:
Drugs: Generally dopaminergic antagonist therapy may elicit the development of
PD. The sensitivity of patient to this therapy increases with increase in the age.
Drug addict persons consuming heroin substitute containing methyl phenyl tetra
hydro pyridine (MPTP) get suffered from PD, as MPTP get converted to toxic
metabolite MPP which selectively taken up by dopaminergic neurons in brain
(nigrostriatum) causing neuronal destruction i.e. PD.
Genetics: In rare cases it has been observed that some mutations in genes causes
the development of PD.
Lewy bodies: Aggregation of some substances are found within brain cells are
microscopic markers of Parkinson's disease. These are called Lewy bodies, and
researchers believe that these Lewy bodies play an important role to the cause
Parkinson's disease. A natural and widespread protein called alpha-synuclein
(asynuclein) is found within Lewy bodies. It's found in all Lewy bodies in a
clumped form that cells can't break down. This is currently an important focus
among Parkinson's disease researchers.

6. The complications due to Parkinson's disease may include:
 Cognitive Problems--Cognitive problems tend to occur in the later stages of the disease,
where thinking and reasoning may become impaired. Currently, there is no medication
available to treat this complication.
 Depression and Anxiety--It's common for people living with Parkinson's disease to suffer
from emotional changes such as depression or anxiety.
 Difficulty in Swallowing--As Parkinson's disease progresses, some patients may
experience swallowing difficulties. This may also lead to an excess of saliva in the mouth
and drooling.
 Sleep Disorders--Sleep disorders include are difficulty extremely falling common asleep,
in people restless with leg syndrome, Parkinson's REM disease. sleep behavior disorder
and sleep apnea.
 Bladder and Bowel Problems--Difficulty in controlling urination or starting urination is a
common complication of Parkinson's disease. In addition, many may find that they suffer
from constipation.
 Sudden Changes in Blood Pressure--Dizziness when standing up is due to a sudden drop in
blood pressure.
 Loss of Sense of Smell--Many Parkinson's disease patients report a decline in their sense of
smell or being unable to distinguish between different smells.

7. Anticholinergic Drugs: Benztropin.
Dopaminergic drugs: Levodopa.
Dopamine receptor agonist: Bromocriptine,
Apomorphine.
Dopamine releasing agents: Amantadine.
Monoamine Oxidase inhibitors (MAO):
Selegilline.