Parkinson’s Disease and Parkinsonism : Summary

Parkinson’s Disease: Epidemiology, Causes, Features, Diagnosis and Management

“ Akinetic Rigid Syndrome’ or Idiopathic Parkinson Disease-Are a number of degenerative diseases affecting Basal Ganglia which present with differing combinations of

  • Bradykinesia
  • Rigidity
  • Tremor
  • Loss of postural reflex

Epidemiology-

  • 90% cases are above 45 years
  • Male  and Female have equal risk
  • Cigarette smoking is known to be protective.

Cause or Etiology-

  • Unknown but toxin called MPTP ( Methyl-Phenyl-Tetrahydropyridine) suspected if disease starts in Young.

Pathology-

Symptoms are the result of depletion of Pigmented Dopaminergic neurons in Substancia Nigra causing impairment in dopaminergic transmission through the NigroStriatal pathway. Lewy Bodies are seen in Nigral cells. Atrophic changes in S. nigra and decrease neurons in Locus Cerulous.

Clinical Features-

source: Brainmind.com

Initial symptoms include- Tiredness, Aching limbs, Mental slowness, Depression and Micrographia ( small handwriting)

General features-

  • Expressionless face ( Hypomimia)
  • Greasy skin
  • Soft Rapid indistinct speech
  • Flexed posture
  • Impaired postural reflexes

Gait- Festinate Gait is typical of Parkinsonism.  Slow to start walking, short strides, reduced arm swing and loss of balance on turning can occur.

Tremors-

  • Resting tremor is typical for Parkinsonism. Coarse tremors usually thumb and fingers ‘ Pill Rolling motion’ , later whole body may have tremors.
  • Postural tremors are less obviously noticed but are present

Rigidity-

  • Cog Wheel Rigidity- Rigidity with Tremor. Movement become like turning of Cog-wheel .
  • Lead Pipe or Plastic Rigidity

Bradykinesia –

  • Slowness in Initiating and repeating movements
  • Poor fine-movements

Investigations-

Diagnosis is made Clinically

CT, MRI to rule out other causes of tremor like Wilsons Disease.

Management:

LevoDopa ( Dopamine Precursor) + Carbidopa / Benserazide ( Peripheral Dopa Decarboxylase Inhibitor) Is Best combination for treatment of Parkinsonism.

Others- Trihexiphenidyl ( Benzhexol) Or Orphenadrine help to cope with Cholinergic Side-effects of above drugs.

Amantadine ( anti-flu drug) has no effect on Bradykinesia but worksfor Rigidity and Tremor

Entacapone- ( COMT Inhibitor)

Selegiline ( MAO-B Inhibitor)

Dopamine Receptor Agonists like – Apomorphine, Domperidome, Bromocriptine, Pergolide, Ropinirole and Pramipexole are sometimes used.

Surgery-

  • Sterotactic Thalamotomy
  • Pallidotomy
  • Implantation Of fetal midbrain cells in basal ganglia is under experiment.

Speech Therapy and Physiotherapy

Warning- Do not take drug without Physicians Prescription.

Source- Davidson’s Medicine, Lecture Notes.

Details Reading and latest researches on PD – Interested readers http://en.wikipedia.org/wiki/Parkinson’s_disease

2 Comments
  1. July 12, 2010
  2. July 22, 2011

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