Lewy body in Parkinson's Disease

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

3 Replies to “Parkinson’s Disease and Parkinsonism : Summary”

  1. Excellent summary on Parkinson’s disease. Thank you. Would appreciate similar summaries on epilepsy, insomnia, schizophrenia and depression.

  2. I am a 51 year old female that just found out I have Parkinson’s about a year and half, but I have been having signs of it for years, tremors, depression, body weakness. ECT. I honestly don’t think my doctor was reading the signs because of my gender and age. A few years ago I had my shoulder lock up on me and I was sent to a P.T since x-rays didn’t show any physical damage. My shaking was getting worse and I began falling. Only when my speech became so bad that it brought concern to my dentist was Parkinson’s even considered. He phoned my doctor with his concerns about my shaking and balance problems. By this time I was forgoing shots in the back of my neck for back and neck pain to which once again I was sent to a P.T (although x-rays showed no damage) I was told I had a few spurs which were most likely causing the pain. Here I was feeling like my whole body was falling apart and doctor could not find anything wrong, maybe in was all in my head? My doctor even seemed annoyed with me and things just kept progressing and I just kept it to myself, why bother going through testing and them finding nothing? Well, it was after my second P.T called my doctor about the weakness in my legs and arms, by this time I have developed a gait in my walk and I fell more frequently. Only then did my doctor send me to a specialist and it was found that I had Parkinson’s, and that I have had it for awhile. I think because I was a woman that my signs and symptoms weren’t taken seriously and therefor left untreated for so long,I was taking pramipexole dihydrochloride three times daily, I Was on carbidopa levodopa but only lasted 90 minutes then wore off.I found that none of the current medications worked effective for me.I got tired of using those medication so I decided to apply natural herbs formula that was prescribed to me by my second P.T, i purchase the herbal formula from totalcureherbsfoundation. com, There has been huge progression ever since I start the treatment plan which will last for 15 weeks usage.all the symptoms and sign has begin to disappear .

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