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PARKINSONS DISEASE IN TAMIL Introduction causes pathophysiology symptoms diagnosis treatment
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PARKINSON'S DISEASE • Introduction • Most common degenerative disease • Affecting basal ganglia • BASAL GANGLIA • A group of nuclei • Located deep within the cerebral hemispheres. • Part of the extrapyramidal motor system • Function: • control of posture and movements • • CARDINAL FEATURES OF PARKINSON'S DISEASE • Bradykinesia - Slowness of movement • Rigidity - increased tone • Tremors • loss of postural reflexes • • CAUSES • Idiopathic • Genetic • Environmental - Pesticides, MPTP • Structural lesion • Viral infection - encephalitis • • Free radicals • Metabolism of dopamine -- hydrogen peroxide • Glutathione breakdown the hydrogen peroxide • Low Glutathione – increase free radical • Lewy bodies • Lewy bodies are clumps of protein that can form in the brain • Eosinophilic cytoplasmic inclusion in nigral cells • Incidence • second most common neurodegenerative disease after Alzheimer's disease • Occur in the age of 60 • Most common in Men women • PATHOPHYSIOLOGY • • CLASSICAL CLINICAL FEATUREs OF PARKINSON’S DISEASE • PARKINSONISM • Rigidity • Defined as increased resistance to passive motion • The clinical hallmark of Parkinson's disease • Felt uniform in agonist and antagonist muscle • Type of rigidity • Cogwheel rigidity • Lead pipe rigidity • Cogwheel rigidity • Jerky ratchet-like resistance to passive motion and muscle alternatively tense and relax • Lead pipe rigidity • More sustained resistance to passive movement • Prolonged rigidity • contractures and postural deformity • • Bradykinesia • slowness and difficulty to start and continue the movement and posture • Rigidity and depression influence the bradykinesia • Tremor • Involuntary oscillation of body parts • pill-rolling tremor of hand • Resting tremor • forearm, jaw, tongue • Postural tremor • Completely diminish during sleep • • Postural instability • Increase difficulty during walking turning functional reach • Extensor muscle of trunk greater weakness than flexor muscle, • flexed stooped posture • Flexion of trunk, neck, hip, knee • Other clinical features • Micrographia • Hypomimia • Slurred speech • Dysphagia • Reduced eye blinking • Freezing • Anosmia • depression • Sleep disturbance • Glabellar tap sign • Repetitive tapping on the forehead - glabellar region • Blinking of eyes -- positive sign • Indication - Parkinson's disease • Diagnosis • Clinical diagnosis is common • CT /MRI • Any suggestive of Pyramidal cerebellar or autonomic involvement • Exclusion of Stroke • DaT scan • Pre • abnormalities in putamen • Post • return to almost normal after levodopa • Drug therapy • 1. Levodopa 50mg - 8th/12th hrly • 2. Dopamine agonist • pramipexole • 3. Dopamine receptor agonist • Bromocriptine. • 4. Dopamine releaser • amantadine • 5. COMT inhibitors • Entacapone 200mg with each dose of levodopa • 6.MAOb inhibitors • Selegiline 5 - 10mg • 7. Anticholinergics • Benzhexol 1-4 mg -8th hrly • • Relaxation exercise • Flexible exercise • Strength training • Functional training • Balance training • Locomotor training • Surgical treatment • Deep brain stimulation • Stereotactic thalamectomy • Used to treat tremor • Destruction of the affected area of the thalamus • PROGNOSIS • Onset middle age • Likely shorten the lifespan because of fall • Slowly progressive • Onset after 70 • Unlikely Shorten the life span • Become more severe • Other akinetic rigidity syndrome • Drug-induced parkinsonism • Dopamine antagonist • neuroleptic agent • atypical agent • Antiemetics • CCB • flunarizine • Amiodarone , valproic acid , lithium • Parkinson's plus syndrome • Orthostatic hypotension • Dementia • Abnormal eye movement • Babinski’s sign • Urinary retention • #parkinsons #parkinsonsdisease #parkinson #neuron #pd #dementia #braininjury #neurology #disease #medicalvideo #lovemedics #parkinsonspower
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