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Case Based Discussion Parkinson's Disease

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8 views24 pages

Case Based Discussion Parkinson's Disease

Uploaded by

gshasantopal
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Parkinson Disease

Prof. Murat AKSU


• Paralysis Agitans

• James Parkinson’s monograph: Shaking Palsy (1817)


Parkinson Disease
• Asymetric

• Mostly starts with Resting tremor

• Bradykinesia (slowness of movement) - akinesia


(absence of movement)

• Rigidity

• Postural instability
• Spesific pathological findings

• Depigmentation ofthe SN due to loss of


melanin-laden dopaminergic neurons containing
eosinophilic cytoplasmicinclusions (Lewy bodies)
Epidemiology
• Prevalence: 360 per 100 000

• Incidence:18 per 100,000 per year.

• Gradual increase in prevalence beginning after


age 50, with a steep increase in prevalence
after age 60

• Before30 years of age is rare and often suggests


a hereditary form of parkinsonism.
Clinical features
• The most common presentation is with rest tremor
in one hand.

• Associated with decreased arm swing and


shoulder pain
Parkinson Disease
• Bradykinesia and rigidity are often detectable on the symptomatic side
• Midline signs such as reduced facial expression or mild contralateral
bradykinesia and rigidity may already be present.

• The presentation may be delayed if bradykinesia is the earliest


symptom, particularly when the onset is on the nondominant side.

• The disorder usually remains asymmetrical throughout much of its


course.

• With progression of the illness, generalized bradykinesia may cause


difficulty arising from a chair or turning in bed. Patients typically
develop stooped posture and in some cases the flexion of the trunk can
become quite severe, the so-called camptocormia
Parkinson Disease
• The gait and balance are progressively affected.

• Falls may occur.

• Sudden arrests in movement, also called freezing or


motor blocks with gait initiation.
Motor Abnormalities
• Reduction in facial expression

• Reduction in arm swing

• Slowing of activities of daily living

• Asymmetrical at the beginning

• Handwriting: Smaller, slower

• Swallowing difficulties.
Nonmotor Symptoms of
Parkinson Disease
• Autonomic symptoms

• Constipation, urinary frequency and urgency, impotence,


disordered sweating, and orthostatic hypotension

• Cognitive and behavioral symptoms:

• Attention and concentration wane. Executive dysfunction


with diminished working memory, planning, and organization
is common. Global dementia occurs in approximately 30%
of patients.

• Mood disorders: Anxiety, depression, and other mood disorders

• Sleep disorders
Sleep disorders in PD
• Disordered sleep onset and maintenance lead to fragmentation
of nocturnal sleep.

• RLS and PLMS

• RBD:

• Ask: “Have you ever been told, or suspected yourself, that you
seem to ‘act out your dreams’ while asleep (for example, punching,
flailing your arms in the air, making running movements, etc.)?”

• Vivid dreams and nightmares

• Sleep apnea
• Routine laboratory tests: NOT
USEFUL

• CT Scan, MRI scan: NOT USEFUL


PET Scan
• Positron emission tomography (PET) scans using
radiopharmaceutical 6-[ F]-fluorodopa (F-dopa) show reduced
18

F-dopa uptake in dopaminergic nerve terminals in the putamen


and caudate proportional to the severity of degeneration in
the ipsilateral SN and symptoms in the contralateral
hemibody
Etiology and
Pathogenesis
• Not only in CNS: Myenteric intestinaland cardiac
plexus of patients with PD may contain Lewy
bodies

• Genetic vs sporadic
Genetics of
Parkinson Disease

• 10 %
Enviroment and Toxins
• MPTP

• Heavy metals

• Organic toxins

• The risk of PD seems lower in those with a high


dietary intake of antioxidant-rich foods, as well as
caffeine drinkers and those who have smoked
cigarettes.

• PD provides some type of biological protection


Treatment
• Neuroprotection: Preventive treatment

• Symptomatic treatment of motor symptoms

• Symptomatic treatment of nonmotor


symptoms
What are the causes of
Parkinsonism
• Parkinson Disease (sporadic, hereditary)

• Multisystem Degenerations = Parkinsonism Plus


(PSP, MSA, corticobasal degeneration, Progressive
Pallidal Atrophy, Parkinsonism-Dementia Complex,
Pallidopyramidal Disease)

• Heredodegenerative parkinsonism (Dopa responsive


dystonia, Huntington disease, Wilson disease,
Hallervorden Spatz disease,
Neuroacantocytosis,etc)
Thank you forlistening

Prof. Murat AKSU


Acibadem University Atakent Hospital

[email protected]
r

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