Академический Документы
Профессиональный Документы
Культура Документы
English physician
Dr James Parkinson in 1817
An Essay on the shaking palsy
Also called Paralysis agitans
4 major symptoms:
Rigidity muscles are tensed and contracted
Resting tremor trembling which is most obvious
when the patient is at rest or when stressed
Bradykinesia slowness in initiating movement
Loss of postural reflexes or instability poor
balance and coordination
Non-motor symptoms
Basal Ganglia
Controls movement
Dopamine
Inhibitory neurotransmitter in
Normal movement
dependent on dopamine
production in the
substantia nigra that
innervates the striatum
PD is associated with
massive degeneration of
dopamine-producing
neurons in substantia nigra
When 60 to 80% of these
neurons are lost, symptoms
of PD appear
II
III
IV
EARLY STAGE
Onset of
symptoms, treated
with physical
therapy and
medications
(Levodopa,
dopamine
agonists, etc)
LATER STAGE
Usually after having
received 5+ years of
levodopa treatment.
Wearing-off and
On/Off effect
develops, other
medication in
conjunction levodopa
is commenced.
MAO-B and COMT
inhibitors
Neuroprotective therapy
Monoamine Oxidase Inhibitors
Symptomatic Therapy
Levodopa (L-dopa) is the mainstay of
symptomatic treatment for PD.
Dopamine Agonists
Anticholinergic Agents
Nutritional Management
A high-protein diet can block the
effectiveness of L-dopa. Thus the patients
are advised high-calorie, low-protein diet.
Levodopa (L-DOPA)
Preferred medication to control major
symptoms.
Usually administered at the early onset of
disorder.
Drug is well tolerated and side affects are
limited.
Levodopa
Dopamine
Carbidopa
Dopamine Agonists
Acts directly on the dopamine receptors.
Initially was used with L-DOPA.
Today, sometimes prescribed before L-DOPA,
to delay wearing-off effect and other motor
complications brought on by prolonged use of
L-DOPA.
Pramipexole
Dopamine
Selegeline
Tolcapone(Tasmar )
Amantadine
Antiviral agent.
Known to aid in reducing dyskinesia.
Anticholinergics
Improve tremors and stiffness
Cause impairment and constipation
Ablative Surgery
Pallidotomy
Thalamotomy
Slowly progressive
Long sub clinical period of around 5 years
61% die within 10 years and 83% die
within 15 years
Mean survival with L-dopa as increased
by 5 years
Patients with predominantly tremor have
a benign progression and those with PI &
gait disturbances have rapid progression.
Mortality is due to cardiovascular disease
or pneumonia.