Parkinson disease

Dr Bhupendra ShahAssistant Professor

B.P.koirala Institute of Health Sciences

Difference in life?

Man behind Parkinson disease

Epidemiology of Parkinson diseases

• Second commonest degenerative disease of CNS

• Mean age of onset:60 years

• More common in male

• 85-90% occur sporadically

Patho-physiology

LEWY BODY

Parkinsonism

Bradykinesia

Resting tremorRigidity

Parkinsons disease is degenerative disease diagnosed if fulfilled 2 out of 3 cardinal features.

Clinical features of Parkinson disease

Other non motor features• Micrographia

• Soft voice

• Masked facies

Non motor featues• Mood disorders

• Sleep disorders

• Autonomic disturbances

Atypical Parkinsonism disease

• more widespread neurodegeneration

• Early speech ,gait impairment and no response to levodopa.

• Eg:multisystem atrophy, progressive supranuclear palsy.

Secondary parkinsonism

• Post-infectious

• Drugs

Management

Anti –Parkinsonian drugs:how they work?

• Levodopa--dopadecaboxylase----dopamine…MAO-B/COMT……….3OMD/HVA

Levodopa

• Converted to dopamine by dopa decarboxylase

Side effects

• Acute: nausea , vomiting, postural hypotension

• Chronic : dyskinesia, behavioral effects, wearing off effect.

Classification of antiparkisonian drugs

•Pramipexole•Ropinirole

Dopamine agonist

•Seligilline•Rasagilline

MAO-B inhibitor

•Tolcapone•Entacapone

COMT inhibitor

Anti-Parkinsonian drugs

PARKINSON’S DISEASE

NON PHARMACOLOGICAL PHARMACOLOGICAL

NEUROPROTECTION;RASAGILINE

FUNCTIONAL DISABILITY

NOYES

LEVODOPADOPAMINE AGONIST

COMBINATION THERAPY

SURGERY /CDS

Surgical treatment

• Pallidotomy

• Deep brain stimulation

Deep brain stimulation

Newer experimental therapy

Take home message

• is a progressive neurodegenerative disease involving extrapyramidal system.

• Resting tremor,rigidity and hypokinesia:classical symptoms

• Levodopa is a drug of choice .

Thank you