Management of parkinsons disease

Presented by-Dr Sadaf SiddiquiModerator-Prof.S.A.Azmi

Management of Parkinson's disease

IntroductionParkinson's disease (PD) is the second commonest neurodegenerative disease, exceeded only by Alzheimer's disease (AD). It is estimated that approximately 1 million persons in the United States and 5 million persons in the world suffer from this disorder. The mean age of onset is about 60 years, but cases can be seen in patients in their 20s, and even younger.

Very few studies are available on the prevalence of PD in India. Different studies have shown that the crude prevalence rate (CPR) of PD is 14 per 100,000 in the north India, 27 per 100,000 in south India and 16 per 100,000 in east India. However, in one study of Parsis in Mumbai revealed a CPR of 328 per 100,000.The frequency of PD increases with aging, and based on projected population demographics, it is estimated that the prevalence will dramatically increase in future decades.

Clinically, PD is characterized by rest tremor, rigidity, bradykinesia, and gait impairment, known as the "cardinal features" of the disease.

Other motor featuresMicrographiaMasked facies (hypomimia)equalizeReduced eye blinkSoft voice (hypophonia)DysphagiaFreezing

Nonmotor featuresAnosmiaSensory disturbances (e.g., pain)Mood disorders (e.g., depression)Sleep disturbancesAutonomic disturbances Orthostatic hypotension Gastrointestinal disturbances Genitourinal disturbances Sexual dysfunctionCognitive impairment/Dementia

UK PARKINSONS DISEASE SOCIETY BRAIN BANK CLINICAL DIAGNOSTIC CRITERIAStep 1. Diagnosis of a parkinsonian syndrome Bradykinesia and at least one of the following: muscular rigidity rest tremor (46 Hz) postural instability unrelated to primary visual, cerebellar, vestibular or proprioceptive dysfunction.

Step 2. Exclusion criteria for Parkinson's disease (PD)History of : repeated strokes with stepwise progression repeated head injury antipsychotic or dopamine-depleting drugs definite encephalitis and/or oculogyric crises on no drug treatment more than one affected relative sustained remission

Step 3. Supportive criteria for PDThree or more required for diagnosis of definite PD :unilateral onsetexcellent response to levodoparest tremor presentsevere levodopa-induced choreaprogressive disorderlevodopa response for over 5 yearspersistent asymmetry affecting the side of onset mostclinical course of over 10 years.

IdiopathicGenetic (