Date post: | 15-Apr-2017 |
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Health & Medicine |
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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