PARKINSON'S DISEASE

PARKINSON'S DISEASE

Definitions:

Part of parkinsonism are characterized pathologically by degeneration of the basal ganglia, especially in the substantia nigra par kompakta (SNC), which is accompanied by eosinophilic cytoplasmic inclusions (Lewy bodies)

History of Parkinson's Disease

- James Parkinson in 1817 ® paralysis Agitans

- Charchot 1861 ® PP

- Tretiakoff 1919  Consistent lesion the substantia nigra (SN)

- Bein, Carlsson, Hornykiewicz ® Dopamine (DA)

- MPTP ® neurotoxin SN ® DA.

- Rotenone & paraquate.

Pathogenesis of Parkinson's disease

• Degen SNC ® degen pathway nigrostriatum DA.

• Mechanism:

   - Dysfunction mitokondariia.

   - Oxid. Stress.

   - Excitotox.

   - Inflammation.

SN Death Process

In the indirect pathway PP ® hyperactivity and / hipoaktifitas direct path.

Figure 3

Clinical Symptoms

• Tremor

   - Resting tremor when emotions ↑

   - Tremor coarse (3-7 / sec)

   - Patterns tremor

   - Tremors from the hand to the mouth and throughout the body,

   can also extend to the foot

• Rigidity

   - hipertoni

   - The phenomenon of toothed wheels (cogwheel phenomenon)

• akinesia / bradykinesia - hypokinesia

   - Slow voluntary movement, especially on smooth movement

   - Associative Movement reduced

   - Reduced spontaneous movement

   - Other manifestations:

      1. Hipomimia, hipofonia, mikrografia

      2. Reduced blink of an eye

      3. Convergence disorders, Impaired upward gaze

      4. Difficult doing two activities at once

• Step & street style:

   - Px walk with small steps (Imarche a petit pas)

   -Retropulsion

   - Lazrpulsion

• Others

   - Positive Myerson

   - Muscle pain

   - Chronic obstipation

Parkinson scale

• Hoehn & Yahr Scale:

   - Stage I → unilateral

   - Stage II → bilateral

   - Stage III → dysfunction common being

   - Stage IV → more severe symptoms but still be able to run

     at a certain distance and not be able to stand on its own

   - Stage V → khakhetik stage (total disability is not able to stand up

     & running)

Diagnosis

Diagnostic criteria for Parkinson's:

• Clinical

   - 2 of the 3 cardinal signs of motor disorders tremor, rigidity 

     and bradykinesia

   - 3 of 4 motor signs: tremor, rigidity, bradykinesia and postural

     instability

   - 25% diagnostic mistake (London Brain Bank Study)

• criterion Koller

   - The 2 of the 3 cardinal motor signs (tremor / postural, 

     bradykinesia / rigidity) takes place within 1 year

   - The response to levodopa therapy

• Criteria Gelb & Gilman

   - Symptoms of Clinical Group A:

• Tremor breaks

• bradykinesia

• Rigidity

• The beginning of asymmetric

   - Clinical Symptoms of Group B:

• Postural Instability

• Freezing

• Hallucinations

• Dementia

• Diagnosis "Possible"

   - There are at least two symptoms of group A

   - There were no symptoms of group B

   - Symptoms <3 nbsp="" o:p="" year="">

   - A clear response to levodopa / dopamine agonists

• Diagnosis of "Probable"

   - There are at least 3 of the 4 symptoms of group A

   - There were no symptoms of group B

   - Symptoms <3 o:p="" years="">

   - A clear response to levodopa / dopamine agonists

• Diagnosis certainly

   - Meets criteria for probable and histopathological autopsy certainty

Criteria UK for Parkinson's Disease Society  Brain Bank 

Clinical Diagnosis

• Diangnosis sindarioma parkinsonism:

   - Bradykinesia

   - Muscular rigidity

   - 4-6 Hz resting tremor

   - Postural Instability

• Parkinson exclusion criteria:

   - History of stroke

   - History of head injury

   - The definitive history of encephalitis

   - Oculogyric crises

   - Treatment with neuroleptika the onset of symptoms

   - Supranuclear gaze palsy

   - Babinski sign

   - Tumor Cerebral / hidariosefalus kominikans on CT scan

   - MPTP exposure

   - Symptoms of cerebellar

• Supportive criteria parkinsonism:

   - Onset Unilateral

   - Resting tremor

   - A progressive disorder

   - Asymmetry persistent on the subject during the onset of more

     severe

   - Good response to levodopa (70-100%)

   - Incurred khorea severe due to the use of levodopa

   - The response to levodopa for 5 years / over

   - Perjalan disease for 10 years / over

Diagnosis of Appeals

- Clinical symptoms

• Tremor

• Rigidity

• bradykinesia

- Disease parkinsonism group

PARKINSON DISEASE TREATMENT

Pharmacologic

1. DA-ergic              : * l-dopa

2. Cholinergic             * l-dopa + DDCI

3. Glutamatergik         * l-dopa + + DDCI COMTI

4. Neuron protector    * MAOI

5. Others                    * DA agonists

Non-pharmacologic

1. Treatment

2. Surgery

3. Deep-Brain-stimulus

4. Transplant

DA Agonist

Agonist	D1	D2	5-HT1/2
Derivat ergot : Bromocriptine Cabergoline Lisuride Pergolide Derivat non-ergot : Pramipexole Ropinirole Talipexole	- 0 + + 0 0 0	++ +++ ++ +++ ++ ++ ++	++ 0 0 ++ 0 0 0

Cholinergic Antagonists

• Artane (Trihexyl phenidyl)

• Congentin (Benztropin)

• Akineton (Biperidin)

• Disipal (Orphenadariin)

® Tremor ® memory

Glu-ergic antagonist

• Amantadine

• Remacemide

• Memantine

• Lg 235 959

NST track = GPI ® indirect ¯.

Protective Neurons

1. Neurotrophic factor

2. Anti-excitotoxin: NMDA antagonists.

3. Anti-Oxidant: selegiline.

4. Bionergic Suppl: CoQ10, Nic.

5. Immunosupressant: cyclo Sporine A.

Other ingredients: estrogen and nicotine.