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Clinical Skills Blogspot

Parkinson’s Disease

Title

Ñ    Parkinson’s Disease

Definition

Ñ    Progressive extapyramidal disorder

Characterised by:

Ñ    Tremor

Ñ    Rigidity

Ñ    Bradykinesia

Pathogenesis

Causes

Ñ    Not known

Ñ    Post encephalitis

Ñ    Neuroleptic drugs

Ñ    MPTP (synthetic opiate analogue) toxicity

Pathological Process

Ñ    Progressive cell degeneration in the substantia nigra

Ñ    Formation of Lewy bodies:

Eosinophilic inclusion bodies

Ñ    Decreased dopamine and melanin

Clinical Features

History

Ñ    Age of onset:

Mean 55 years

Ñ    Symptoms usually start on one side and remain worse on that side

Ñ    Slowly progressive illness

E&M

Ñ    Loss of weight

GIT

Ñ    Heartburn

Ñ    Dysphagia

Ñ    Constipation

KUS

Ñ    Urinary incontinence

RAG

Ñ    Impotence

RS

Ñ    Reduced cough

Ñ    Aspiration

CNS

Ñ    Limbs and joints feel stiff and ache

Ñ    Fine movements difficult

Ñ    Writing small and spidery

Ñ    Difficulty rising from chairs and getting out of bed

Ñ    Psychosis

Ñ    Dementia

Examination

IS

Ñ    Greasy skin

Ñ    Excess sweating

CNS

Ñ    Dysarthria

Ñ    Positive glabella tap

Ñ    Tremor:

At rest

Decreased by action

Increased by emotion

Ñ    Tone:

Lead-pipe rigidity

Cogwheel rigidity

Ñ    Bradykinesia

Ñ    Stooped posture

Ñ    Impaired gait

Investigations

Ñ    No laboratory test

Management

Control          

Drugs

Ñ    Laevodopa

Ñ    Aromatic amino acid decarboxylase inhibitors:

Benserazide

Carbidopa

Ñ    Catechol-O-methyl transferase inhibitors:

Entacapone

Ñ    Monoamine oxidase B inhibitors:

Selegeline

Ñ    Dopamine release:

Amantadine

Ñ    Dopamine receptor agonists:

Bromocriptine

Lisuride

Pergolide

Cabergoline

Pramipexole

Ropinirole

Ñ    Anticholinergics:

Benzhexol

Orphenadrine

Ñ    Antioxidants:

Vitamins C and E

Surgery

Ñ    Stereotactic surgery

Ñ    Tissue transplantation

The above are restricted to specialist centres

Support

Staffing

Ñ    Physiotherapy

Equipment

Ñ    Physical aids such as special clothing (use Velcro, slip on type shoes), cutlery, chairs, toilet, flooring

Prognosis

Ñ    Usual course 10-15 years

Ñ    Death is usually from bronchopneumonia

 

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