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Parkinson's disease

Classification and external resources

Illustration of the Parkinson disease by Sir William RichardGowers from

A Manual of Diseases of the ervous System

in 1886

ICD-10

G20. (http://www.who.int/classifications/apps/icd/icd10online/?gg20.htm+g20) ,F02.3 (http://www.who.int/classifications/apps/icd/icd10online/?gf00.htm+f023)

ICD-9

332 (http://www.icd9data.com/getICD9Code.ashx?icd9=332)

DiseasesDB

9651(http://www.diseasesdatabase.com/ddb9651.htm)

MedlinePlus

000755 (http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm)

eMedicine

neuro/304(http://www.emedicine.com/neuro/topic304.htm) neuro/635(http://www.emedicine.com/neuro/topic635.htm#) in young pmr/99(http://www.emedicine.com/pmr/topic99.htm#) rehab

From Wikipedia, the free encyclopedia

Parkinson's disease

(also known as

Parkinson disease

) is a degenerative disease of the brain (central nervoussystem) that often impairs motor skills, speech, and other functions.

[1]

Parkinson's disease belongs to a group of conditions calledmovement disorders. It is characterized by muscle rigidity,tremor, a slowing of physical movement (bradykinesia)and, in extreme cases, a loss of physical movement(akinesia). The primary symptoms are the results of decreased stimulation of the motor cortex by the basalganglia, normally caused by the insufficient formation andaction of dopamine, which is produced in thedopaminergic neurons of the brain. Secondary symptomsmay include high level cognitive dysfunction and subtlelanguage problems. PD is both chronic and progressive.PD is the most common cause of chronic progressiveParkinsonism, a term which refers to the syndrome of tremor, rigidity, bradykinesia and postural instability. PDis also called "primary parkinsonism" or "idiopathic PD"(classically meaning having no known cause althoughmany genetic mutations associated with PD have since been discovered). While many forms of parkinsonism are"idiopathic", "secondary" cases may result from toxicitymost notably of drugs, head trauma, or other medicaldisorders. The disease is named after English physicianJames Parkinson, who made a detailed description of thedisease in his essay: "An Essay on the Shaking Palsy"(1817).

Contents

1 Classification2 Signs and symptoms2.1 Motor symptoms2.2 Neuropsychiatric2.3 Sleep2.4 Perception2.5 Autonomic3 Causes3.1 Genetic3.2 Toxins3.3 Head trauma4 Pathophysiology

Parkinson's disease - Wikipedia, the free encyclopediahttp://en.wikipedia.org/wiki/Parkinson%27s_disease1 of 1527/03/2009 6:20 PM

5 Diagnosis6 Treatment6.1 Levodopa6.2 COMT inhibitors6.3 Dopamine agonists6.4 MAO-B inhibitors6.5 Surgery and deep brain stimulation6.6 Neurorehabilitation7 Prognosis8 Epidemiology9 History10 Research directions10.1 Gene therapy10.2 Neuroprotective agents10.3 Neural transplantation10.4 Complementary therapies11 Famous sufferers12 See also13 References14 External links

Classification

"Parkinson's disease" is the synonym of "primary parkinsonism", i.e. isolated parkinsonism due to aneurodegenerative process without any secondary systemic cause. In some cases, it would be inaccurate tosay that the cause is "unknown", because a small proportion is caused by genetic mutations. It is possible for a patient to be initially diagnosed with Parkinson's disease but then to develop additional features, requiringrevision of the diagnosis.

[2]

There are other disorders that are called

Parkinson-plus diseases

. These include: multiple system atrophy(MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Some include dementiawith Lewy bodies (DLB)—while idiopathic Parkinson's disease patients also have Lewy bodies in their braintissue, the distribution is denser and more widespread in DLB. Even so, the relationship between Parkinsondisease, Parkinson disease with dementia (PDD), and dementia with Lewy bodies (DLB) might be mostaccurately conceptualized as a spectrum, with a discrete area of overlap between each of the three disorders.The natural history and role of Lewy bodies is little understood.These Parkinson-plus diseases may progress more quickly than typical idiopathic Parkinson disease. If cognitive dysfunction occurs before or very early in the course of the movement disorder then DLBD may be suspected. Early postural instability with minimal tremor especially in the context of ophthalmoparesisshould suggest PSP. Early autonomic dysfunction including erectile dysfunction and syncope may suggestMSA. The presence of extreme asymmetry with patchy cortical cognitive defects such as dysphasia andapraxias especially with "alien limb" phenomena should suggest CBD.The usual anti-Parkinson's medications are typically either less effective or not effective at all in controllingsymptoms; patients may be exquisitely sensitive to neuroleptic medications like haloperidol. Additionally,the cholinesterase inhibiting medications have shown preliminary efficacy in treating the cognitive, psychiatric, and behavioral aspects of the disease, so correct differential diagnosis is important.Essential tremor may be mistaken for Parkinson's disease but lacks all other features besides tremor, and has particular characteristics distinguishing it from Parkinson's, such as improvement with beta blockers and

Parkinson's disease - Wikipedia, the free encyclopediahttp://en.wikipedia.org/wiki/Parkinson%27s_disease2 of 1527/03/2009 6:20 PM

alcoholic beverages.

[1]

Wilson's disease (hereditary copper accumulation) may present with parkinsonian features; young patients presenting with parkinsonism or any other movement disorder are frequently screened for this rarecondition, because it may respond to medical treatment. Typical tests are liver function, slit lampexamination for Kayser-Fleischer rings, and serum ceruloplasmin levels.

Signs and symptoms

Parkinson disease affects movement (motor symptoms). Other typical symptoms include disorders of mood, behavior, thinking, and sensation (non-motor symptoms). Patients' individual symptoms may be quitedissimilar and progression of the disease is also distinctly individual.

Motor symptoms

The cardinal symptoms are (mnemonic "TRAP"):

[1]

Tremor

: normally 4–6 Hz tremor, maximal when the limb is at rest, and decreased with voluntarymovement. It is typically unilateral at onset. This is the most apparent and well-known symptom,though an estimated 30% of patients have little perceptible tremor; these are classified as akinetic-rigid.

Rigidity

: stiffness; increased muscle tone. In combination with a resting tremor, this produces aratchety, "cogwheel" rigidity when the limb is passively moved.

Akinesia/bradykinesia

: absence of movement and slowness, respectively. Rapid, repetitivemovements produce a dysrhythmic and decremental loss of amplitude.

Postural instability

: failure of postural reflexes, which leads to impaired balance and falls.Other motor symptoms include:Gait and posture disturbances:Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing anaudible shuffling noise. Small obstacles tend to cause the patient to trip.Decreased arm-swing.Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes,PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.Stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent ata right angle relative to the trunk (camptocormia).

[3]

Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait thatgets progressively faster and faster, often ending in a fall.Gait freezing: "freezing" is a manifestation of akinesia (an inability to move). Gait freezing ischaracterized by an inability to move the feet which may worsen in tight, cluttered spaces or when attempting to initiate gait.Dystonia (in about 20% of cases): abnormal, sustained, painful twisting muscle contractions,often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interfereswith gait.Speech and swallowing disturbances.Hypophonia: soft speech. Speech quality tends to be soft, hoarse, and monotonous. Some peoplewith Parkinson's disease claim that their tongue is "heavy" or have cluttered speech.

[4]

Monotonic speech.Festinating speech: excessively rapid, soft, poorly-intelligible speech.Drooling: most likely caused by a weak, infrequent swallow and stooped posture.Dysphagia: impaired ability to swallow. Can lead to aspiration pneumonia.Other motor symptoms: