prolonged exposure Stage 5 - confined to bed and wheelchair

MOVEMENT DISORDERS  MPTP – synthetic heroin causing severe and

permanent parkinsonism Unified Parkinson’s Disease Rating Scale (UPDRS)
(CNS) Drug-Induced – thought to interfere c dopaminergic
mechanisms Primary Motor Symptoms
Related Anatomy: Basal Ganglia
o Neuroleptics Rigidity – increased resistance to passive motion
Parts
o Antidepressants  Cogwheel – jerky, ratchet-like resistance
 Caudate
o Antihypertensive o Tremor coexists with rigidity
 Putamen
 Reserpine – heart  Lead pipe – sustained resistance to passive
 Globus Pallidus
Metabolic Conditions – disorders of calcium movement with no fluctuations
 Subthalamic Nucleus
metabolism Bradykinesia – slowness of movement
 Substantia nigra
 Hypothyroidism o Insufficient recruitment of muscle force
Substantia Nigra pars compacta – releases dopamine,
 Hyper/hypoparathyroidism during initiation
modulating impulses
 Wilson’s Disease – liver o Bradyphrenia – slowness of thought
Deficiency of dopamine
Parkinsonism-plus Syndromes o Akinesia – poverty of spontaneous
Direct motor loop – excitatory  May present c rigidity and bradykinesia movement (akinetic mutism)
Cortex (Areas 4 & 6)  Striatum  synapse in GPi  indistinguishable from PD o Hypomimia – masked facial expression
Thalamus  Cortex  Symptoms typically do not show measurable Tremor – involuntary shaking/oscillating movement
Indirect loop – decreases thalamocortical activation improvement from administration of anti- d/t contraction of opposing muscles
Cortex  Striatum  GPe  Subthalamic nucleus  Parkinson medications  Resting Tremor – suppressed briefly by
GPi  Thalamus  Cortex Pathophysiology voluntary movement, disappears with sleep
Degeneration of dopaminergic neurons in the BG in the  Aggravated by emotional stress/excitement
Parkinsonism – primary disturbance in the dopamine pars compacta  presence of Lewy bodies  Pill rolling tremor – specific type present in
systems of the BG (cytoplasmic inclusion bodies)  clinical symptoms @ persons with Parkinsonism
30-60% degeneration of neurons Postural Instability
Parkinson’s Disease (Idiopathic/Primary
Parkinsonism) Stages: Festinating gait pattern – both forward and
 “Shaking palsy” by James Parkinson, 1817 Stage 1 – medulla oblongata (intermediate reticular backward walking (anteropulsive)
 Two distinct clinical subgroups zones)
o Postural instability gait disturbed Stage 2 – involves caudal raphe nuclei, gigantocellular Nonmotor
o Tremor predominant reticular nucleus, coeruleus-subcoeruleus complex Sensory
 Motor symptoms (Cardinal)
Stage 3 – Nigrostriatal pathway  Olfactory
Stage 4 – cortex (temporal) Dysphagia – 95% of patients
o Postural instability
Stage 5 – sensory association areas of neocortex and  Problem in all phases of swallowing
o Tremor
prefrontal areas  Sialorrhea
o Rigidity
Stage 6 – sensory areas of neocortex and premotor Speech Disorders
o Bradykinesia
areas  Akinetic Mutism
 Non-motor symptoms
Cognitive Dysfunction
Secondary Parkinsonism Hoehn-Yahr Classification of Disability:  Dementia – loss of executive functioning
 Induced by external/internal factors Stage 1 – minimal/absent, unilateral if present Depression & Anxiety
Post-encephalic Stage 2 – minimal bilateral/midline involvement,
 Encephalitis lethargica balance not impaired Autonomic Dysfunction
Toxic Stage 3 – impaired righting reflexes 
 Certain environmental toxins Stage 4 - standing and walking possible only c
 Manganese – m/c, hazard to miners after Assistance Pharmacologic Management – correct levels of
dopamine and acetylcholine
 Levodopa + Carbidopa (Sinemet) – gold
standard, metabolic precursor of dopamine;
dopamine cannot cross the blood-brain barrier
(carboxylase metabolizes L-dope into
dopamine)
o Given in high doses
o Carbidopa – carboxylase inhibitor
combined with L-Dopa to minimize
needed
 Dopamine Agonists – enhances dopaminergic
action
 Anticholinergic – adjunct therapy
 Monoamine Oxidase B Inhibitors
 Antiviral (Amantadine)

Deep Brain Stimulation

Common prescription – walker with wheels