PARKINSON DISEASE

↳ progressive degeneration of dopaminergic neurons in substantia nigra → altered movements

1. ETIOLOGY / EPIDEMIOLOGY
" "
→ PARKINSONISM
-

↳ describes a GROUP of disorders i 1° disturbances in

systems g- Basal Ganglia :

Mei sporadic or
familial =
Parkin mutation ; Parka
PARK 4
① PD / Idiopathic Parkinsonism /Quimjgsenfial ) :
A) unilateral @ onset
alpha synuclein (SNCA) I
① Secondary Parkinsonism drug-induced ; infections /viral ; toxins; trauma
:

↳
; A) tumor
↳
↳ dopamine antagonists / dep letters dementia Pugilistica
incemastnigiadessé ↳ @ sub Nigra
-

.
=
(→ dopamine

③ Parkinson Plus syndrome mimic PD bwtdlt other neurodegenerative dlo

- :

A) loss of upward gaze frequent Falls

a. Progressive Nuclear Palsy
=

mousekonn
:

MRI A) Hummingbird sign /Sagittal ) ; mickey :

these are NOT seen

OH Features
Multiple Systems Atrophy
"→ in primary PD
b. :

MRI A) Hot cross bun sign (coronal

:
view )

•
M > W ; ↑ risk c- Family Hx of PD
•
onset @ 45-70%0 ; peak @ 6040
•

④ urban areas
pesticides
↳ "

Toxic parkinsonism "=

manganese
•
smokers { alcoholics have ↓ risk
d/t active
dopaminergic system

II. APK striatum

¥¥£¥ÉÉÉÉy¥
*

① BASAL GANGLIA f- Telencephalon ←

Prosonuphalon)
Fx smoothens
: motion in initiating 1 directing voluntary movement
_
Glutamate
*.

::÷:
-

"""in .

②
3 main
nuclei
:
caudate ,
putamen globus pallidus , s
Fx stores and
:
Fx :
regulate Fx : regulation of movement
process memories movement ; influence
motor learning Direct Motor Loop
③ Subcortical Nuclei reticular's
Direct Pathway
- pars
:
GABA
-
Substantia Nigra -
compacta dopamine

*t¥¥÷ÉÉÉ;;÷÷!
pars :

} excitatory

d.
-

subthalamic Nucleus
④ Neurotransmitters ~ - GABA

" www.ini.im
-

dopamine "

-
GABA inhibitory : sir

glutamate CNS
} excitatory
:
-

-
acetylcholine PNS :
III. PATHOPHYSIOLOGY
-
Direct motor loop is affected

41
÷÷÷:*:reduced
↑innin¥¥✗
!¥putn
① degeneration of dopaminergic

③ ↑ inhibition by Gpi to VAIVL

④ reduced motor output
neurons

striatum __ ↓ excitation
nucleus
@ striatum

↓
Direct Pathway
hypokinetic -
in Parkinson Dse -

movements

IV. Signs and Sx

① Prodromal ② Cardinal ③ Others ④ Non motor
-

sleep disturbance Brady kinesics " "" "2 •

hYP°mimia /Masked Fascie
-

•
depression
rolling]
•
_

•
Anosmia loss
:
of sense / smell
•
Resting Tremor / pill
-
•
hypophomia speaks slowly
:
• dementia
wheel) micrograph ia
•
constipation •
Rigidity / cog -
• • autonomic
dysfunction
• anxiety / depression •
postural Instability •
dysphagia
• Flexed / hypnotic Posture • sialorrhea •
auditory Hallucination
↳ semian posture
Gait
•

-
shuffling : short steps
-

f-estimating catches
: COG

Freezing / akinesia
-

V. ANCILLARY PROCEDURES
① MRI :
uh of chemical markers lvidentipy dopaminergic deficits
② Sonography / Basal Ganglia)
③ PTT Scan : determine levels of dopamine

VI. MEDICAL MX
① Levodopa
② Carbidopa
Gold standard :
SINEMTT
} Dopamine replacement

③ Setegeline prevents dopamine breakdown :

④ Anticholinergic (Benztropine) blocks :

Ach # to ↓ tremors ;
V11 .
PT Mx
A. PT Assessment
•
special tests
⑧ blinking 201min
:

① Glabellar Tap
.

:
c- PD 5- 71min
:
.

② Rigidity :
↑ resistance to PROM
at cogwheel -

jerky ; b) lead pipe . -

uniform

•
UPDRS scale used to track severity { progression of PD
:

•
Modified Hoehn and Yahr progression of PD + level of disability
:

0 No
signs
1 Unitat .

1. 5 Unitat .
i trunk involvement
2 Bitat .
I balance problems
2.5 mild bitat .
i postural instability
3 mild → mod bitat c- postural instability
.

4 severe disability ; indep .

c- AD

5 He bound ; bedridden

B. PT Tx

NE! Best time to treat =

1 Hour I medications WAY ?

TENS Gait
V5 a- stretching Tandem Walk
PRES
PNF / LIE Dz ✓; LE Di / )

wobble Board
Rhythmic Stab

OHP
Frenkel's ex

Relaxation ex .
(gentle rocking)