Boala Parkinson

Bolnavi notabili
Papa Ioan Paul II

Bolnavi notabili
Salvador Dali

Salvador Dalí - Persistenţa memoriei - Museum of Modern Art, New York

Bolnavi notabili
Muhammad Ali

Bolnavi notabili
Mao Zedong

Preşedintele Republicii Populare Chineze

Bolnavi notabili
Ray Kennedy

ETIOPATOLOGIE
• Boală neurodegenerativă
– Degenerescența sistemelor:
§ DOPAMINergice centrale § alte căi monoaminergice (NA, Serotonina) § Subs. P alterată § GABA alterată § Metenkefalină alterată

• Predomină la sexul masculin • Prevalentă 120: 100.000 locuitori

SIMPTOMALOGIE
• Debutul este insiduos cu senzatie de parestezii si intepenire a unui segment cu dificultate in executarea si controlul unor miscari ; alteori boala incepe cu tremorul caracteristic la extremitatea distala a mainii ; mersul devine incetinit,faciesul inexpresiv cu lentoare in vorbire ;

SIMPTOMALOGIE
• In perioada de stare se gasesc intricate cele trei sindroame principale ;
– Akinezie – Hipertonia de tip extrapiramidal – Tremorul parkinsonian –

DIAGNOSTICUL POZITIV
Este usor de pus pe existenta celor trei sindroame: akinezia, hipertonia de tip extrapiramidal si tremorul. • •

Po si n - e m i o n to m o g ra p h i sca n o f th e b ra i tro ssi c n sh o w i g th e d i re n ce i fl o ro d o p a ( FD O PA ) l ve l n ffe n u e s b e tw e e n th o se w i a n d w i o u t Pa rki so n ' d i a se . th th n s se

• • • • • • • • • • •

Sdr. Postencefalic Sdr. Toxic Manganic (indus terapeutic) Sdr. Toxic Oxid de Carbon (indus terapeutic) Sdr. Vascular Sdr. Luetic (Sifilis) Sdr. Traumatic Paralizia supranucleară progresivă (~60 ani) Boala Creutzfeldt-Jacob complex Guam Boala lui Shi-Drager Boala Willson

DIAGNOSTICUL DIFERENTIAL

[!!!] In toate aceste cazuri pe linga unele particularitati ale parkinsonismului se tine cont de etiologia care actionind asupra sinapsei dopaminergice produce simptomatologia

EVOLUTIE
• Lent progresivă • prognosticul vital in general bun dar pot apare unele complicatii
§ (respiratorii, embolice, urinare, si cutanate)

• terapia moderna dopaminica lungeste speranta de viata.

TRATAMENTUL

1. Paliativ 2. Invaziv 3. Trial

1. Paliativ
Preparate Anti-Parkinsoniene: • Prep. ce activează sistemul dopaminergic

– Dopaminomimetice (agoniști ai receptorilor dopaminergici) – Inhibitori ai MAO-b

• Preparate ce inhibă influențele glutamatergice • Preparate ce inhibă influențele

NMDA-Receptorii

TRATAMENTUL

1. Paliativ 2. Invaziv 3. Trial

TRATAMENTUL

1. Paliativ 2. Invaziv 3. Trial

Implantable Electrodes for the Treatment of Parkinson's Disease

tes by the Food and Drug Administration for the treatment of Parkinson's.[*] DBS ca
tremors. Retrieved October 18, 2006.

Insertion of electrode during surgery

Thalamotomy and Pallidotomy

Table 1 . Summary Comparison of Treatments * Procedure Levodopa Drug Combinations Advantages Non-invasive treatment. Rigidity and bradykinesia are dramatically improved Immediate Effects. Can improve levodopa-induced dyskinesia. Improves bradykinesia and rigidity. Disadvantages Loses effectiveness after prolonged use. Levodopa-induced motor complications arise. Risk of hemorrhage, irreversible procedure. Long term results unknown. Safety of bilateral procedure undefined.

Pallidotomy

Thalamotomy

Same as pallidotomy, but targeted Risk of hemorrhage, irreversible for the improvement of tremor procedure. Bilateral procedure can cause speech problems. Reduction, or possible Long term results are unknown. discontinuation of levodopa use. Risk of infection and rejection. Immediate improvement. Bilateral Long term results are unknown. stimulation possible. Reversible Batteries must be replaced. Not yet procedure. covered by health insurance.

Tissue implants Chronic Pallidal/ Thalamic Stimulation (implantable electrodes)

* Krauss JK, Jankovic J. Surgical Treatment of Parkinson's Disease. American Family Physician 1996; 54:1624.

Bibliografie
• • • • • • Farmacologie, D.A.Harchevici, Chișinău 2009 Textbook Of Medical Physiology (Guyton 11th ed) Lippincott's Pharmacology, ed.2009 Rang and Dales Pharmacology 6th Ed, 2007 Neurosurgical Treatment of Movement Disorders, Isabelle M. Germano