Parkinson disease

Posted by e-Medical PPT Wednesday, September 29, 2010
Parkinson's disease is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions.It is characterized by muscle rigidity, tremor, postural abnormalities, gait abnormalities, bradykinesia and akinesia in extreme cases.The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine produced in the dopaminergic neurons of the midbrain (specifically the substantia nigra). Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic and progressive.
Parkinson's disease is the most common form of parkinsonism, and refers to the normal presentation of idiopathic parkinsonisms.Parkinson-plus diseases are primary parkinsonisms which present additional features.They include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and dementia with Lewy bodies.
Four motor symptoms are considered cardinal in PD: tremor, rigidity, bradykinesia and postural instability.Tremor is the most apparent and well-known symptom.It is most commonly a rest tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep.It affects to a greater extent the most distal part of the extremity and is typically unilateral at onset becoming bilateral later. Rigidity is due to joint stiffness and increased muscle tone, which combined with a resting tremor produce a ratchety, "cogwheel rigidity" when the limb is passively moved.Rigidity may be associated with joint pain, such pain being a frequent initial manifestation of the disease.Bradykinesia (slowness of movement) is the most characteristic clinical feature of PD and it produces difficulties not only with the execution of a movement but also with its planning and initiation.
There is no cure for Parkinson's disease, but medications, surgery and multidisciplinary management can provide relief from the symptoms.Main families of drugs useful for motor symptoms of PD are Levodopa, dopamine agonists and MAO-B inhibitors.

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