Parkinson’s disease

General
The disease is named after the English doctor James Parkinson, who published the first detailed
description in An Essay on the Shaking Palsy (1817). The disease is called short PD. PD is more common
in the elderly with most cases occurring after the age of 50 years. Parkinson’s disease is a degenerative
disorder of the central nervous system. It results from the death by unknown causes of the dopamine-
containing cells of the substantia nigra, which is a region of the midbrain. Early in the course of the
disease, the most obvious symptoms are movement-related.The main motor symptoms are collectively
called parkinsonism. Parkinson's disease is often defined as a Parkinsonian syndrome that is
idiopathic (has no known cause), although some atypical cases have a genetic origin.

Signs and symptoms

1. Motor:
Four motor symptoms are considered cardinal in PD: tremor, rigidity, slowness of movement, and postural
instability.

Tremor. Tremor is an involuntary movement of the limbs. It usually occurs when the limb is at
rest, or when the arm or leg is held out. Tremor is the most apparent and well-known symptom.
Over time, tremor can be seen in the head, lips, tongue, and feet.

Rigidity. Rigidity is a characterized by an increased muscle tone (an excessive and continuous

contraction of muscles) which produces stiffness and resistance to limb movement.

Bradykinesia (slowness of movement) is the most characteristic clinical feature of PD and is

associated with difficulties along the whole course of the movement process, from planning to initiation
and finally execution of a movement. it is the most disabling symptom in the early stages of the disease,
because it makes problems when performing daily tasks such as writing sewing and getting dressed.

Postural instability. in the late stages postural instability is typical, which leads to impaired balance and
frequent falls, and secondarily to bone fractures.

2. Neuropsychiatric
 Here are some neuropsychiatric symptoms:

Anxiety, stress, and tension

Confusion

Dementia- is a serious loss of cognitive ability in a previously unimpaired person.

Depression

Fainting

Hallucinations

Memory loss

3. Other.
Sleep problems. They can manifest as daytime drowsiness, disturbances in REM sleep, or insomnia.

Urinary incontinence (UI) is any involuntary leakage of urine.

Intestinal pseudoobstruction is decreased ability of the intestines to push food through.

Orthostatic hypotension, also known as postural hypotension,[1]  colloquially as head rush  is a form
of hypotension in which a person's blood pressure suddenly falls when the person stands up.

Pathology
1. Anatolical pathology. The basal ganglia, a group of "brain structures" innervated by
the dopaminergic system, are the most seriously affected brain areas in PD. The
main pathological characteristic of PD is cell death in the substantia nigra and, more specifically,
the ventral part of the pars compacta.

2. Pathophysiology. The primary symptoms of Parkinson's disease result from greatly

reduced activity of dopamine-secreting cells due to cell death in the pars compacta region of the
substantia nigra.

3. Brain cell death. There is speculation of several mechanisms by which the brain
cells could be lost. One mechanism consists of an abnormal accumulation of the protein alpha-
synuclein bound to ubiquitin in the damaged cells. Other cell-death mechanisms
include proteosomal and lysosomal system dysfunction and reduced mitochondrial activity.

Diagnosis
A physician will diagnose Parkinson's disease from the medical history and a neurological
examination. There is no lab test that will clearly identify the disease, but brain scans are sometimes used
to rule out disorders that could give rise to similar symptoms. Computed tomography (CT) and magnetic
resonance imaging (MRI) brain scans of people with PD usually appear normal. These techniques are
nevertheless useful to rule out other diseases that can be secondary causes of parkinsonism, such as
basal ganglia tumors, vascular pathology and hydrocephalus.

Treatment. People with Parkinson's often must take a variety of medications to manage the disease's
symptoms. The main families of drugs useful for treating motor symptoms are Levodopa,
dopamine agonists and MAO-B inhibitors.

Levodopa. Levodopa (or L-DOPA) has been the most widely used treatment for over 30 years. L-DOPA is
transformed into dopamine in the dopaminergic neurons by dopa-decarboxylase. Since motor symptoms
are produced by a lack of dopamine in the substantia nigra the administration of L-DOPA temporarily
diminishes the motor symptomatology. Levodopa has many side effects which can be alleviated with
substances like carbidopa and benserazide.

Dopamine agonists. Dopamine agonists in the brain have a similar effect to levodopa since they bind to
dopaminergic post-synaptic receptors.

MAO-B inhibitors. MAO-B inhibitors (Selegiline and rasagiline) increase the level of dopamine in the basal
ganglia by blocking its metabolization. They inhibit monoamine oxidase-B (MAO-B) which breaks down
dopamine secreted by the dopaminergic neurons.

Other drugs. There is some indication that other drugs such as amantadine and anticholinergics may be
useful as treatment of motor symptoms in early and late PD. Examples are the use of clozapine for
psychosis, cholinesterase inhibitors for dementia and modafinil for day somnolence.

Surgical. Ablation. Ablative surgery locates and destroys the part of the brain that is associated with
the neurological symptoms.

Dbs. Deep brain stimulation (DBS) is the most commonly used surgical treatment. It involves the
implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific
parts of the brain