PD

Nivedita Mpt (Neuro)

Parkinson’s disease (PD)
• Described by James Parkinson in 1817
• Parkinson's disease is a chronic progressive
neurodegenerative movement disorder affecting the
extrapyramidal motor system
• The 3 cardinal features of PD are:
(1) Bradykinesia (slowness of movement)
(2) Rigidity (increased tone)
(3) Resting tremor
etiology

• The basal ganglia are essential for the modulation of pyramidal motor
output to allow normal movement. This process of modulation is
dependent on two pathways within the substantia nigra, the direct
and indirect pathways.
• accumulation of alpha-synuclein in various parts of the brain,
primarily the substantia nigra, leading to degeneration and
subsequent loss of dopamine in the basal ganglia that control muscle
tone and movement.
• It involves degeneration of the dopaminergic neurons
in the Substantia nigra.
• The loss of SN pars compacta dopaminergic neurons
projecting to the caudate and putamen is considered its
neuropathological hallmark
epidimiology
• PD affects 1% of the general population over age 60, though 5-10%
have onset before age 40 years
pathophysiology
C/f
• Bradykinesia - slowness of movement initiation or complete lack of
movement (akinesia), slow speed of movement (bradykinesia), and
reduced amplitude of movement (hypokinesia)
• Rigidity
• Tremor involuntary rhythmic oscillating movements in limbs or the
whole body
• Resting tremor “pill-rolling” tremor (tremor affecting the thumb and
index finger)
Other clinical features
• The gait in PD is slow and shuffling, arm swing is
reduced, and the posture is flexed.
• Festinant gait- with a tendency to run forwards
• hypophonia, dysarthria, micrographia, hypomimia,
and sialorrhea, Glabellar tap
• cognitive decline
• Dementia, depression, hallucinations, fatigue,
constipation and REM sleep disorder and psychosis
Investigations:
• history and physical examination
• neuroimaging (CT/MRI)
• Positron emission tomography (PET) scanning
Management
• Levodopa
• dopamine agonists (bromocriptine, ropinirole)
• Catechol-O-methyl-transferase (COMT) inhibitors (entacapone)
• Deep brain stimulation (DBS)
• Speech therapy
• antipsychotics
• SSRIs