PARKINSON'S DISEASE

PARKINSON'S DISEASE-Onset, Risk Factors, Pathophysiology, Clinical Manifestations, Complications, Prevention, Treatment.

Edited by, VAISHNAVI

Parkinson's disease is a progressive brain disorder characterized by loss of neurons in an area of midbrain Known as the Substantia nigra. It is the second most common Neurodegenerative disease after Alzheimer's in India.

ONSET: Sixth or Seventh decade of life. 5-10% people get before fourth decade.

CAUSES: Unknown

RISK FACTORS: Advancing age, Sex(Men are more prone), Genetics, Exposure to environmental toxins.

PATHOPHYSIOLOGY:

Excitation and inhibition of striatal neurons through direct and indirect pathway occurs.

Dopamine activates direct pathway and inhibits indirect pathway in normal people.

Depletion of dopamine due to destruction of dopaminergic neurons in Parkinsonism suppresses direct pathway and overstimulates indirect pathway leading to suppression of voluntary movements.

CLINICAL MANIFESTATIONS:

In early stages,

• Speech may become soft or slurred

• Little or no facial expression in later stages

• Tremor at rest

• Stiffness/rigidity of muscles

• Slowness of movement(Bradykinesia)

• Repetitive 'pill rolling' movement

• Head held forward and open mouth

• Problems with posture and balance

• Drooling and dysphagia (difficulty swallowing)

• Difficulty in writing

MARKERS:

• Clumps of Lewy bodies within brain cells

• Alpha-synuclein found within Lewy bodies.

COMPLICATIONS:

The following complications are associated with Parkinson's Disease

• Thinking difficulties

• Depression and Emotional changes

• Chewing and swallowing problems

• Sleep disorders

• Bladder problems

• Sexual dysfunction

PREVENTION:

Although it is not possible to prevent, Some lifelong activities may help reduce the risk. These includes,

• Regular aerobic Exercise

• Intake of turmeric

• Avoiding aldehydes

TREATMENT:

The commonly used medications for treatment may include,

• Dopamine agonist

• Levodopa

• Catechol O-Methyl Transferase inhibitors

• MAO-B Inhibitors

• Anticholinergics

Progressive worsening of condition may require surgery which includes,

• Deep brain Stimulation(DBS)

• Carbidopa-Levodopa infusion

• Pallidotomy(surgical procedure that destroys a tiny area in the brain called Globus pallidus Interna)

• Thalamotomy(Precise destruction of tiny area of brain called thalamus)