Introduction:
Parkinson disease is named for the English doctor James Parkinson. In 1817 he described a chronic, slowly progressive disease of the nervous system characterized by a combination of tremor, rigidity, and stooped posture. 11 April is considered as World Parkinson day on the birthday of James Parkinson. Red tulip is the symbol of this disease.
Definition:
It is a progressive brain disorder characterized by loss of neurons in an area of midbrain known as substantia nigra.
Pathophysiology:
Etiogical causes leads to degeneration of monamine containg cell population in brain stem & basal ganglia particularly dopamine affecting to brain & spinal cord causing neurotoxicity causing cell death
Etiology & risk factors:
- Idiopathic Parkinsonism
- Secondary Parkinsonism:
- Drug induced: Neuroleptics, antiemetics, lithium
- Hydrocephalus
- Hypoxia
- Toxins: carbon monoxide, cyanide, methanol
- Infections: AIDS
- Metabolic: Hypo/Hyper calcemia, Wilson's disease, chronic hepatocerebral brain degeneration
- Psychogenic
- Trauma
- Vascular causes
- Parkinson plus syndromes:
- Multiple system atrophy
- Progressive supranuclear palsy
- Corticobasal ganglionic degeneration
- Progrssive pallidial atrophy
- Lytico-Bodig : It is referred to by neuroscientists as amyotrophic lateral sclerosis-parkinsonism-dementia.
- Heredodegenerative disease:
- Alzheimer's disease
- Dementia with lewy bodies
- Pick's disease
- Huntington's disease
- X linked dystonia parkinsonism
- Genetic factors:
- Alanine 53- threonine mutation
- The parkin gene dominant
Sign & Symptoms:
Cardinal features:
Bradykinesia:
- It means decreased movements characterized by delay in initiation & execution of willed movements & a general reduction of automatic movements.
- It manifests:
- Facial Hypomania
- Reduced blinking
- Impaired ocular convergence
- Bradylalia
- Anarthria
- Drooling of saliva
- Micrographia
- Slow shuffling gait with reduced associated movements
Muscle Rigidity:
- It is characterized by resistance to passive movements that affects flexion, extension, pronation & supination.
- Axial & proximal limb muscles rigidity will be present.
- Cogwheel Rigidity: It is characterized by periodic modification of muscle tone due to superimposed tremor that can be seen & felt when passively moving the extremity.
- Akinetic rigid syndrome is the characteristic of PD which is seen in due to abnormal dopaminergic input in to brain.
Resting tremors:
- It is characterized by pill rolling between thumb & index finger
- Illegible writing
- Tremors may increase due to emotional response, fatigue, stress, anxiety & disturbed sleep pattern.
- It typically affects the distal appendicular muscles causing:
- Abduction- adduction movemen ts of thumb [pill rolling]
- Pronation-supination movements of wrist
- Often unilateral involving thumb & fingers
- Lower limp of same side will be affected before involving opposite side of body.
- Tremors of lips, head & jaw may be seen
Disorder of postural fixation:
- May affect head, trunk & limbs causing:
- Instability of trunk
- Forward displacement of head
- Difficulty in maintaining erect posture
- Slight leaning forward while standing
- Parkinson's gait
Freezing phenomenon:
- Motor act stucks in place lasting for seconds
- The voluntary acts are halted as agonist & antagonist muscles are spontaneously contracting.
- This phenomenon include:
- Freezing when initiating gait [start hesitation]
- Freezing when turning [turn hesitation]
- Freezing when approaching the target [destination hesitation]
- Freezing when obstacle is encountered
- Repetition of first syllable
- Apraxia of eye opening
- Freezing of limbs [during writing & brushing teeth]
Other features:
- Parkinson Posture: Forward flexion of trunk, flexion of elbows & partial flexion of knees
- Prkinsonian hand: Dorsiflexion of wrist, extensoion & adduction of fingers, slight ulnar deviation, flexion of metacarpophalangeal joints
- Dystonic foot posture: Extension of great toe, flexion of toes, arching of sole & inversion of foot
- Hpokinetic dysarthria
- Palilalia
- Bradyphrenia
- Hypophonia
Behavioural Signs:
- Depression
- Sudden onset of sleep
- Bent spine syndrome
Medical & Nursing Management:
- Antiparkinsonian drug: Levadopa, carbidopa levadopa
- Dopamine receptor agonists: Pergolide, Bromocriptine, Pramipexole
- Selegiline
- Catchechol O- methyltranferase: entocapone, tolcapne
- Acetylcholine blocking drugs: Biperiden, Procyclidine
- Monitor neurological status
- Encourage respiratory changes
- Encourage exercise
- Passive ROM
- Weight Patient
- Advice patient to take medicines & reduces risk of falls
- Encourage diet high in protein & calories
- Encourage soft diet
Distinctive facts:
- Ix: CSF analysis shows decrease in dopamine levels
- Sx: Thalomotomy, pallidotomy, deep brain stimulation
- Cx: Dementia
- Dopamine level will decrease
- Occurs between 45-65 years
- Lewy bodies may be absent
- Autosomal dominant & autosomal recessive gene inheritance may be identified
Prognosis:
It is progressive disorder with no cure. symptoms may be managed with medicines & may come off when medicine stops.
