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Management Of Parkinson’s Disease Ppt

What Is The Outlook For Persons With Parkinsons Disease

Parkinson’s Disease (Shaking Palsy) – Clinical Presentation and Pathophysiology

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

  • Using stem cells to produce new neurons, which would produce dopamine.
  • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
  • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

Motor Circuit In Parkinson Disease

The basal ganglia motor circuit modulates the cortical output necessary for normal movement .

Signals from the cerebral cortex are processed through the basal ganglia-thalamocortical motor circuit and return to the same area via a feedback pathway. Output from the motor circuit is directed through the internal segment of the globus pallidus and the substantia nigra pars reticulata . This inhibitory output is directed to the thalamocortical pathway and suppresses movement.

Two pathways exist within the basal ganglia circuit, the direct and indirect pathways, as follows:

  • In the direct pathway, outflow from the striatum directly inhibits the GPi and SNr striatal neurons containing D1 receptors constitute the direct pathway and project to the GPi/SNr

  • The indirect pathway contains inhibitory connections between the striatum and the external segment of the globus pallidus and between the GPe and the subthalamic nucleus striatal neurons with D2 receptors are part of the indirect pathway and project to the GPe

The STN exerts an excitatory influence on the GPi and SNr. The GPi/SNr sends inhibitory output to the ventral lateral nucleus of the thalamus. Dopamine is released from nigrostriatal neurons to activate the direct pathway and inhibit the indirect pathway. In Parkinson disease, decreased striatal dopamine causes increased inhibitory output from the GPi/SNr via both the direct and indirect pathways .

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Remaining Issues In The Pharmacotherapy Of Early Parkinson’s Disease

In spite of the plethora of recent work addressing dopamine agonist monotherapy, many questions still remain. A change in practice to using agonist monotherapy for every new case of Parkinson’s disease would double or treble the cost of treatment immediately. Is this worth it from the National Health Service’s perspective in terms of cost effectiveness, and from the patient’s perspective in terms of quality of life? Is agonist monotherapy neuroprotective and/or is levodopa toxic? It has been suggested that agonist monotherapy delays motor complications until levodopa is introduced, then complications accelerate until they are as severe as they would have been if an agonist had never been given. No data on this are available from the existing trials so this possibility remains. The recent agonist monotherapy trials included predominantly younger patients with Parkinson’s disease: ropinirolemean age 63 years pramipexolemean age 61 years pergolidemean age 59 years. So the results of these trials should not be generalised to the elderly population in whom further data are required before recommendations can be made. Similar questions are outstanding regarding selegiline monotherapy in terms of its effects on quality of life, cost effectiveness, and neuroprotection.

    Figure 3

    Summary of the design of the PD MED trial . COMT, catechol-O-methyltransferase MAOB, monoamine oxidase B.

    What Medications Are Used To Treat Parkinsons Disease

    PPT

    Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

    Medications combat Parkinsons disease by:

    • Helping nerve cells in the brain make dopamine.
    • Mimicking the effects of dopamine in the brain.
    • Blocking an enzyme that breaks down dopamine in the brain.
    • Reducing some specific symptoms of Parkinsons disease.

    Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

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    What Are The Symptoms Of Parkinsons Disease

    Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:

    Other symptoms include:

    • Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
    • Handwriting changes: You handwriting may become smaller and more difficult to read.
    • Depression and anxiety.
    • Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
    • Pain, lack of interest , fatigue, change in weight, vision changes.
    • Low blood pressure.

    What Are The Different Stages Of Parkinsons Disease

    Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

    In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

    Early stage

    Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

    Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

    Mid stage

    Mid-late stage

    Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

    Advanced stage

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    Parkinson’s Disease Nurse Specialists

    The development of specialist peripatetic nurses for Parkinson’s disease has been led by the Parkinson’s Disease Society in the UK. From small beginnings, around 100 are now funded from various sources including the NHS. The nurses have a number of roles but they primarily act as a key worker for the patient with Parkinson’s disease, liaising with therapists, social services, the primary and secondary care teams, etc. They serve to educate the patient, relatives, and members of the medical and allied professions about the condition. Their ability to help the patient with complex changes in medication, including apomorphine infusions, within set limits can be invaluable. Parkinson’s disease nurse specialists have been the subject of a recent large RCT which showed significant improvements in an open label patient global impression scale at no additional cost to the NHS. No advantages in quality of life or mortality were found, but the study was confounded by selegiline withdrawal.

    What Are The Surgical Treatments For Parkinsons Disease

    Parkinson’s Disease PowerPoint Presentation

    Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

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    What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

    Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

    Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

    Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

    Dementia With Lewy Bodies

    Dementia with Lewy bodies typically occurs in individuals over the age of 50 and is characterized by the presence of significant and fluctuating thinking, memory, and attention difficulties .

    Detailed and recurrent visual hallucinations and rapid eye movement sleep behavior disorder are additional core symptoms.

    Both DLB and PD are characterized by the presence of Lewy bodies in the brain. Lewy bodies are abnormal clumps of a protein called alpha-synuclein.

    Other possible symptoms of DLB include:

    • Repeated falls
    • Behavior changes like agitation and aggression

    Patients with DLB also commonly experience parkinsonism , although they are not essential for diagnosis.

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    Is Surgery An Option

    If medicine doesnât work well enough, your doctor may suggest deep brain stimulation . In DBS, your doctor implants electrodes deep in the brain. A device connected to them delivers electrical pulses. Those pulses can help control the tremors caused by Parkinson’s.

    In the past, doctors sometimes used other operations to damage the brain in ways to help with movement symptoms. But they rarely use those surgeries now.

    What Is Parkinsons Disease

    Parkinsons Disease Treatment Ppt

    Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

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    General Approach To Management

    The primary goal in the management of PD is to treat the symptomatic motor and nonmotor features of the disorder, with the objective of improving the patients overall quality of life. Appropriate management requires an initial evaluation and diagnosis by a multidisciplinary team consisting of neurologists, primary care practitioners, nurses, physical therapists, social workers, and pharmacists., It is also important that the patient and his or her family have input into management decisions.

    Effective management should include a combination of nonpharmacological and pharmacological strategies to maximize clinical outcomes. To date, therapies that slow the progression of PD or provide a neuroprotective effect have not been identified., Current research has focused on identifying biomarkers that may be useful in the diagnosis of early disease and on developing future disease-modifying interventions.,

    How Is Parkinsons Disease Diagnosed

    Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.

    To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.

    If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.

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    Is Parkinsons Disease Inherited

    Scientists have discovered gene mutations that are associated with Parkinsons disease.

    There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

    Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

    Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

    Is There A Cure For Parkinsons

    Dealing with Dementia in Parkinson’s Disease

    Theres currently no cure for Parkinsons, a disease that is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinsons is often misdiagnosed.

    Its reported that Parkinsons complications was the

    Complications from Parkinsons can greatly reduce quality of life and prognosis. For example, individuals with Parkinsons can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.

    Proper treatment improves your prognosis, and it increases life expectancy.

    It may not be possible to slow the progression of Parkinsons, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.

    Parkinsons disease is not fatal. However, Parkinsons-related complications can shorten the lifespan of people diagnosed with the disease.

    Having Parkinsons increases a persons risk for potentially life threatening complications, like experiencing:

    • falls

    Parkinsons often causes problems with daily activities. But very simple exercises and stretches may help you move around and walk more safely.

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    Types Of Parkinsons Disease

    Parkinson’s disease is a neurodegenerative condition that causes movement-related symptoms like shaking, stiffness, slow movements, and balance problems. These symptoms arise from the death of dopamine-producing nerve cells deep in the brain. Dopamine transmits chemical messages between nerve cells.

    PD is classified into different types based on its cause and age of onset. For instance, idiopathic PD occurs in persons around 60 years of age. Early-onset PD occurs in younger patients, often before the age of 50.

    There are also secondary parkinsonism and atypical parkinsonism. These are conditions that have similar symptoms and signs of PD but are caused by something else, like a drug, stroke, or other primary neurodegenerative disease.

    This article will review the different types of Parkinson’s disease, including causes of secondary parkinsonism and atypical parkinsonism. It will also discuss two conditions that mimic and are possibly related to PD.

    Management Of Parkinsons Disease

  • 1. Presented by-Dr Sadaf SiddiquiModerator-Prof.S.A.AzmiManagement of Parkinson’sdisease
  • 2. Introduction Parkinson’s disease is the second commonestneurodegenerative disease, exceeded only by Alzheimer’sdisease . It is estimated that approximately 1 million persons in theUnited States and 5 million persons in the world sufferfrom this disorder. The mean age of onset is about 60 years, but cases can beseen in patients in their 20s, and even younger.
  • 3. Very few studies are available on the prevalence of PD inIndia. Different studies have shown that the crude prevalencerate of PD is 14 per 100,000 in the north India, 27 per100,000 in south India and 16 per 100,000 in east India.However, in one study of Parsis in Mumbai revealed a CPRof 328 per 100,000. The frequency of PD increases with aging, and based onprojected population demographics, it is estimated thatthe prevalence will dramatically increase in futuredecades.
  • 4. Clinically, PD ischaracterized by resttremor, rigidity,bradykinesia, and gaitimpairment, known as the”cardinal features” of thedisease.
  • 5. Other motor features Micrographia Masked facies equalize Reduced eye blink Soft voice Dysphagia Freezing
  • 6. Nonmotor features Anosmia Sensory disturbances Mood disorders Sleep disturbances Autonomic disturbances Orthostatic hypotension Gastrointestinal disturbances Genitourinal disturbances Sexual dysfunction Cognitive impairment/Dementia
  • 13. WHAT CAN BE DONE TO HELPPARKINSONS SUFFERERS?
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