mostly parkinson’s disease but also few other movement disorders due to diseases of the basal...
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Mostly Parkinson’s disease but also few other movement disorders due to
diseases of the basal ganglia
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Direct and indirect pathways
• Dopamine excites the Direct pathway leading to cortical excitation and movement.
• Dopamine inhibits the Indirect pathway leading to cortical excitation and movement.
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Hypokinetic disorders• Lack of dopamine leads to over-activity of
the indirect pathway and under-activity of the direct one.
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Hyperkinetic disorders
• Dopamine excess leads to under-activity of the indirect pathway and over-activity of the direct one.
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Hypokinetic disorders
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Resting tremor, bradykinsesia, rigidity and postural instability
Parkinsonism
Neurodegenerativeprocess
Drug-induced
Idiopathic Parkinson’s
Disease
Parkinson Plus Syndromes:1. Multiple System Atrophy (MSA)2. Progressive Supranuclear palsy (PSP)3. Corticobasal Degeneration (CBD)4. Others
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Dopamine deficiency in the striatum
Parkinsonism
Neurodegenerativeprocess
Drug-induced
Idiopathic Parkinson’s
Disease
Parkinson Plus Syndromes:1. Multiple System Atrophy (MSA)2. Progressive Supranuclear palsy (PSP)3. Corticobasal Degeneration (CBD)4. Others
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Parkinson’s disease
1. Resting tremor - Usually involves a hand, “Pill-rolling” tremor.
2. Rigidity – increased resistance to passive movement.
3. Bradykinesia – slowness of voluntary movements, reduction of automatic movements (arm swinging, hypomimia, blinking)
4. Postural instability.
Usually asymmetrical and responds to
Levodopa.
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Natural History of Parkinson’s Disease
Time (years)
Sev
erit
y O
f D
isea
se
Symptoms resistant totherapy (dementia, gait and balance, bulbar)
Motor symptoms (tremor, rigidity, bradykinesia)
Pre-motor symptoms (depression, constipation,Impaired smell sensation,acting out of dreams)
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Epidemiology of Parkinson’s disease
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Pathology
Normal Parkinson’s Disease
α-synuclein containingintracytosolic Lewy Bodies
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Progression of Lewy bodies
Braak staging
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Etiology
• No clear etiology is found for the majority of patients.
• Organic solvents and rural living were associated with higher risk.
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https://www.michaeljfox.org
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Gan-Or, Neurogenetics, 2010
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Treatment
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Time (years)
Sev
erit
y O
f D
isea
se
Diagnosis
Motor complications
Therapy honeymoon(minimal symptomson treatment)
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Levodopa induced dyskinesia
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Surgical treatment
• Deep brain stimulation of substantia nigra or Glubus Pallidus interna has replaced palidotomy.
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Hyperkinetic disorders
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Hyperkinetic disorders
• Chorea / Athetosis• Tics• Ballismus• Dystonia
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Example: Chorea
• Rapid, semi purposeful, graceful vs jerky, irregular movement that tends to occur in the distal limb or face.
• Inherited diseases – Huntington, Wilson• Rheumatic – Sydenham, Chorea gravidarum• Systemic – SLE, APLA• Drug-induced – Neuroleptics, cocain, excess L-dopa
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The End