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What is Parkinson's disease?
- Progressive neurodegenerative disease
- Affects motor ability
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Cardinal symptoms
- Tremor
- Rigidity
- Bradykinesia or Akinesia
- Postural instability
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Primary vs Secondary
- Most people have primary or idiopathicSecondary symptoms form brain tumors or certain anti-psychotic drugs
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Stages of PD
- I: initial stage-unilateral limb involvement, minimal weakness, hand/arm trembling
- II: mild stage- Bilateral limb, masklike face, slow shuffling gait
- III: moderate disease- Postural instability, gait disturbances
- IV: severe disability- Akinesia, rigidity
- V: complete ADL dependence
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Patho
- Widespread degeneration of the substantia nigra leads to a decrease in dopamine. ACh remains active, creating an imbalance btwn excitatory/inhibitory activity
- PD not only interferes c mvmnt, also reduces SNS influence on the heart & blood vessels resulting in orthostatic hypotension
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Rigidity classifications
- Cogwheel: rhythmic interruption of muscle mvmnt
- Plastic: mildly restrictive mvmnt
- Lead pipe: total resistance to mvmnt
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Masklike expression
- Wide open, fixed, staring eyes caused by rigidity of facial muscles
- Difficulty chewing/swallowing esp if pharyngeal muscles are involved
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Diagnosis
- Made on basis of clinical findings p neurological diseases are eliminated
- No specific tests
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Diet
- High-protein or high-calorie foods or supplements to maintain weight
- Monitor pt ability to eat/swallow
- Small frequent meals/liquid thickeners for difficulty swallowing
- Elevate head to prevent aspiration
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Nonsurgical management
- Dopamine agonists mimic dopamine by stimulating dopamine receptors in the brain
- Most effective first 3-5yrs of use
- Fewer incidents of dyskinesia and "wearing off" phenomenon-loss of response to drug
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Dopamine agonists
- Apomorphine (Apokyn)
- Pramiexole (Mirapex)
- Ropinirole (Requip)
- Ritigotine (Neupro)
Side effects-orthostatic hypotension, hallucinations, sleepiness/drowsiness
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Drug therapy
- *Sinement-improve motor function
- COMT inhibitors
- MAO-B
- Dopamine receptor agonist
- Antiviral
- Anticholinergic
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Treatment drug toxicity/tolerance
- Reduction in drug dosage
- Change of drug/frequency of admin
- Drug holiday- 10 days no PD meds
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Nonsurgical interventions
- Exercise/ambulation-yoga, tai chi,ROM, stretching
- Self management- encourage pt participation in ADL's
- Injury prevention- monitor sleeping patterns (naps)
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Surgical management
- Stereotactic pallidotomy
- Thalamotomy
- Fetal tissue transplantation
- Deep brain stimulation
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What is a stereotactic pallidotomy?
- Target area id'd by CT or MRI
- Head frame palced on pt
- Burr hole made into cranium into the pallidum within the corpus striatum
- Electrode placed-recieves mild shock
- When probe in correct spot, permanent lesion made to destroy tissue
- Monitor pt in PACU for 1hr
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What is a thalamotomy?
- Opening into thalamus for thermocoagulation
- Only unilateral surgery done to prevent complications
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What is fetal tissue transplantation?
- Experimental/highly controversial
- Fetal substantia nigra tissue is transplanted into caudate nucleus of brain
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What is deep brain stimulation?
Thin electrode is implanted in thalamus or subthalamus and connected to pacemaker that delivers an electric current
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