parkinson's

• Progressive neurodegenerative disease
• Affects motor ability

• Tremor
• Rigidity
• Bradykinesia or Akinesia
• Postural instability

• Most people have primary or idiopathic
• Secondary symptoms form brain tumors or certain anti-psychotic drugs

• 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

• 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

• Cogwheel: rhythmic interruption of muscle mvmnt
• Plastic: mildly restrictive mvmnt
• Lead pipe: total resistance to mvmnt

• Wide open, fixed, staring eyes caused by rigidity of facial muscles
• Difficulty chewing/swallowing esp if pharyngeal muscles are involved

• Made on basis of clinical findings p neurological diseases are eliminated
• No specific tests

• 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

• 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

• Apomorphine (Apokyn)
• Pramiexole (Mirapex)
• Ropinirole (Requip)
• Ritigotine (Neupro)

Side effects-orthostatic hypotension, hallucinations, sleepiness/drowsiness

• *Sinement-improve motor function
• COMT inhibitors
• MAO-B
• Dopamine receptor agonist
• Antiviral
• Anticholinergic

• Reduction in drug dosage
• Change of drug/frequency of admin
• Drug holiday- 10 days no PD meds

• Exercise/ambulation-yoga, tai chi,ROM, stretching
• Self management- encourage pt participation in ADL's
• Injury prevention- monitor sleeping patterns (naps)

• Stereotactic pallidotomy
• Thalamotomy
• Fetal tissue transplantation
• Deep brain stimulation

• 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

• Opening into thalamus for thermocoagulation
• Only unilateral surgery done to prevent complications

• Experimental/highly controversial
• Fetal substantia nigra tissue is transplanted into caudate nucleus of brain

Thin electrode is implanted in thalamus or subthalamus and connected to pacemaker that delivers an electric current