non-pharmacological management of parkinson's_13_03_12

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Non-pharmacological Management of Parkinson’s Disease:

Non-pharmacological Management of Parkinson’s Disease Presented By: Amin Younis Medical University of Lodz

Parkinson’s Disease:

Parkinson’s Disease Degenerative disorder of the central nervous system. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain.

Parkinson’s Disease:

Parkinson’s Disease Pathology of the disease The pathology of the disease is characterized by the accumulation of a protein called alpha- synuclein into inclusions called Lewy bodies in neurons. Lewy bodies are the pathological hallmark of the idiopathic disorder, and the distribution of the Lewy bodies throughout the Parkinsonian brain varies from one individual to another. The anatomical distribution of the Lewy bodies is often directly related to the expression and degree of the clinical symptoms of each individual. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation.

Parkinson’s Disease:

Parkinson’s Disease Pathology of the disease – as seen in MRI

Signs and Symptoms (motoric):

Signs and Symptoms (motoric) Tremor I s the most apparent and well-known symptom. It is the most common; though around 30% of individuals with PD do not have tremor at disease onset, most develop it as the disease progresses. It is usually a rest tremor, maximal when the limb is at rest and disappearing with voluntary movement and sleep . It affects to a greater extent the most distal part of the limb and at onset typically appears in only a single arm or leg, becoming bilateral later .

Signs and Symptoms (motoric):

Signs and Symptoms (motoric) Bradykinesia S lowness of movement, is another characteristic feature of PD, and is associated with difficulties along the whole course of the movement process, from planning to initiation and finally execution of a movement.

Signs and Symptoms (motoric):

Signs and Symptoms (motoric) Rigidity is stiffness and resistance to limb movement caused by increased muscle tone, an excessive and continuous contraction of muscles. The combination of tremor and increased tone is considered to be at the origin of cogwheel rigidity. Rigidity may be associated with joint pain; such pain being a frequent initial manifestation of the disease .

Signs and Symptoms (motoric):

Signs and Symptoms (motoric) Postural instability I s typical in the late stages of the disease, leading to impaired balance and frequent falls, and secondarily to bone fractures . Instability is often absent in the initial stages, especially in younger people. Up to 40% of the patients may experience falls and around 10% may have falls weekly, with number of falls being related to the severity of PD.

Signs and Symptoms (Neuropsychiatric):

Signs and Symptoms (Neuropsychiatric) Parkinson's disease can cause neuropsychiatric disturbances which can range from mild to severe. This includes disorders of speech, cognition, mood, behavior, and thought . Cognitive disturbances can occur in the initial stages of the disease and sometimes prior to diagnosis, and increase in prevalence with duration of the disease. The most common cognitive deficit in affected individuals is executive dysfunction, which can include problems with planning, cognitive flexibility, abstract thinking, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information. A person with PD has two to six times higher risk of suffering dementia compared to the general population.

Non-Pharmacological Management:

Non-Pharmacological Management Ablative Surgery This procedure locates, targets, and then destroys (ablates) a clearly-defined area of the brain affected by Parkinson's disease. The goal of this surgery is to destroy tissue that produces abnormal chemical or electrical impulses that result in tremors and dyskinesias . In ablative surgery, a heated probe or electrode is inserted into the targeted area. It is safer to treat a small area and risk the tremor returning or not being eliminated, than to treat a larger region and risk serious complications, such as paralysis or stroke .

Non-Pharmacological Management:

Non-Pharmacological Management Ablative Surgery Types of ablative surgery include: Pallidotomy —ablation of brain tissue in the globus pallidus. This procedure is performed to eliminate uncontrolled dyskinesias. Thalamotomy —ablation of brain tissue in the thalamus. This procedure is performed to eliminate tremors. A related procedure, called cryothalamotomy, uses a supercooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors .

Non-Pharmacological Management:

Non-Pharmacological Management Deep Brain Stimulation - DBS Deep brain stimulation targets the subthalamic nucleus, which is located below the thalamus. In DBS, the targeted region is inactivated, not destroyed, by an implanted electrode. The electrode is connected via a wire running beneath the skin to a stimulator and battery pack in the patient's chest. This procedure is reversible (by turning off the current) and allows for precise calibrated symptom control.

Non-Pharmacological Management:

Non-Pharmacological Management Rehabilitation Regular physical exercise with or without physiotherapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life . One of the most widely practiced treatments for speech disorders associated with Parkinson's disease is the Lee Silverman voice treatment (LSVT ).

Non-Pharmacological Management:

Non-Pharmacological Management Diet Muscles and nerves that control the digestive process may be affected by PD. A balanced diet, based on periodical nutritional assessments, is recommended and should be designed to avoid weight loss or gain and minimize consequences of gastrointestinal dysfunction. As the disease advances, swallowing difficulties (dysphagia) may appear. In such cases it may be helpful to use thickening agents for liquid intake and an upright posture when eating, both measures reducing the risk of choking.

Non-Pharmacological Management:

Non-Pharmacological Management Restorative Surgery These procedures are still considered experimental for Parkinson's disease. In transplantation, or restorative, surgery dopamine-producing cells are implanted into the striatum. The cells used for transplantation may come from one of several sources: the patient's body, human embryos, or pig embryos . Preliminary studies have shown that pig embryo cells do survive transplantation and have an effect on symptoms.

Other Methods:

Other Methods rTMS - Repetitive transcranial magnetic stimulation temporarily improves levodopa-induced dyskinesias. Its usefulness in PD is an open research topic. Fava beans and velvet beans are natural sources of levodopa and are eaten by many people with PD. While they have shown some effectiveness in clinical trials, their intake is not free of risks. Life-threatening adverse reactions have been described, such as the neuroleptic malignant syndrome.

Question 1:

Question 1 All of the following are symptoms of PD, except: A ) T remor B ) Macrographia C ) Cognitive disturbances D ) B radykinesia

Question 2:

Question 2 Thalamotomy (ablation of brain tissue in the thalamus) is performed to eliminate which of the following symptoms? A) Tremor B) Muscle rigidity C) Cognitive disturbances D) Bradykinesia

Question 3:

Question 3 Which of the following methods uses an implanted electrode? A ) Ablative surgery B) Restorative surgery C) Repetitive transcranial magnetic stimulation D ) Deep brain stimulation


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