Transcript A Movement Disorder

Understanding
Parkinson’s disease
Mrs Gisela Stanek
Admin & Training Manager
Parkinson’s Disease & Related Movement Disorders
Defining Parkinson’s Disease
A Movement Disorder
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It is understood that a Dopamine deficiency in the brain
is at the root of the matter, yet WHY this initially occurs is
less clear.
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Parkinson's disease is a disease in a group of conditions
called movement disorders – disorders that result from a
loss of the brain’s ability to control voluntary movements.
Incomplete signals
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PD occurs when 80% of dopamine producing cells- the
“brain messenger” have died.
What causes Parkinson's?
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The cause is still unknown, but……
of part of the brain – the substantia
nigra.The cells need dopamine to control movement
and as the cells die, the brain becomes depleted of
this chemical.
 Environmental toxins
 Accelerated aging
 Genetic factors
 A degeneration
Research
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U.S. scientists have discovered that brain networks damaged by
P.D. become abnormal a few years before any symptoms appear.
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Currently TWO abnormal networks have been discovered –
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1. involved in the mediating the motor symptoms of PD, and
2. the network regulating the cognitive dysfunction that develops in
many patients with this illness.
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Symptoms in PD initially occur on one side of the body and as the
illness progresses, both sides become involved. Researchers
watched the network of the other side of the brain – still not
showing symptoms and discovered that side also showed signs
of abnormality, but symptoms were delayed be an average of 2
years.
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The brain network that governs cognition began showing
impairment after TWO MORE YEARS had passed, which was 4
years after the diagnosis.
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Stem cells; Neurosurgeons have discovered that the
transplantation of adult neuro stemcells taken directly from the
patient’s own tissue may drastically reduce the disabilitating
effects of PD.
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Doctor’s took some of the patients Stem Cells and introduced
a chemical that forced the cell to change form. They became
neurons that secrete dopamine, a critical substance lacking in
PD patients. Months later, the new cells were implanted into the
patient’s brain. They amplified and multiplied the number by
several millions, and the kind of cells that were introduced were
mature neurons, whereas initially only a few were harvested.
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The study group achieved 80% improvement on their
symptoms. But the doctors are cautiously optimistic. It is to
early to be sure that this procedure works as well as it seems,
but if the patients cases are no fluke, the researchers could be
looking at a breakthrough in the treatment of PD.
Research cont.
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Early signs of PD symptoms include:
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Loss of sense of taste and smell
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Constipation
 people
with a history of constipation may be at
increased risk of developing PD. A research study
has found that about twice as many people get PD
than in an age matched group of men and women
who did not have the illness.
Parkinson’s is NOT:
Contagious
 Curable
 Normal for older people – or impossible for
younger people
 A reason to make immediate life-changing
decisions
 Bound to get you if you life long enough

Parkinson’s IS:
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Chronic (when you have it, you have it – like
arthritis or diabetes)
Slowly progressive (over time – often years)
Manageable (often for years) with proper
treatment
Life-changing for you, your family and friends
Learning how to live with it
Definition and Symptoms
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Although it typically develops after the age of 65, about
15% of patients develop “young-onset” Parkinson’s
Disease before reaching the age of 50.
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On average , the patient has already suffered from
Parkinson’s Disease for 13 years at the time when the
typical symptoms manifest themselves.
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Symptoms only appear once 80% of the DOPAMINE in
the brain has been lost.
The primary symptoms of Parkinson’s
Disease are
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Tremor – involuntary, rhythmic
shaking of a limb, head, or the entire
body.
This can affect the hands, arms, legs,
jaw, and face
It may affect only one part or side of
the body – especially in the early
stages of the disease.
Its referred to as a resting tremor
Approximately 25% of people
diagnosed with PD never develop a
tremor
Major symptoms
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Rigidity-(stiffness or inflexibility of the limbs or joints). Muscles
remain constantly tense and contracted. This may cause aching,
stiffness, weakness and jerky movements. (incomplete signals)
This muscle rigidity experienced often begins in the legs and
neck. It affects most patients.
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Bradykinesia–(slowness of movement) This is one of the classic
symptom of Parkinson’s Disease. They eventually may lose their
ability to start and keep moving and after a few years experience
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Akinesia- absence of movement or “freezing” resulting in not
being able to move at all.
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Dyskinesia – increased movements – in PD normally a side
effect of medication – “peak time phase” or wearing off phase
……..Symptoms continued
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Postural Instability-Impaired
balance and co-ordination. A
stooped position, with the head
bowed and shoulders drooped is
typical. They may develop a forward
or backward lean and may have
falls that cause injuries.
Other possible symptoms
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“Mask like” face/Changes in expression
Depression
Emotional changes
Memory loss/Slow thinking
Problems swallowing/Chewing
Changes in Speech/Slurred speech
Urinary problems
Constipation
Other possible symptoms
………..continuation
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Handwriting problems
Difficulty getting
dressed
Freezing episodes
Oily/dry skin
Difficulty sleeping
Shuffle walking
Drooling
Classification of PD
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Idiopathic Parkinsonism
 The
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cause is unknown
Secondary Parkinsonism
 Drug
induced
 Infectious
 Metabolic
 Psychogenic
 Trauma
 Toxin
Classification of PD - continuation
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Parkinson-Plus Syndromes
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Corticobasal degeneration in the brain
Dementia Syndromes
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Multiple System atrophy syndromes
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Alzheimers disease (progressing memory loss)
Dementia with Lewy bodies (thinking and memory problems are
among the early and primary symptoms)
Pick’s disease
Shy-Drager Syndromes
Progressive supranuclear palsy
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A rare disease that gradually destroys nerve cells in parts of the
brain that control eye movement, breathing, and muscle
coordination.
Illnesses that resemble PD
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Heredodegenerative diseases examples:
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Huntington’s disease
 A rare
hereditary condition that causes progressive
chorea (jerky muscle movements) and mental
deterioration that end in dementia
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Wilson’s disease
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An inborn defect of copper metabolism in which free copper
may be deposited in a variety of areas of the body.
Deposits in the brain can cause tremor and other symptoms
of Parkinson’s disease
Comparison of Parkinson’s Disease &
Essential Tremor
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Characteristics
Parkinson’s Disease
Essential Tremor
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Family History
Alcohol
Medical attention sought
Age at onset
Tremor Type
Body parts affected
Disease course
Usually negative
Possible effect
Early in course
Mid-adulthood
Resting
Hands and legs
Progressive
May be present
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Bradykinesia, rigidity&
Postural instability
Positive 50%
Marked tremor reduction
Often late in course
Childhood, adulthood or elderly
Postural, kinetic
Hands, head, voice
Slowly progressive; static for
long periods
Never present
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Treatment
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Levadopa
Primidone
Propranolol
Effective
No effect
May decrease tremor
No effect
Effective
Effective
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How is it diagnosed?
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Clinical diagnosis
 No
blood test
 No brain scan
 Detailed history
 Careful observation of
movements
Treatment Options
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Parkinson’s Disease can be treated with a
variety of medications. However, they may lose
effectiveness over time or cause troubling side
effects.
The treatments include:
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Drug therapies – ( including Levadopa) – a class of drugs with
dopamine-like action
Dopamine agonists - a class of drugs that binds the dopamine
receptors and imitates the action of dopamine.
Anticholinerics – type of drug that decreases the activity of
another neurotransmitter that controls movement.
MAO-B inhibitors – a class of drugs that blocks an enzyme that
breaks down levadopa and boosts the effects of Synamet.
COMT inhibitors – a class of drugs that prolongs symptom relief
by blocking the action of an enzyme which breaks down
levadopa.
PD drugs and withdrawal effects:
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Reduced dosages of dopamine agonists, drugs
routinely used to threat PD, can cause symptoms
similar to those experienced by addicts in
withdrawal, such as anxiety, panic attacs, pain,
dizziness and drug cravings.
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These symptoms have been dubbed “ dopamine
agonists withdrawal syndrome” and have been
linked to a disruption in levels of dopamine in the
brain.
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“Like cocaine and methamphetamines, these
dopamine agonists work by stimulating the reward
pathways in the brain”
……….Treatment options continued
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Deep Brain Stimulation.
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This is a surgical intervention and offers an adjustable, reversible treatment
for Parkinson’s Disease. The treatment uses an implanted medical device,
similar to a pacemaker, to deliver electrical stimulation to precisely targeted
areas of the brain. Stimulations to these areas appears to block signals that
cause disabling motor symptoms.
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It is a treatment option for people with advanced Parkinson’s disease,
Essential Tremor and primary Dystonia.
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DBS is adjustable and can be changed over time to match the need for
symptom control.
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However it does NOT cure Parkinson’s disease, but offers a better quality of
life for extended periods and years. It effectively controls symptoms that
make day-to-day tasks difficult and which are often the cause of social
embarrasment for patients.
Deep Brain Stimulation - procedure
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The surgeon drills a small hole in the skull and then
inserts and electrode (called lead), positioning it in the
targeted area of the brain
 The surgeon then inserts a pulse generator under the
skin in the area of the collarbone.
 The neurotransmitter is then
programmed to send signals
Lobotomies and Palliotomies are no longer the
preferred surgical intervention.
Treatment options CONCLUSION
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Remember that all treatment
options are only for symptomatic
relief and quality of life. It does
not change the sequence of
events.
Helping yourself with exercise
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Regular exercise is one of the most important self-help
strategies for coping with PD. The phrase “USE IT OR LOSE IT” definitely applies when it comes to PD.
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Benefits of exercise:
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Increase muscle strength
Improve balance
Overcome gait problems
Decrease speech/swallowing problems
Improve mood and lift depression
Reduce muscle and joint injuries
Feel more in control/reduce feelings of isolation
Upper Body Strength and
Shoulder Flexibility
Grasp stick with both hands and lift over head;
repeat 10 times
Leg Strength Plus Knee and Ankle
Mobility
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Kick leg out in front
with knees straight;
repeat 10 times
Raise leg off floor;
make 10 circles in
each direction
with ankle
Trunk Twists
With elbows raised, twist sideways 10 times on each side
Walking
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PD patients have no
restrictions on exercise if
they are able to perform
the exercise
Walking improves muscle
tone and cardiovascular
fitness
Delay the use of the
wheeled walkers but if
required be aware of the
change in the balance
base.
Nutrition for Good Health
Well-balanced,
nutritional meals are
the key to good
general health
Special Dietary Considerations
for Patients With PD
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Increase calories if weight loss is a problem – but avoid obesity
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Add butter or margarine to vegetables
Increase intake of nutritional juices or milk
Add legumes to supplement calories and fiber
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Avoid high-protein meals after the patient takes a dose
of levodopa — protein interferes with levodopa absorption
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Avoid supplemental vitamin B6 if patient is taking levodopa without carbidopa
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Prevent constipation by increasing fiber in diet
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Frequent small meals
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Do not take protein and medication together – allow at least 30 min before or 60min
after a meal.
Difficulty With Swallowing
(Dysphagia)
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The same muscles that affect speech also affect swallowing
The symptoms of dysphagia are:
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Eating slowly
Fatigue while eating
Food stuck in throat or in pocket of mouth
Choking on food or liquid
Difficulty swallowing pills
Difficulty with swallowing increases the risk of weight loss, choking, and aspiration
pneumonia
Patient should sit upright and tilt the head forward while eating
Small bites or sips of liquid will help
Thicken liquids if clear fluids cause choking
“Double swallowing”
If patient gets fatigued while eating, serve smaller meals more often
Serve well-cooked, smoother textured food, and more tender cuts of meat
Liquidize food
Assistance for Preparing Meals
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Preparing food and eating can present
challenges for the patient
Many aids are available to improve safety and
help with food preparation
 A pot
stabilizer and light-weight pans help prevent
burns
 Jar openers and electric can openers help the patient
who has decreased strength or dexterity
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Specially designed wide-handled eating utensils
and plates with rims are available to assist the
patient while eating
Caregiver Information
Advice for Caregivers
Be patient ― some tasks
may take longer to do
Help patients
to help themselves
Maximize
Independence
Patient may need more
help at certain times of day
Ability to perform tasks
may fluctuate with
symptoms
For further information and updates
contact us or become a member of
our Association.
011-787-9287 or 011-326-2112
www.parkinsons.co.za
[email protected]
[email protected]