20.%20Motor_Parkinsons

20.%20Motor_Parkinsons - 11/14/2009 Parkinsons Disease...

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11/14/2009 1 Parkinsons Disease Brett Lil ie 2009 Seesaw ACH and Dopamine Brett Lil ie 2009 Decrease in Dopamine = ↑ activity of Striatal (Putamen + Caudate) Cholinergic System Produces Excessive inhibition on Globus Pallidus = Hypokinesia. Brett Lil ie 2009 L-dopa blocks the cholinergic hyperactivity Brett Lil ie 2009 Huntingtons – loss of Ach in Striatum (mostly Caudate head) Brett Lil ie 2009 Brett Lil ie 2009
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11/14/2009 2 Brett Lil ie 2009 First described in 1807. Most common CNS degenerative disease. Incidence of 4.5 to 20.5 (300 per 100,000), b ’s with advancing age (1 in 3 over 85 yrs). Brett Lil ie 2009 Pathology consists of decrease in DA stores of the subst. Nigra with consequent depigmentation of this structure and presence of Lewy bodies (intracellular inclusions) It is the DA that gives the subst. Nigra its colour and hence its name. Brett Lil ie 2009 The loss of DA from subst. Nigra affects direct and indirect pathways of BG resulting in an B in excitatory thalamic input to the cortex. Brett Lil ie 2009 It is proposed that PD is an acceleration of the ageing process. Average age of onset is 35 to 60 years. Males slightly > females. Aetiology is unknown; slow viral process, environmental factors, long term effects following infection, pesticides/toxic factors (link b/w growing up in rural area), family history is important??? Brett Lil ie 2009 Features 1. Tremor 2. Rigidity 3.Bradykinesia (slow mvt) Michael J. Fox Brett Lil ie 2009
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11/14/2009 3 Feature’s of Parkinson’s Three main features are: 1. Tremor Present at rest (opp. to intention). Rhythmic. In hands, legs, tongue, lips and lightly closed eyes. 2. Rigidity Throughout full ROM. Decreased by mvt. Present in limbs, trunk and neck. Brett Lil ie 2009 Feature’s of Parkinson’s 3.Bradykinesia (slow mvt) Mask-like faces and blinking. Lead-pipe or cogwheel. Facial mvt. Quiet, monotonous voice. Poorly articulated speech. Eating and swallowing. Hands and fingers for fine tasks, eg. writing (micrography) and dressing. Trunk for turning, in bed or when walking. Legs, making the gait slow and shuffling. Brett Lil ie 2009 Brett Lil ie 2009 Plus Gait 1. shuffle 2. difficult to turn 3. freezing 4. postural instability Brett Lil ie 2009 Postural abnormalities include assumption of a flexed posture, lack of equilibrium reactions and a decrease in trunk rotation. Brett Lil ie 2009 1. Tremor at rest “Pill-rolling” – flexed at wrist, fingers extended and thumb abd. Disappears with mvt. Regular rhythm of 4-7 beats per sec (alternating bursts of antagonistic muscles). Tremor 1 Tremor 2 Brett Lil ie 2009
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11/14/2009 4 Appears to be due to lesion of tracts from BG to Thalamus. Tremor rarely interferes with daily activity.
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This note was uploaded on 07/15/2011 for the course ECO 2023 taught by Professor Mr.raza during the Summer '10 term at FAU.

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20.%20Motor_Parkinsons - 11/14/2009 Parkinsons Disease...

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