PARKINSON’S DISEASE By: AARUSHI JAIN AMRUTA KAMBLE ANNETT MARY JACOB AVANTI DEO M.Sc. PRIST (09-11)

HISTORY It is referred to as Kampavata in the ancient Indian medical system of Ayurveda. In Western medical literature it was described by the physician Galen as "shaking palsy“ in AD 175. In 1817, a detailed medical essay was published by London doctor James Parkinson. In 1960s, the chemical differences in the brains of Parkinson's patients were identified.

INTRODUCTION PARKINSON’S DISEASE is a brain disorder which occurs when neurons in the Substantia nigra die or become impaired. These cells produce a vital chemical known as “DOPAMINE” DOPAMINE allows smooth, co-ordinated function of the body’s muscles and movement Parkinson’s symptoms appear when 80% of dopamine producing cells are damaged.

EPIDEMIOLOGY Average incidence is 20 per 1,00,000 in North America 1 million affected in United states 50,000 new cases per year Cost estimated to exceed $5.6 Billion annually Men and Women affected equally

SYMPTOMS  Major symptoms Tremor Rigidity Bradykinesia Postural instability Difficulty with balancing

 Other symptoms Small, cramped handwriting Stiff facial expression Shuffling walk Muffled speech Depression

RISK FACTORS Genetic factors Age Exposure to environmental toxin Reduced estrogen levels

CAUSES Combination of several factors including Free radicals Accelerated aging External or internal toxins Genetic predisposition In rare instances,viral infection Certain health disorders Poor nutrition

PATHOPHYSIOLOGY Imbalance of dopamine and acetylcholine Loss of 80% to 90% of dopaminergic production in the substantia nigra Lewy bodies

PROGNOSIS AND COMPLICATIONS Pneumonia Urosepsis Hip fractures 27% life time risk Falls –brain trauma Malnutrition 4 times more likely to have 10 pound weight loss 2-3 fold increase in early mortality which depends on duration, age and presence of dementia

STAGES StageDescription 0 No clinical signs evident I Unilateral involvement II Bilateral involvement but no postural abnormalities III Bilateral involvement with mild postural imbalance on examination or history of poor balance or falls; patient leads independent life IV Bilateral involvement with postural instability; patient requires substantial help V Sever, fully developed disease; patient restricted to bed or wheelchair

MANAGEMENT  GENERAL: Nutrition Exercising Performing activities Complementary therapies Finding support

 MEDICAL: Based on the severity of symptoms and their impact on quality of life. Levodopa with Carbidopa Levodopa with benserazide COMT inhibitors Dopamine agonists

CASE STUDY Female, Age 66 years, Parkinson's Disease This 66-year-old female noticed the onset of Parkinson's symptoms, including rigidity, jerky movements, and loss of hand coordination, at 58 years of age. Other health complaints included neck pain, hand numbness, low back pain, and sciatica. During her initial evaluation, her most severe Parkinson's symptoms included loss of motivation, poor handwriting, difficulty swallowing, slurred speech, difficulty turning in bed, loss of facial expression, rigidity in her neck, arms, and legs, and bradykinesia. After upper cervical care, this subject reported complete correction of neck pain, substantial reduction in rigidity, and a decrease in low back pain and sciatica. She also reported improved ability to turn in bed, improved flexibility in her neck, arms, and legs, and improved movement overall

The Effects of Vitamin D and Bone Loss in Parkinson's Disease (PDVD) Verified by Memorial Medical Center, October 2009 First Received: May 22, 2009 Last Updated: October 13, 2009 Sponsor: Medical Center Collaborator: Department of Defense Information provided by: Memorial Medical Center ClinicalTrials.gov Identifier: NCT ConditionCondition - Parkinson Disease InterventionIntervention - Dietary Supplement: Vitamin D3 Other: Placebo PhasePhase - Phase II

CONCLUSION Although Parkinson’s disease was first described almost two centuries ago, it is only recently that we have begun to understand the complex nature of the functional deficits. The pace of discovery is quickening. The development of new technologies such as the use of stem cells and viral vectors in its treatment. With advanced treatment and better understanding about Parkinsonism, there is hope for patients in nearby future.

World Parkinson's Day Is Held Annually on April 11th

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