1. Diseases: PARKINSON’S AND MYASTHENIA GRAVIS Jane E. Binetti RN MSN
NEURO CONDITIONS 2
Diseases:
PARKINSON’S AND MYASTHENIA GRAVIS
Jane E. Binetti RN MSN

2. Parkinson’s Disease
Neurodegenerative disease that is chronic and progressive characterized by:
Bradykinesia
Rigidity
Tremor at rest
Gait disturbances
“Parkinsonism” is a term that encompasses many other conditions than just Parkinson’s Disease

3. What is it?
A breakdown of dopamine producing neurons causes an imbalance between dopamine and acetylcholine
Dopamine is a neurotransmitter to the motor system
Posture, balance, movement
Disease is advanced before sx appear
80% of neurons lost
Incidence is 20/100,000
Prevalence >50; Peak onset >70
~ 15% < 50

4. What do you see? Sx are very slowly progressive, sometimes not noted
Unilateral at first – pts can accommodate
Triad of sx is classic presentation:
Tremor – often 1st sign, at rest, “pill rolling”
Rigidity – jerky movement of muscles
Bradykinesia – Pt lacks automatic, involuntary movement

5. Complications Aside from all the motor deficits pts also suffer:
depression, apathy, loss of memory
fatigue
constipation, impotence
With progression of disease:
Total immobility or dementia
Hallucinations, psychosis
Malnutrition, aspiration
Risk for falls and sleep disturbances

6. Diagnostics No specific testing Careful H and P
Minimum of 2 of the classic triad sx
Best reflection of accurate dx is response to tx
Research involves PET scans and MRIs

7. Collaborative Care
Medications used to enhance dopamine or decrease cholinergic action:
Dopaminergics:
Levodopa (L-Dopa)
Levodopa/carbidopa (Sinemet, Parcopa)
Dopamine Receptor Agonists
Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)

8. More Medication
Anticholenergics – decrease activity of acetylcholine to keep balance between L-Dopa and acetylcholine.
Trihexyphenidyl (Artane)
Benztropine (Cogentin)
Biperiden (Akineton)
Symmetrel
Other drugs used in combination to address specific sx

9. Surgical Therapy
Three surgical therapies can be used for pts who are unresponsive to medical therapy
Ablation
Done to target areas around the thalamus – used for 50 yrs
Deep Brain Stimulation
Newer treatment, done with electrode in and around the thalamus and a generator in the chest
Programmed like a pacer
Transplantation
Experimental

10. Nutrition Dietary concerns include
Dysphagia, malnutrition, constipation
Pt may need to be fed
Absorption of L-Dopa can be impaired by protein and B6
Watch fortified cereals
Multivitamins

11. What do you do? Care centers around maintence of good health
Movement – PT
Safety – falls
Nutritional needs
Mental health
Maximize quality of life
Support groups
Compliance

12. Myasthenia Gravis
Autoimmune Disease affecting the neuromuscular junctions
Skeletal muscle weakness
Age range 10-65
2 times more common in women
peak in childbearing years
As population ages, male and female are equal
6/100,000 people
About 18,000 people with this disease in US

13. What is it? Antibodies attack acetylcholine receptors
Impairs conduction for muscle contraction
Some cases wax and wane; stabilize; some rapidly progress
No sensory loss, no atrophy, reflexes are intact
Exacerbations triggered by:
Illness, trauma, stress, pregnancy, temperature

14. Other exacerbation risks
Aminoglycosides
Cardiac Drugs
Beta–adrenergic blockers, some anti-arrhythmics
Anti- Epileptics
phenytoin
Psych meds:
Lithium, benzos, tricyclics
Phenothiazines
Neuro meds:
Neuromuscular blockers

15. What do you see? Initially, skeletal weakness that improves with rest
Facial muscles often first affected
Weaker through the day
Speech, voice, neck, shoulder
Eventually arms and legs

16. Complications Myasthenic Crises Sudden exacerbation of muscle weakness
Triggers:
Infection, surgery, trauma
Emotional distress, overdose
Noncompliance with meds
Major risk is respiratory failure
Inability to swallow leads to aspiration pneumonia

17. Diagnostics Detailed H and P EMG and NCS Tensilon Test
IV dose of Tensilon
Increases muscle contractility
Cholinergic Crisis
Too much is given and cholinesterase is inhibited
Very strong muscle weakness, sweating, pupil constriction
IV atropine on hand

18. Collaborative Care Medications
Anticholinesterase: pyridostigmine (Mestinon)
Corticosteroids: prednisone
Azathioprine (Imuran)
Mycophenolate (Cellcept)
Cyclosporine (Sandimmune)

19. Collaborative Care Surgical Therapy Other Therapies Thymectomy
Decrease production of AChR antibodies
Thymomas
Other Therapies
Plasmaphoresis – for crisis or pre-op
IgG infusions

20. What do you do? The goal is to optimize muscle function Priorities:
Control fatigue
Avoid complications
Maintain optimal quality of life
Priorities:
Patent airway
Medication administration
Assessing side effects
Meeting ADLs
Support

21. Nursing Diagnoses Ineffective Breathing Pattern
Ineffective airway clearance
Impaired verbal communication
Imbalanced nutrition
Disturbed sensory perception
Activity intolerance
Disturbed body image