Parkinson's disease

Introduction 

In Parkinson's disease the dopamine producing neurons in substantia nigra are lost

Parts of substantia nigra

Caudate nucleus

Putamen

Globus Pallidus

Subthalamic nucleus

Substantia nigra

Signs and symptoms

1. Bradykinesia - Slowing of movements

2. Rigidity 

Cog wheel rigidity

Lead pipe rigidity

3. Mask facies - Expressionless face

4. Tremors

Resting tremor 

Pill rolling tremor - Index finger and thumb are affected 

5. Gait - Shuffling gait

6. Autonomic disturbance 

Hypersalivation, constipation, incontinence

7. Cognitive impairment

Treatment

Medications improve symptoms but don't slow progression

Goal is to increase dopamine availability inside CNS

Medications used are

Carbidopa - Levodopa - Levodopa is combined with carbidopa to help Levodopa reach the brain

Pramipexole

Selegiline

Amantadine

Tolcapone/Entacapone