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4. Vascular (atherosclerotic,Binswangers)
5. Cerebral trauma
6. etc
III. Parkinsonism Plus (Multiple system
degeneration)
1. Progresive Supra Nuclear Palsy
2. Multiple System Atrophy; striatonigral
degeneration, Shy-Drager Syndrome,
Olivopontocerebellar Degeneration,
Parkinsonism Amyotrophy Syndrome.
3. Corticobasal ganglionic degeneration.
4. Demensia syndromes; Parkinsonism-demensia
ALS (Guam) complexs, Diffuse Lewy bodies
disease, Jacob Creutzfeldt disease, Alzheimer
disease.
Excitatory neurotransmitter
Neurotransmitter project from cortex to
striatum, project from thalamus to cortex
and project from cortex to medula spinalis.
Neurotransmitter project from STN to GPE
and GPI.
GABA :
Inhibitory neurotransmitter
Neurotransmitter project from all basal ganglia
nucleus except STN
Acetylcholine (AK):
Neurotransmitter project from peduncule pontis
nucleus to striatum
1. Imbalance theory of direct pathway and indirect
pathway
2. Imbalance theory of dopaminergic-cholinergic
neuron
General :
Symtom begin on one side at onset.
Resting tremor
No the other deficit Neurologis
Laboratorium and radiology finding in normal
limit.
The progression of diseease is slowly.
Respond to levodopa tratment.
Tremor :
It is a rest tremor. It decrease or disappears
with movement. It disappears with sleep.
Frequency of tremor among 4 to 6 Hz
Typically tremor begins in one upper limb with
involvement of the corresponding lower limb
approximately 2 years later.
Occasionally, the disease produces tremor at
the jaw, lip, or tongue. Rarely it affects the head
or voice.
Rigidity : Cogwheel phenomenon
Bradykinesia
Facial impassivity produces a fixed expression
Infrequent blinking
Speech volume becomes reduced
Micrographia
A change in walking speed
constipation
Mood disturbances : depression
Adverse effect of drug
Essential tremor
Symptomatic Parkinsonism
Parkinsonism Plus
Indication : in order to role out other
disease
Medication :
- Algorithm of Management
- Notice :
* Individualize medication regimen
* Responsiveness to treatment
* Adverse effect of drug
Surgery Unilateral Thalamotomy,
pallidotomy, Foetal substansia nigra
transplant , deep brain stimulation.
Medical Rehabilitaation :
- Physiotherapy
- Occupation therapy
- Speech therapy
- Psycotherapy
- Social therapy
Recent development in therapeutical strategies
increase quality of life and longevity in PD
patients.
Life expectancy still below normal
expectations due to complications such as
choking , pneumonia, and falls.
The progression of symptoms no way to