PARKINSON’S DISEASE IN PAKISTAN MANAGEMENT ISSUES. Prof. Shaukat Ali Head of the Department of Neurology Jinnah Postgraduate Medical Centre, Karachi. Parkinson's Disease. James Parkinson’s original 1817 describe “shaking palsy” now called parkinsons disease.
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Prof. Shaukat Ali
Head of the Department of Neurology
Jinnah Postgraduate Medical Centre, Karachi
James Parkinson’s original 1817 describe “shaking palsy” now
called parkinsons disease.
Parkinson's disease is a progressive degenerative disorder of the
central nervous system.
Idiopathic Parkinson's disease is caused by the progressive loss of
dopaminergic neurons in the substantia nigra and nigrostriatal
pathway of the midbrain and the presence of lewy bodies.
The hallmark physical signs of Parkinson's disease are tremor,
rigidity and bradykinesia.
Poor postural reflexes are sometimes included as the fourth
hallmark sign. When postural reflexes are inadequate, patients
may fall if they are pushed even slightly forward or backward, or if
they are standing in a moving vehicle such as a bus or train.
in substantia nigra.
usually project to
Tremor, slowness of movement (bradykinesia),
trouble initiating movement (akinesia), rigidity.
Affects 1/250 over 40; 1/100 over 65.
do not seek medical advice
productive life, Overall improves the QOL
Parkinson’s Disease Related
Insomnia Fragmentation of sleep (sleep
Sleep onset insomnia
Motor Function- Akinesia (difficulty turning)
Related Restless Legs
Periodic limb movements of sleep
Urinary Difficulties Nocturia
Nocturia with secondary postural
Parasomnias Vivid dreams
Altered dream content
REM Behavior disorder
Motor: Nocturnal off-period-related tremor
Off-period-related pain/ paresthesia/
Off-period-related incontinence of urine
? Off-Related panic attacks
? REM Behavior disorder
2. Sleep disorders secondary to behavioral
Transient and new Urinary tract infection
Onset incontinence Medications
Chronic incontinence Parkinsonism
Lack of mobility
Anatomic stress incontinence
(prostate in men)
Other peripheral or central
Dementia or apathy
Parkinsonian Idiopathic parkinsonism with central
syndromes autonomic involvement
Multiple system atrophy
Selegiline (especially combined with lovodopa)
Brainstem and spinal cord lesions
Dehydration, intercurrent illness
Decreased oral intake from dysphagia
Decreased salt intake
Sodium chloride tablets
Elevation of the head of the bed 5-20 degrees
Changing position slowly
Pressure stockings, pantyhose
liberalizing salt and fluid intake
Avoidance of hot weather, hot tubs or baths, alcohol,
Patient and caregiver education.
Depression in Parkinson’s Disease
TREATMENT OF DEPRESSION IN PD
DEMENTIA IN PARKINSON’S DISEASE
1. Side effects: Disease A. Peripheral (and /or central): a. Nausea, vomiting, anorexia b. Orthostatic hypotension
a. Chorea, stereotypy
2. Motor complications:
A. Motor fluctuations
a. Delayed onset of response
b. Wearing off phenomenon
c. Drug resistant “Off”
d. Random oscillations “On-Off phenomenon
a. Peak dose dyskinesia (I-D-I)
b. Diphasic dyskinesia (D-I-D)