PARKINSONS DISEASE

Def: a broad & heterogenous syndrome characterized by tremor,

3 main categories:
Primary Parkinsons
Secondary Parkinsons Disease
Disease
- Characterized by
- Results of external
parkinsonism
factors:
Drugs (neuroleptics)
alone
- Result of
Wilsons disease
interaction
Anoxia
Vascular (stroke)
between genetic
Punch drunk
& environmental
syndrome (dementia
factors
pugilistica)
Carbon
monoxide/manganese
poisoning
-

rigidity & bradykinesia

Parkinsonism-plus Syndrome
Def: a group of degenerative disorders of nervous
system characterized by degenerative process at
various areas (in addition to basal ganglia) such as
cerebellum, pyramidal tract, mid-brain, autonomic
system & cerebral cortex
CF:
Extrapyramidal signs (tremor, rigidity & bradykinesia)
Non extrapyramidal signs:
Cerebellum (cerebellar signs)
Pyramidal tract (motor weakness upgoing
plantar
Midbrain (vertical gaze palsy)
Autonomic system (postural hypotension)
Cerebral cortex (cortical signs)
Types:
Progressive supranuclear palsy (Steele-RichardsonOlzewski syndrome)
Vertical (then, horizontal) gaze palsies
Axial rigidity

Non treatable

Respond well to
Levodopa

Early frequent falls

Eyelid apraxia
Pesudobulbar palsy
Multiple system atrophy (MSA)
Striatonigral Degeneration (SND)
o Early onset falls
o Dysarthria/dysphonia
o Pyramidal tract signs
o Minimal/absent tremor
Shy Drager Syndrome (SDS)
o Autonomic dysfunction (postural
hypotension, impotence, urinary
incontinence)
Olivopontocerebellar Atrophy Syndrome (OPCA)
o Cerebellar signs
Corticobasal Ganglionic Degeneration (CBD)
Cortical signs (aphasia, apraxia, agnosia, other
parietal lobe signs)
Asymmetrical rigidity/bradykinesia
Myoclonus
Dystonia
Dementia

Some causes are

treatable:
Wilsons disease
Withdrawal of
neuroleptic drugs
-

Poorly respond to Levodopa & most drugs (dopamine

agonists)

Respond to brain
surgery
(pallidotomy,
deep brain
stimulation)
Better prognosis

Do not respond to brain surgery (pallidotomy, deep brain

stimulation)

Poor prognosis (expected life: 5 years survival)

Commonest: secondary parkinsonism due to neuroleptics

How to diagnose Parkinson disease?

DIAGNOSTIC CRITERIA OF WARD & GIBB, 1990
Clinical evidence of disease progression
2 out these signs: tremor, rigidity, bradykinesia
At least 2 of: marked response to Levodopa, asymmetry of signs, asymmetry of onset
Absence of clinical features of alternative diagnosis: Parkinsonism-plus Syndrome
Exclusion of secondary parkinsonism

How to approach patient with Parkinsonism?

Confirm parkinsonism by physical examination:

Determine which categories is he belongs to:

Symptoms of
Parkinsonism

History & physical

examinations

Trial of Levodopa

Responded

No response

Trial of Dopamine
agonist
No response

Parkinsons disease

Alternative diagnosis
(PPS)