Boala Parkinson

Bolnavi notabili

Papa Ioan Paul II

Bolnavi notabili

Salvador Dali

Salvador Dalí - Persistenţa memoriei -

Museum of Modern Art, New York
Bolnavi notabili

Muhammad Ali
Bolnavi notabili

Mao Zedong

Preşedintele Republicii Populare Chineze

Bolnavi notabili

Ray Kennedy
 ETIOPATOLOGIE
• Boală neurodegenerativă
– Degenerescența sistemelor:
 DOPAMINergice centrale
 alte căi monoaminergice (NA, Serotonina)
 Subs. P alterată
 GABA alterată
 Metenkefalină alterată

• Predomină la sexul masculin

• Prevalentă 120: 100.000 locuitori
 SIMPTOMALOGIE
• Debutul este insiduos cu senzatie de parestezii
si intepenire a unui segment cu dificultate in
executarea si controlul unor miscari ; alteori
boala incepe cu tremorul caracteristic la
extremitatea distala a mainii ; mersul devine
incetinit,faciesul inexpresiv cu lentoare in
vorbire ;
 SIMPTOMALOGIE
• In perioada de stare se gasesc intricate cele
trei sindroame principale ;
– Akinezie
– Hipertonia de tip extrapiramidal
– Tremorul parkinsonian
 DIAGNOSTICUL POZITIV
Este usor de pus pe existenta celor trei
sindroame: akinezia, hipertonia de tip
extrapiramidal si tremorul.
Positron-emission tomographic scan of the brain showing the
difference in fluorodopa (FDOPA) levels between those with and
without Parkinson's disease.
 DIAGNOSTICUL DIFERENTIAL
• Sdr. Postencefalic
• Sdr. Toxic Manganic (indus terapeutic)
• Sdr. Toxic Oxid de Carbon (indus terapeutic)
• Sdr. Vascular
• Sdr. Luetic (Sifilis)
• Sdr. Traumatic
• Paralizia supranucleară progresivă (~60 ani)
• Boala Creutzfeldt-Jacob
• complex Guam
• Boala lui Shi-Drager
• Boala Willson
[!!!] In toate aceste cazuri pe linga unele particularitati ale parkinsonismului se
tine cont de etiologia care actionind asupra sinapsei dopaminergice produce
simptomatologia respectiva.
 EVOLUTIE
• Lent progresivă
• prognosticul vital in general bun dar pot
apare unele complicatii
 (respiratorii, embolice, urinare, si cutanate)
• terapia moderna dopaminica lungeste
speranta de viata.
 TRATAMENTUL

1. Paliativ
2. Invaziv
3. Trial
 1. Paliativ
Preparate Anti-Parkinsoniene:
• Prep. ce activează sistemul dopaminergic
– Dopaminomimetice (agoniști ai receptorilor
dopaminergici)
– Inhibitori ai MAO-b
• Preparate ce inhibă influențele glutamatergice
• Preparate ce inhibă influențele colinergice
(Anticolinergice )
NMDA-Receptorii
 TRATAMENTUL

1. Paliativ
2. Invaziv
3. Trial
 TRATAMENTUL

1. Paliativ
2. Invaziv
3. Trial
Implantable Electrodes for the
Treatment of Parkinson's Disease
 Deep brain stimulation (DBS) is
approved in the United States by the
Food and Drug Administration for the
treatment of Parkinson's.[*] DBS carries
the risks of major surgery, with a
complication rate related to the
experience of the surgical team.

[*] U.S. Department of Health and Human Services.

FDA approves implanted brain stimulator to control tremors.
Retrieved October 18, 2006.

Insertion of electrode during surgery

Thalamotomy and
Pallidotomy
Table 1. Summary Comparison of Treatments*

Procedure Advantages Disadvantages

Levodopa Drug Non-invasive treatment. Rigidity Loses effectiveness after
Combinations and bradykinesia are prolonged use. Levodopa-induced
dramatically improved motor complications arise.

Pallidotomy Immediate Effects. Can improve Risk of hemorrhage, irreversible

  levodopa-induced dyskinesia. procedure. Long term results
  Improves bradykinesia and unknown. Safety of bilateral
rigidity. procedure undefined.

Thalamotomy Same as pallidotomy, but Risk of hemorrhage, irreversible

targeted for the improvement of procedure. Bilateral procedure can
tremor cause speech problems.
Tissue implants Reduction, or possible Long term results are unknown.
discontinuation of levodopa use. Risk of infection and rejection.
Chronic Pallidal/ Immediate improvement. Long term results are unknown.
Thalamic Bilateral stimulation possible. Batteries must be replaced. Not
Stimulation Reversible procedure. yet covered by health insurance.
(implantable
electrodes)

* Krauss JK, Jankovic J. Surgical Treatment of Parkinson's Disease. American Family Physician 1996; 54:1624.
 Bibliografie
• Farmacologie, D.A.Harchevici, Chișinău 2009
• Textbook Of Medical Physiology (Guyton 11th ed)
• Lippincott's Pharmacology, ed.2009
• Rang and Dales Pharmacology 6th Ed, 2007
• Neurosurgical Treatment of Movement Disorders, Isabelle M.
Germano