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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.


Po sitro n - e m issio n to m o g ra p h ic sca n o f th e b ra in
sh o w in g th e d iffe re n ce in flu o ro d o p a ( FD O PA ) le ve ls
b e tw e e n th o se w ith a n d w ith o u t Pa rkin so n 's d ise a se .
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
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
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
tes by the Food and Drug Administration for the treatment of Parkinson's.[*] DBS ca
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 prolonged
Combinations and bradykinesia are dramatically use. Levodopa-induced motor
improved 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 targeted Risk of hemorrhage, irreversible


for the improvement of tremor procedure. Bilateral procedure can
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. Bilateral Long term results are unknown.
Thalamic stimulation possible. Reversible Batteries must be replaced. Not yet
Stimulation procedure. 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