boala parkinson

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

Insertion of electrode during surgery

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.

Thalamotomy and Pallidotomy

Procedure Advantages DisadvantagesLevodopa Drug Combinations

Non-invasive treatment. Rigidity and bradykinesia are dramatically improved

Loses effectiveness after prolonged use. Levodopa-induced motor complications arise.

Pallidotomy

Immediate Effects. Can improve levodopa-induced dyskinesia. Improves bradykinesia and rigidity.

Risk of hemorrhage, irreversible procedure. Long term results unknown. Safety of bilateral procedure undefined.

Thalamotomy Same as pallidotomy, but targeted for the improvement of tremor

Risk of hemorrhage, irreversible procedure. Bilateral procedure can cause speech problems.

Tissue implants Reduction, or possible discontinuation of levodopa use.

Long term results are unknown. Risk of infection and rejection.

Chronic Pallidal/ Thalamic Stimulation (implantable electrodes)

Immediate improvement. Bilateral stimulation possible. Reversible procedure.

Long term results are unknown. Batteries must be replaced. Not yet covered by health insurance.

* Krauss JK, Jankovic J. Surgical Treatment of Parkinson's Disease. American Family Physician 1996; 54:1624.

Table 1. Summary Comparison of Treatments*

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