Parkinson resident survival guide: Difference between revisions
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*The cause of [[Parkinson's disease]] is a [[dopamine]] depletion due to a [[necrosis]] of [[Dopaminergic neuron|dopaminergic neurons]] in the [[substantia nigra]]. | *The cause of [[Parkinson's disease]] is a [[dopamine]] depletion due to a [[necrosis]] of [[Dopaminergic neuron|dopaminergic neurons]] in the [[substantia nigra]]. | ||
*Factors that may contribute to the | *Factors that may contribute to the development of [[Parkinson's disease]] are: | ||
**Low [[norepinephrine]] levels | **Low [[norepinephrine]] levels | ||
**The presence of [[Lewy bodies]] | **The presence of [[Lewy bodies]] | ||
| Line 23: | Line 23: | ||
==Diagnosis== | ==Diagnosis== | ||
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020">{{cite journal|last1=Marino|first1=Bianca L.B.|last2=de Souza|first2=Lucilene R.|last3=Sousa|first3=Kessia P.A.|last4=Ferreira|first4=Jaderson V.|last5=Padilha|first5=Elias C.|last6=da Silva|first6=Carlos H.T.P.|last7=Taft|first7=Carlton A.|last8=Hage-Melim|first8=Lorane I.S.|title=Parkinson’s Disease: A Review from Pathophysiology to Treatment|journal=Mini-Reviews in Medicinal Chemistry|volume=20|issue=9|year=2020|pages=754–767|issn=13895575|doi=10.2174/1389557519666191104110908}}</ref><br><br> | Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020">{{cite journal|last1=Marino|first1=Bianca L.B.|last2=de Souza|first2=Lucilene R.|last3=Sousa|first3=Kessia P.A.|last4=Ferreira|first4=Jaderson V.|last5=Padilha|first5=Elias C.|last6=da Silva|first6=Carlos H.T.P.|last7=Taft|first7=Carlton A.|last8=Hage-Melim|first8=Lorane I.S.|title=Parkinson’s Disease: A Review from Pathophysiology to Treatment|journal=Mini-Reviews in Medicinal Chemistry|volume=20|issue=9|year=2020|pages=754–767|issn=13895575|doi=10.2174/1389557519666191104110908}}</ref><br><br> | ||
<br> | |||
{{Family tree/start}} | {{Family tree/start}} | ||
{{ | {{familytree | | | | | | | | A01 |A01=Prodromal period }} | ||
{{ | {{familytree | | | | |,|-|-|-|-|^|-|-|-|-|.| | | }} | ||
{{familytree | | | B01 | | | | | | | | | B02 | | |B01='''Possible early symptoms of Parkinson disease''' | |||
<br>• Rapid eye movement sleep behavior disorder | |||
<br>• Autonomic symptoms (eg, constipation, orthostatic hypotension) | |||
{{ | <br>• Hyposmia |B02='''Family history''' | ||
<br>• First-degree relative with Parkinson disease | |||
<br>• Known Parkinson disease gene mutation in family }} | |||
{{familytree | | | | |`|-|-|-|-|v|-|-|-|-|'| }} | |||
{{ | {{familytree | | | | B01 | | | B02 | | | B03 | |B01='''Physical examination''' <br>Findings must include | ||
{{ | <br>• Bradykinesia | ||
<br>• Rigidity and/or tremor <br>Findings may include | |||
<br>• Hypophonia | |||
<br>• Micrographia | |||
{{ | <br>• Decreased arm swing | ||
<br>• Short step length|B02='''Patient medical history''' <br>Symptoms may include | |||
<br>• Slowness | |||
<br>• Tremor | |||
{{Family tree/end}}<br> | <br>• Gait changes | ||
<br>• Soft voice | |||
<br>• Decreased facial expression | |||
<br>• Depression and/or anxiety |B03='''Other factors''' <br>• Dopamine transporter single-proton emission computed tomography imaging findings | |||
<br>• Genetic data }} | |||
{{familytree | | | | |`|-|-|-|-|v|-|-|-|-|'| }} | |||
{{Family tree/end}}<br><br> | |||
==Treatment== | ==Treatment== | ||
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines. | Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines. | ||
Revision as of 03:11, 27 January 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Moises Romo, M.D.
Synonyms and keywords:Parkinson's disease management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment
Overview
Parkinson's disease is a degenerative movement disorder of the central nervous system. It is characterized by motor symptoms such as bradykinesia, rigidity, and tremor, but also cognitive and comunicative symptoms such as facial masking and dysarthria. These primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine. Diagnosis is mainly clinical, it may be supported by MRI findings and dopamine transporter single-photon emission computed tomography (DaT SPECT), but definitive diagnosis is made by autopsy. The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion. Other therapies will depend on comorbidities.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Parkinson's disease is not a life-threatening condition that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- The cause of Parkinson's disease is a dopamine depletion due to a necrosis of dopaminergic neurons in the substantia nigra.
- Factors that may contribute to the development of Parkinson's disease are:
- Low norepinephrine levels
- The presence of Lewy bodies
- Autoimmune factors
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Parkinson's disease according to the American Academy of Neurology guidelines:[1]
| Prodromal period | |||||||||||||||||||||||||||||||||||
| Possible early symptoms of Parkinson disease
• Hyposmia | Family history
• Known Parkinson disease gene mutation in family | ||||||||||||||||||||||||||||||||||
| Physical examination Findings must include
• Short step length | Patient medical history Symptoms may include
• Depression and/or anxiety | Other factors • Dopamine transporter single-proton emission computed tomography imaging findings • Genetic data | |||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Use levodopa preparations, dopamine agonists, and monoamine oxidase-B (MAO-B) inhibitors initially for motor symptoms.[1]
- Be aware of cognitive impairment and other side effects when using anticholinergic agents in young people.[2]
- Prescribe an appropriate exercise regimen at the time of diagnosis and throughout the disease.[1]
- Use deep brain stimulation and other surgical approaches when individuals with Parkinson disease experience either the “wearing off” phenomenon or dyskinesias that do not respond to medication.[1]
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 1.2 1.3 Marino, Bianca L.B.; de Souza, Lucilene R.; Sousa, Kessia P.A.; Ferreira, Jaderson V.; Padilha, Elias C.; da Silva, Carlos H.T.P.; Taft, Carlton A.; Hage-Melim, Lorane I.S. (2020). "Parkinson's Disease: A Review from Pathophysiology to Treatment". Mini-Reviews in Medicinal Chemistry. 20 (9): 754–767. doi:10.2174/1389557519666191104110908. ISSN 1389-5575.
- ↑ Fox, Susan H.; Katzenschlager, Regina; Lim, Shen-Yang; Barton, Brandon; de Bie, Rob M. A.; Seppi, Klaus; Coelho, Miguel; Sampaio, Cristina (2018). "International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease". Movement Disorders. 33 (8): 1248–1266. doi:10.1002/mds.27372. ISSN 0885-3185.