Parkinson

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Parkinsons Disease

• Busra Berika Yucel
• Columbia University Medical Center / Neurological
  Institute

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History of Parkinsons Disease

• Parkinsons disease was first described by James
  Parkinson in his Essay on the Shaking Palsy in
  1817. James Parkinson was a physician and surgeon
  practicing in London. In his words, shaking
  palsy, which we call Parkinsons now, was
  described as

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Shaking Palsy

• Involuntary tremulous motion, with lessened
  muscular power, in parts not in action and even
  when supported with a propensity to bend the
  trunk forwards, and to pass from a walking to
  running pace the senses and intellect being
  injured.
• James Parkinson

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Symptoms

• By looking at his article we can clearly say
  that the main symptoms of the disease are -
  Tremor - Stiffness (rigidity) - Bradykinesia
  (slowness of bodily movement)

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Tremor

• It is the symptom which usually first comes to
  patients attention.
• Typically, tremor occurs when the affected hand
  or foot is at rest.
• It disappears during sleep or when the patient is
  resting quietly.
• Nervousness and being under stress enhances the
  tremor.

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Bradykinesia

• Muscular rigidity slows movement.
• Loss of automatic movements- swinging arms
  while walking- eye blinking- expressive
  movements of the
• face and hands

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Stiffness (rigidity)

• There is often a regular, jerky quality to the
  resistance as if there was a ratchet gear or
  cogged wheel in the joint being manipulated.
• Physicians call this as cogwheel rigidity

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Symptoms (cont.)

• Other symptoms of disease include- tendency to
  stand in a
• stooped posture- walking with short,
  shuffling
• steps- change in tone- decrease in facial
  expressions- memory problems

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Other signs

• While they are writing, their writing goes
  upwards instead of straight.
• Lose their face expression
• Decreased tone while talking
• They have difficulty with swallowing. Their food
  might accidentally go to trachea
• Personality changes
• There is difficulty with turning in bed
• There is drooling day night
• Stoop position, not swinging arms while walking
• While driving, they might make a big swipe turn
  to left, and small turn to right (which may cause
  an accident)
• Eyes may stare at one point

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Cause

• There is not a clear answer for the cause of the
  disease, but its known to be related to a
  chemical substance called dopamine.

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Dopamine

• Dopamine is a chemical naturally produced in the
  body. In the brain, dopamine functions as a
  neurotransmitter, activating dopamine receptors.
• Since dopamine cannot cross the blood-brain
  barrier, dopamine given as a drug does not
  directly affect the central nervous system.
• Shortage of dopamine, particularly the death of
  dopamine neurons in the nigrostriatal pathway,
  causes Parkinson's disease, in which a person
  loses the ability to execute smooth, controlled
  movements.

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Michael J. Fox

• Michael J. Fox was diagnosed with Parkinsons in
  1991, when he was 30.
• He has the biggest foundation of Parkinsons
  disease research, which is Michael J. Fox
  Foundation for Parkinson's Research

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Muhammad Ali

• He had signs of decreasing motor skills during a
  fight against Larry Holmes in 1980.
• It was noted that his illness was probably
  brought on by repetitive head trauma.
• There is a Muhammad Ali Parkinson Research Center
  at Barrow Neurological Institute

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Treatments

• Surgery
• Surgery may be used to control symptoms of
  Parkinson's disease and improve the quality of
  life when medication ceases to be effective or
  when medication side effects, such as jerking and
  dyskinesias, become intolerable.
• Only about 10 of Parkinson's patients are
  estimated to be suitable candidates for surgery.

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Treatments (cont.)

• Medication
• Medication could also be used as a treatment of
  Parkinsons Disease. The main medicine to treat
  Parkinsons is Sinemet. Sinemet is a combination
  of Carbidopa and Levadopa. (Levodopa is a prodrug
  that is converted to dopamine by DOPA
  decarboxylase and can cross the blood-brain
  barrier)
• But there are some side effects of Sinemet it
  might have reactions with proteins, such as milk
  and milk products might lead to some involuntary
  activities when it is not used in the right dose
  and it also causes tendency to sleep.

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Current Research about Parkinsons Disease

• There is a research being done about stem cell
  therapy, where you inject dopamine to stem cells.
  Since stem cells are part of the nervous system,
  it is suppose to effect directly to brain.
• Doing exercise is also being research it seems,
  it helps Parkinsons patients to lose some of
  their symptoms.

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References

• Parkinsons Disease Roger C. Duvoisin, M.D
• www.parkinson.org
• http//menshealth.about.com/od/diseases/f/parkinso
  n_nine.htm
• http//neurologicalillness.suite101.com/article.cf
  m/muhammad_alis_fight
• http//www.maprc.com
• http//www.neurologychannel.com/parkinsonsdisease/
  surgery.shtml
• http//www.3dchem.com/molecules.asp?ID289

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Acknowledgements

• Dr. Karen Bell
• Dr. Lucien Cote
• CUMC
• HCS staff
• Dr. Sat
• Audience

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Any questions ?