موضوعنا اليوم عن #parkinson الشلل الرعاشِ اهم امراض الجهاز العصبي! 🧠 أُصاب فيه اشهر ملاكم في العالم 🥊 يلا نعرف تفاصيل المرض في هذا الثريد👇🏼
Parkinson disease الشلل الرعاشِ (PD) 👨🏼is a chronic, progressive movement disorder resulting from loss of dopamine in the brain, characterized by rigidity,bradykinesia, postural disturbances, and tremor
داء حركي ببسب فقد الدوبامين في الدماغ يظهر في شكل تصلب، بطء حركة وارتعاش
داء حركي ببسب فقد الدوبامين في الدماغ يظهر في شكل تصلب، بطء حركة وارتعاش
غالبا اعمار المصابين فيه من ٥٠ سنة ل٨٠ سنة 👨🏼👵🏻
PD develops insidiously and progresses slowly over many years (2) (symptoms of PD are progressive, within 10 to 20 years, significant immobility results for most pt )
PD develops insidiously and progresses slowly over many years (2) (symptoms of PD are progressive, within 10 to 20 years, significant immobility results for most pt )
Pathophysiology 🧠
The loss of dopamine producing neurons result in imbalance 🛑 between dopamine”an inhibitory neurotransmitter” and “excitatory neurotransmitter “ ACh ➡️ leads to an excess of excitatory ACh at the synapse, and consequent rigidity, tremors, and bradykinesia
The loss of dopamine producing neurons result in imbalance 🛑 between dopamine”an inhibitory neurotransmitter” and “excitatory neurotransmitter “ ACh ➡️ leads to an excess of excitatory ACh at the synapse, and consequent rigidity, tremors, and bradykinesia
Risk factors
👨🏼Age: 60 years of age or older
✅Genetics
Gender: Men more than women
🔘 Exposure to toxins: Ongoing exposure to herbicides and pesticides increases the risk of Parkinson's disease
👨🏼Age: 60 years of age or older
✅Genetics
Gender: Men more than women
🔘 Exposure to toxins: Ongoing exposure to herbicides and pesticides increases the risk of Parkinson's disease
الأسباب:
No causes yet, it's believed that combination of genetic changes and environmental factors may be contribute to the PD
Other causes of parkinsonism: 🧠👋🏻
"Parkinsonism" is term used to describe the symptoms of tremors, muscle rigidity and slowness of movement
No causes yet, it's believed that combination of genetic changes and environmental factors may be contribute to the PD
Other causes of parkinsonism: 🧠👋🏻
"Parkinsonism" is term used to describe the symptoms of tremors, muscle rigidity and slowness of movement
These include parkinsonism caused by:
💊 medications : some types of antipsychoti 🧠, usually improve once the medication is stopped
brain conditions : such as progressive supranuclear palsy, multiple systems atrophy and cortico-basal degeneration
CVD: series of small strokes
💊 medications : some types of antipsychoti 🧠, usually improve once the medication is stopped
brain conditions : such as progressive supranuclear palsy, multiple systems atrophy and cortico-basal degeneration
CVD: series of small strokes
Clinical presentation 🔍:
Motor symptoms : TRAP ❗️
T = Tremor at rest (“pill rolling”)
R = Rigidity (stiffness and cogwheel rigidity)
A = Akinesia or bradykinesia
P = Postural instability and gait abnormalities
Motor symptoms : TRAP ❗️
T = Tremor at rest (“pill rolling”)
R = Rigidity (stiffness and cogwheel rigidity)
A = Akinesia or bradykinesia
P = Postural instability and gait abnormalities
Non-motor Symptoms (SOAP)❗️
S=Sleep disturbances (insomnia restless legs syndrome)
O=Other miscellaneous symptoms (problems with nausea🤢 fatigue pain, dysesthesias, vision)
A=Autonomic symptoms(drooling constipation, sexual dysfunction urinary problems
P=Psychological symptoms
S=Sleep disturbances (insomnia restless legs syndrome)
O=Other miscellaneous symptoms (problems with nausea🤢 fatigue pain, dysesthesias, vision)
A=Autonomic symptoms(drooling constipation, sexual dysfunction urinary problems
P=Psychological symptoms
Diagnosis 🧑🏻🔬
clinical diagnosis requires the presence of 2 of 3 cardinal signs:
1- Bradykinesia (along with resting tremors and/or rigidity) 👋🏼
2- Prominent asymmetry
3-positive response to dopaminergic medications 💊
clinical diagnosis requires the presence of 2 of 3 cardinal signs:
1- Bradykinesia (along with resting tremors and/or rigidity) 👋🏼
2- Prominent asymmetry
3-positive response to dopaminergic medications 💊
Goal of therapy 🌟 💊
⬇️ to minimize symptoms, disability
and side effects while maintaining quality of life.
Education pt and caregivers, exercise, and proper nutrition are essential 🥗
⬇️ to minimize symptoms, disability
and side effects while maintaining quality of life.
Education pt and caregivers, exercise, and proper nutrition are essential 🥗
Non-pharmacological management
🏃♂️ Exercise and nutrition
🎤 Speech therapy
Psychological support
🧠 Deep brain stimulation: implantable device sends electrical signals
to the basal ganglia.
🏃♂️ Exercise and nutrition
🎤 Speech therapy
Psychological support
🧠 Deep brain stimulation: implantable device sends electrical signals
to the basal ganglia.
الخطة العلاجية 💊
🔘anticholinergic drugs
ADR: Confusion-Drowsiness to avoid it reduce dose ⬇️
🚫avoid in elderly, pt with a history of constipation, memory impairment & urinary retention
⚪️ Improve tremors & dystonic features
Used as monotherapy or with other medications.
🔘anticholinergic drugs
ADR: Confusion-Drowsiness to avoid it reduce dose ⬇️
🚫avoid in elderly, pt with a history of constipation, memory impairment & urinary retention
⚪️ Improve tremors & dystonic features
Used as monotherapy or with other medications.
🔘Carpidopa-levodopa products
ADR: Drowsiness -Dyskinesias -Nausea🤢
to avoid it Reduce dose ⬇️ Take it with food 🍱
🌟 The most effective drug available
L-dopa is absorbed in the proximal duodenum so ⬆️ high-protein meals can interfere with bioavailability
ADR: Drowsiness -Dyskinesias -Nausea🤢
to avoid it Reduce dose ⬇️ Take it with food 🍱
🌟 The most effective drug available
L-dopa is absorbed in the proximal duodenum so ⬆️ high-protein meals can interfere with bioavailability
Long-term, L-dopa
associated motor complications can be disabling.
The most common of these are “end-of-dose wearing off” and “peak-dose dyskinesias” Which can occur 5 to 6 months after starting
l-dopa, especially when excessive doses are used initially 💊
associated motor complications can be disabling.
The most common of these are “end-of-dose wearing off” and “peak-dose dyskinesias” Which can occur 5 to 6 months after starting
l-dopa, especially when excessive doses are used initially 💊
🔘Dopamine agonist
Used in pt with fluctuating responses to
L-dopa
❇️Decrease the “off” period
⭕️Bromocriptine: ergot derivative and should be avoided in pt with dementia or cognitive problems
Used in pt with fluctuating responses to
L-dopa
❇️Decrease the “off” period
⭕️Bromocriptine: ergot derivative and should be avoided in pt with dementia or cognitive problems
⭕️pramipexole, rotigotine, ropinirole:
non-ergot derivative which are safer and effective as monotherapy in mild to moderate
non-ergot derivative which are safer and effective as monotherapy in mild to moderate
✅Dopamine agonists are preferred in young pt because they develop motor fluctuations
❗️Carbidopa/l-dopa may be best in elderly since thery are experience psychosis and orthostatic hypotension from dopamine agonists
〽️Bromocriptine: not commonly used, risk of pulmonary fibrosis
❗️Carbidopa/l-dopa may be best in elderly since thery are experience psychosis and orthostatic hypotension from dopamine agonists
〽️Bromocriptine: not commonly used, risk of pulmonary fibrosis
⭕️Pramipexole needs adjusted in renal insufficiency
fluoroquinolones and smoking 🚬 may alter ropinirole clearance ❕
Apomorphine is a nonergot dopamine subcutaneous “rescue” injection, it triggers the “on” response
fluoroquinolones and smoking 🚬 may alter ropinirole clearance ❕
Apomorphine is a nonergot dopamine subcutaneous “rescue” injection, it triggers the “on” response
🔘MAO-B inhibitors
ADR: Nausea 🤢Take with food 🍱
Agitation, confusion, Insomnia hypotension ▶️ Take early in day.
⬇️ dose
Selective, irreversible inhibitors of
MAO induce a “cheese reaction” 🧀(hypertension, headache) unless excessive amount of dietary tyramine is ingested.
ADR: Nausea 🤢Take with food 🍱
Agitation, confusion, Insomnia hypotension ▶️ Take early in day.
⬇️ dose
Selective, irreversible inhibitors of
MAO induce a “cheese reaction” 🧀(hypertension, headache) unless excessive amount of dietary tyramine is ingested.
❌MAO-B Contraindicated +meperidine or opioid analgesics
Selegiline: extends the “on” time of l-dopa up to 1 hou by blocking dopamine breakdown, which helps to ⬇️ decrease l-dopa dose
⬆️ the peak effects of l- dopa and worsen preexisting dyskinesias or psychiatric symptoms‼️
Selegiline: extends the “on” time of l-dopa up to 1 hou by blocking dopamine breakdown, which helps to ⬇️ decrease l-dopa dose
⬆️ the peak effects of l- dopa and worsen preexisting dyskinesias or psychiatric symptoms‼️
🔍Rasagiline: ⬆️enhances l-dopa effects & beneficial as monotherapy.
provide 1 hour of extra “on” time during the day.
It is considered a 🔘first- line agent for managing motor fluctuations of l-dopa.
provide 1 hour of extra “on” time during the day.
It is considered a 🔘first- line agent for managing motor fluctuations of l-dopa.
🔘Miscellaneous
ADR: Confusion/ Livedo reticularis/ Sedation Hallucinations to avoid it ⬇️Reduce dosage 🔺adjust dose for renal impairment
Modest benefit for tremor, rigidity, and bradykinesia, but often used for L- dopa-induced dyskinesia
ADR: Confusion/ Livedo reticularis/ Sedation Hallucinations to avoid it ⬇️Reduce dosage 🔺adjust dose for renal impairment
Modest benefit for tremor, rigidity, and bradykinesia, but often used for L- dopa-induced dyskinesia
🔘COMT inhibitors
ADR ❗️ Drowsiness /Dyskinesias /Nausea to avoid it ▶️ Reduce dose ✅ antidiarrheal agents
Tolcapone : -monitoring of liver function every 2–4 weeks for the first 6 months
limited use because of the fatal liver toxicity,
ADR ❗️ Drowsiness /Dyskinesias /Nausea to avoid it ▶️ Reduce dose ✅ antidiarrheal agents
Tolcapone : -monitoring of liver function every 2–4 weeks for the first 6 months
limited use because of the fatal liver toxicity,
🔺Used in conjunction with carbidopa/l-dopa to prevent the peripheral conversion of l-dopa to dopamine thus increasing the “on” time to almost 2 hours and decreasing l- dopa required dos
Avoid use of nonselective MAO inhibitors since it inhibits normal catecholamine metabolism.
🌟 Entacapone: first- line agent for managing motor fluctuations of l-dopa
🌟 Entacapone: first- line agent for managing motor fluctuations of l-dopa
Note: 🌟
Monotherapy usually begins with (MAO-B) inhibitor 🥇
Consider addition of (COMT) inhibitor if motor fluctuations develop to extend l-dopa duration of activity. Alternatively, consider addition of a MAO-B inhibitor or dopamine agonist
Monotherapy usually begins with (MAO-B) inhibitor 🥇
Consider addition of (COMT) inhibitor if motor fluctuations develop to extend l-dopa duration of activity. Alternatively, consider addition of a MAO-B inhibitor or dopamine agonist
initial treatment in early Parkinson’s disease‼️Therapy with two or more antiparkinsonian drugs may be necessary as the disease
progresses.
Most pt eventually require levodopa and subsequently develop motor complications. 🧠
progresses.
Most pt eventually require levodopa and subsequently develop motor complications. 🧠
👨🏻⚕️Evaluation of therapeutic outcome
monitoring is essential to achieve desired outcomes
Educate pt, caregivers about medication doses. administration times and duration of on and off periods متابعة الخطة العلاجية وتثقيف المرضى ومقدمي الرعاية في جرعات الدواء فترة الاعطاء والتوقف
monitoring is essential to achieve desired outcomes
Educate pt, caregivers about medication doses. administration times and duration of on and off periods متابعة الخطة العلاجية وتثقيف المرضى ومقدمي الرعاية في جرعات الدواء فترة الاعطاء والتوقف
🔍 Monitor symptoms, SE، activities of daily living, individualize therapy
Concomitant med that may worsen motor symptoms, memory, falls, or behavioral symptoms should be discontinued if possible
ايقاف الادوية التي تفاقم الاعراض الحركية او الذاكرة او الاعراض السلوكية 🧠
Concomitant med that may worsen motor symptoms, memory, falls, or behavioral symptoms should be discontinued if possible
ايقاف الادوية التي تفاقم الاعراض الحركية او الذاكرة او الاعراض السلوكية 🧠
🌟 حابين نقدم شكر لأعضاء فريق جرعة ترياق ككل وشكر خاص لكتابة المحتوى
1-: Rashed Aldausari @4RASDAU
2-: Ghaida Aldajani @ghaiiiiiida
3- Hashim Halawani @hashim_halawani
4-: Abdullah AL-Duayrim: @Abdullah_PharmD
1-: Rashed Aldausari @4RASDAU
2-: Ghaida Aldajani @ghaiiiiiida
3- Hashim Halawani @hashim_halawani
4-: Abdullah AL-Duayrim: @Abdullah_PharmD
5-: Rahaf alghamdi @Rahaf_M_G
6-: Asma Asiri
7 : Alanoud Alherz @Alanoud042
8: Esra Gabr @Esragabr
10-: Lama alguraini @lama_lab
6-: Asma Asiri
7 : Alanoud Alherz @Alanoud042
8: Esra Gabr @Esragabr
10-: Lama alguraini @lama_lab
والاشراف على المحتوى العلمي وتخطيطه:
بقيادة
@drantisaad د.سعد
ونائبيه :
@morooj_3 د.مروج
@heroxide د.خزنه سعد
بقيادة
@drantisaad د.سعد
ونائبيه :
@morooj_3 د.مروج
@heroxide د.خزنه سعد
وفريق دار تجهيز الثريد
بقيادة بدور @ibodor_
اعضائها:
ساره @saraaal9_
محمد @mbashammakh96
وبأشراف :
د.رنا الشمري @rana_alshlagy
بقيادة بدور @ibodor_
اعضائها:
ساره @saraaal9_
محمد @mbashammakh96
وبأشراف :
د.رنا الشمري @rana_alshlagy
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