Parkinson's Disease

Parkinson 's disease is a degenerative disease of the nervous system , characterized by tremors at rest , difficulty to initiate the movement and muscle stiffness .

Parkinson's affects about 1 out of 250 people aged over 40 years and about 1 in 100 people aged over 65 years .

CAUSE

Deep inside there is an area of the brain called the basal ganglia .
If the brain commands an activity ( eg, lifting the arm ) , the nerve cells in the basal ganglia will help soften the movement and regulating changes in posture .

Basal ganglia signal processing and delivering the message to the thalamus , which will convey the information that has been processed back to the cerebral cortex .

Overall the signals delivered by chemical neurotransmitters as electrical impulses along nerve pathways and between nerves .

Primary neurotransmitter is dopamine in the basal ganglia .

In Parkinson's disease , nerve cells in the basal ganglia deteriorated resulting in the formation of dopamine is reduced and relations with other nerve cells and muscles are also less.
The cause of the deterioration and loss of dopamine nerve cells is usually not known .
It appears that genetic factors do not play a major role , although the disease tends to be lowered .

Sometimes the cause is unknown .

In some cases , Parkinson's is a very advanced complications of encephalitis due to the virus ( an infection that causes inflammation of the brain ) .

Another case occurs if other degenerative diseases , drugs or toxins affect or hinder the work of dopamine in the brain . For example, anti- psychosis medications are used to treat severe paranoia and schizophrenia inhibit the action of dopamine in nerve cells .

SYMPTOMS

Parkinson 's disease begins as a vague and slow to develop .

In many patients , the first appeared as Parkinson's tremors ( shaking ) when the hand is at rest , the tremors will be reduced if the hand is moved deliberately and disappear during sleep .

Emotional stress or fatigue may aggravate tremor .

At first tremor occurred on one hand , on the other hand will eventually , arms and legs . Tremor also be on the jaw , tongue , forehead and eyelids .

In one third of patients , tremor is not an early symptom ; in other tremor sufferers wane in line with the development of the disease and the rest had never experienced tremors .

Patients have difficulty in initiating a movement and muscle stiffness occur .
If the forearm bent backward or straightened out by others , the movement feels stiff .

Stiffness and immobility can cause muscle pain and fatigue .

Stiffness and difficulty in starting a movement can cause a variety of difficulties . Small muscles in the hand are often impaired , so that daily work ( eg, buttoning clothes and tying shoelaces ) more difficult.

Patients have difficulty in moving and often hobbled where his arm is not in accordance with the swinging stride .

If the patient has started to walk , they find it difficult to stop or turn around . His pace quickened so as to encourage them to run small so as not to fall .

Her posture becomes stooped and difficult to maintain a balance so that tends to fall forward or backward .

The patient's face becomes less expressive because the facial muscles to form expressions are not moving .

Sometimes reduced facial expression is mistaken for depression , although there are many people with Parkinson's who end up depressed .

The view looks empty with mouth open and his eyes rarely blink .
Patients often ileran or choking because of stiffness in the muscles of the face and throat causing difficulty swallowing .

Patients spoke very quietly and without accent ( monotonic ) and stutter because of difficulties in articulating his thoughts .
Most of the patients had normal intellectual , but there also are becoming senile .

Diagnosis

Diagnosis symptoms .

TREATMENT

Parkinson's disease can be treated with various drugs , such as levodopa , bromocriptine , pergolide , selegiline , anticholinergics ( benztropine or triheksifenidil ) , antihistamines , antidepressants , propranolol and amantadine .

None of these drugs that cure the disease or stop its development , but these drugs cause patients more easily perform a movement and prolong survival .

In the brain levodopa is converted into dopamine . These drugs reduce tremors and muscle stiffness and improve movement .

Patients with mild Parkinson's I went back to normal activities and the patient is bedridden before becoming independent again .

The basic treatment for Parkinson's is levodopa - carbidopa .

The addition of carbidopa is intended to improve the effectiveness of levodopa in the brain and to reduce the undesirable effects of levodopa outside of the brain .

Consuming levodopa over the years can cause movement of the tongue and lips are not dikehendakik , grinning face , head nodding and arms and legs spinning.

Some experts believe that adding or replacing levodopa with bromocriptine during the first years of treatment could delay the emergence of movements that are not desired .

Nerve cells producing dopamine from human fetal tissue transplanted into the brains of Parkinson's patients can improve chemical abnormalities but not yet enough data on these measures .

To maintain mobility , patients are encouraged to keep doing their daily activities as much as possible and follow a regular exercise program .
Physical therapy and the use of mechanical aids ( eg wheelchairs) can help people remain independent .

Foods rich in fiber can help overcome constipation due to lack of activity , dehydration and some medications .

Additional food and stool softeners can help facilitate defecation .
Feeding should be properly addressed because it can cause muscle stiffness sufferers have difficulty swallowing so can suffer from malnutrition ( malnutrition ) .

Medicines to treat Parkinson's disease

Obat	Aturan Pemakaian	Keterangan
Levodopa (dikombinasikan dengan karbidopa)	Merupakan pengobatan utama untuk Parkinson Diberikan bersama karbidopa untuk meningkatkan efektivitasnya & mengurangi efek sampingnya Mulai dengan dosis rendah, yg selanjutnya ditingkatkan sampai efek terbesar diperoleh	Setelah beberapa tahun digunakan, efektivitasnya bisa berkurang
bromokriptin atau pergolid	Pada awal pengobatan seringkali ditambahkan pada pemberianLevodopa untuk meningkatkan kerja Levodopa atau diberikan kemudian ketika efek samping Levodopa menimbulkan masalah baru	Jarang diberikan sendiri
Seleglin	Seringkali diberikan sebagai tambahan pada pemakaian Levodopa	Bisa meningkatkan aktivitas Levodopa di otak
Obat antikolinergik (benztropin & triheksifenidil), obat anti depresi tertentu, antihistamin (difenhidramin)	Pada stadium awal penyakit bisa diberikan tanpa Levodopa, pada stadium lanjut diberikan bersamaan dengan Levodopa, mulai diberikan dalam dosis rendah	Bisa menimbulkan beberapa efek samping
Amantadin	Digunakan pada stadium awal untuk penyakit yg ringan Pada stadium lanjut diberikan untuk meningkatkan efek Levodopa	Bisa menjadi tidak efektif setelah beberap bulan digunakan sendiri