Thursday, November 27, 2014

Parkinson's Disease

Dictionary Meaning -
(according to Dorland's pocket medical Dictionary)

Parkinsonism - a group of neurological disorders marked by hypokinesia, tremor, and muscular rigidity, including the parkinsonian syndrome and parkinson disease.

Pathological Point Of View -
  • The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown. 
  • Early in the course of the disease, the most obvious symptoms are movement-related; these include shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, thinking and behavioral problems may arise, with dementia commonly occurring in the advanced stages of the disease, whereas depressionis the most common psychiatric symptom. Other symptoms include sensory, sleep and emotional problems. 
  • Parkinson's disease is more common in older people, with most cases occurring after the age of 50.
  • The main motor symptoms are collectively called parkinsonism, or a "parkinsonian syndrome". Parkinson's disease is often defined as a parkinsonian syndrome that is idiopathic (having no known cause), although some atypical cases have a genetic origin. 
  • Many risk and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers. 
  • Lewy bodies are the pathological hallmark of the idiopathic disorder, and the distribution of the Lewy bodies throughout the Parkinsonian brain varies from one individual to another. 
  • The anatomical distribution of the Lewy bodies is often directly related to the expression and degree of the clinical symptoms of each individual. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation.
  • Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use of levodopa and dopamine agonists
  • As the disease progresses and dopaminergic neurons continue to be lost, these drugs eventually become ineffective at treating the symptoms and at the same time produce a complication called dyskinesia, marked by involuntary writhing movements. 
  • Diet and some forms of rehabilitation have shown some effectiveness at alleviating symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. 
  • Research directions include investigations into new animal models of the disease and of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.
  • The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817. Several major organizations promote research and improvement of quality of life of those with the disease and their families. Public awareness campaigns include Parkinson's disease day (on the birthday of James Parkinson, 11 April) and the use of a red tulip as the symbol of the disease. People with parkinsonism who have increased the public's awareness of the condition include actor Michael J. Fox, Olympic cyclist Davis Phinney, and professional boxerMuhammad Ali. Parkinson's not only affects humans, but other primates as well, which have often been used in researching the disease and testing approaches to its treatment.
Causes :-

Pathophysiology :-

Signs & Symptoms :-

Classification :-
Parkinsonian syndromes can be divided into four subtypes according to their origin —
  1. primary or idiopathic
  2. secondary or acquired
  3. hereditary parkinsonism, and
  4. Parkinson plus syndromes or multiple system degeneration.

I. Drug-induced Parkinsonism

  • Side effects of some drugs, especially those that affect dopaminelevels in the brain, can actually cause symptoms of Parkinsonism.
  • Although tremor and postural instability may be less severe, this condition may be difficult to distinguish from Parkinson’s disease.
  • Medications that can cause the development of Parkinsonism include:
    • Antipsychotics
    • Metaclopramide
    • Reserpine
    • Tetrabenazine
    • Some calcium channel blockers
    • Stimulants such as amphetamines and cocaine
    • Usually after stopping those medications Parkinsonism gradually disappears

II. Progressive Supranuclear Palsy (PSP)

  • PSP is one of the more common forms of atypical Parkinsonism.
  • Symptoms of PSP usually begin after age 50 and progress more rapidly than PD.
  • These symptoms include: imbalance, frequent falls, rigidity of thetrunk, voice and swallowing changes and (eventually) eye-movement problems including the ability to move eyes up and down.
  • Dementia develops later in the disease. There is no specific treatment for PSP.
  • Dopaminergic medication treatment is often tried and may provide some benefit.
  • Other therapies such as speech therapy, physical therapy, andantidepressants are important for management of patients with PSP.
  • No laboratory/brain scan testing exists for PSP. In rare cases, some patients may have shrinking of a particular part of the brain, called the “Pons”, which can be seen on an MRI of the brain.

III. Corticobasal Degeneration (CBD)

  • CBD is the least common of the atypical causes of Parkinsonism
  • CBD develops after age 60 and progresses more rapidly than PD.
  • The initial symptoms of CBD include asymmetric bradykinesia, rigidity, limb dystonia, postural instability, and disturbances of language.
  • There is often marked and disabling apraxia of the affected limb, where it becomes difficult or impossible to control the movements of the affected limb even though there is no weakness or sensory loss.
  • No laboratory/brain scan tests exist to confirm the diagnosis of CBD. CBD is a clinical diagnosis.
  • There is no specific treatment for CBD.
  • Supportive treatment such as botulinum toxin (Botox) for dystonia, antidepressants, speech and physical therapy may be helpful.
  • Levodopa and dopamine agonists (common PD medications) seldom help.

IV. Multiple System Atrophy (MSA)

  • MSA is a larger term for several disorders in which one or more system in the body deteriorates.
  • Included in the category of MSA are: Shy-Drager syndrome (DSD), Striatonigral degeneration (SND) and OlivoPontoCerebellar Atrophy (OPCA).
  • The mean age of onset is in the mid-50s.
  • Symptoms include: bradykinesia, poor balance, abnormal autonomic function, rigidity, difficulty with coordination, or a combination of these features.
  • Initially, it may be difficult to distinguish MSA from Parkinson’s disease, although more rapid progression, poor response to common PD medications, and development of other symptoms in addition to Parkinsonism, may be a clue to its diagnosis.
  • No laboratory/brain scan testing exists to confirm the diagnosis of MSA.
  • Patients respond poorly to PD medications, and may require higher doses than the typical PD patient for mild to modest benefits.

V. Vascular Parkinsonism

  • Multiple small strokes can cause Parkinsonism.
  • Patients with this disorder are more likely to present with gait difficulty than tremor, and are more likely to have symptoms that are worse in the lower part of the body.
  • Some will also report the abrupt onset of symptoms or give a history of step-wise deterioration (symptoms get worse, then plateau for a period).
  • Dopamine is tried to improve patients’ mobility although the results are often not as successful. 
  • Vascular Parkinsonism is static (or very slowly progressive) when compared to other neurodegenerative disorders.

VI. Dementia with Lewy bodies (DLB)

  • DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration.
  • Patients with DLB usually have early dementia, prominent hallucinations, fluctuations in cognitive status over the day, and Parkinsonism.
  • Cognitive changes in patients with DLB include deficits in attention, executive function (problem solving, planning) and visuospacial function (the ability to produce and recognize figures, drawing or matching figures).
  • There are no known therapies to stop or slow the progression of DLB.
Management :-

Treatment in Homoeopathy :-
One Single Simple Drug Substance In Its Most Suitable Potency, According To Symptom Similarity Based On Totality! "

In Case Of Parkinson's Disese, List Of Useful Remedies (According To REPERTORY
by Oscar E. BOERICKE, M.D.) Are As Below-

Agitans -- Agar., Ars., Aur. sul., Avena, Bufo, Camph. monobr., Can. ind., Cocaine, Cocc., Con., Dub., Gels., Helod., Hyos., Hyosc. hydrobr., Kali br., Lathyr., Lolium, Mag. p., Mang. ac., Merc. s., Merc., Nicotine, Phos., Physos., Plumb., Scutel., Tab., Tar. h., Zinc. cy., Zinc. picr.

Some Examples Are :-


Weakness of limbs, trembling of extremities, especially hands. Paralytic agitans. Lacerating pain in joints. Cold and clammy sweat on limbsOily perspiration.Tremors everywhere in body. Weakness with trembling from least exertion. All symptoms are aggravated at night, warmth of bed, Damp, cold, rainy weather and during perspiration. Complaints increase during sweating and rest. All symptoms always associated with weariness, prostration and trembling.
Slow in answering questions. Memory weakened and loss of will power. Skin alwaysmoist and freely perspiring. Itching worse warmth of bed.
Violent trembling (twitching) of the whole body especially after emotions. Twitching in children. Chorea.  Paralysis of hands and feet. Trembling of hands while writing. Lameness, weakness, trembling and twitching of various muscles. Feet in continued motion, cannot keep still. Worse touch, between 5-7 pm., after dinner, better eating, discharges.
When the tremors start with pain which is relieved by motion. There is stiffness of the parts affected. Numbness and formication, after overwork and exposure. Paralysis; trembling after exertion. Limbs stiff and paralysed.All joints hot and painful. Crawling and tingling sensation in the tips of fingers. Worse during sleep, cold, wet rainy weather and after rain, night, during rest, drenching and when lying on back or right side. Better warm, dry weather, motion, walking, change of position, rubbing, stretching out limbs.
Centers its action on nervous system, causing various degrees of motor paralysis…Dizziness, drowsiness, dullness and trembling are the hallmark of this remedy. Trembling ranks the highest in this remedy, weakness and paralysis, especially of the muscles of the head. Paralysis of various groups of muscles like eyes, throat, chest, sphincters and extremities. Head remedy for tremors. Mind sluggish and muscular system relaxed. Staggering gait. Loss of power of muscular control. Cramps in muscles of forearm. Excessive trembling and weakness of all limbs. Worse by dampness, excitement, bad news. Better by bending forwards, profuse urination, continued motion and open air.
Argentum Nitricum
It is complimentary to Gelsemium. Memory impaired; easily excited and angered; flatulence and greenish diarrhea.Inco-ordination, loss of control and imbalance with trembling and general debility. Paralysis with mental and abdominal symptoms. Rigidity of calves. Walks and stands unsteadily. Numbness of body. Specially arms.
Agaricus Muscarius
Trembling, itching and jerking, stiffness of muscles; itching of skin over the affected parts and extreme sensitiveness of the spine. Cannot bear touchJerking and trembling are strong indications. Chorea and twitching ceases during sleep. Paralysis of lower limbs with spasmodic conditions of arms. Numbness of legs on crossing them. Paralytic pain in left arm followed by palpitation. Stiffness all over with pain over hips.
Head trembles while eating and when it is raised higher. Knees sink down from weakness. Totters while walking with tendency to fall on one side. Cracking of the knee when moving. Lameness worse by bending. Trembling and pain in limbs. One-sided paralysis worse after sleep. Intensely painful, paralytic drawing. Limbs straightened out and painful when flexed.
It shows special affinity for light haired females especially during pregnancy.
Tremors of the upper extremities with paralytic weakness of the lower limbs. Feels as if limbs are hard and contracted; limbs feel heavy. Feels as if floor is irregular and is obliged to keep his eyes on the ground to guide his feet. Affects the lateral and anterior columns of cord. Does not produce pain. Reflexes always increased. Lateral sclerosis and Infantile paralysis. Finger tips numb. Tremuloustottering gait. Excessive rigidity of legs with spastic gait. Knees knock against each other while walking. Cannot extend or cross legs when siting.Stiff and lame ankles.
Marked fibrillary tremors and spasms of the muscles, worse from motion or application of cold water. Palpitation and fluttering of the heart felt throughout the body. Depresses the motor and reflex activity of the cord and causes the loss of sensibility to pain, muscle weakness and paralysis.  Paralysis and tremors, chorea. Meningeal irritation with rigidity of muscles. Pain in right popliteal space. Burning and tingling in spine. Hands and feet numb with sudden jerking of limbs on going to sleep. Crampy pain in limbs.
Ambra Grisea
Tremors with numbness, limbs go to sleep on the slightest movement, coldness and stiffness of limbs. The finger nails become brittle and are shriveled. Cramps in hands and fingers. Worse grasping anything. Cramps in legs. Extreme nervous hypersensitiveness. Dread of people and desire to be alone. Music causes weeping. One sided complains call for it.
Trembling along nerves in limbs. Tired feeling, very weak and nervous, fainting, numb sensation. It causes locomotor ataxia. The eyes become more prominent and corneal opacities visible. Very depressed and sensation as if would fall on right side. Sensationas if walking on sponge. As if the feet were swollen. When walking, lifts feet higher than usual and puts down heel hard. Stretching relieves pains in muscles and limbs.
Trembling; shaking of hands, involuntary. Paralysis agitans. Cramps in calves, feet very tender. Twitching, Chorea, cramps. Numbness of finger tips. Worse right side, cold, touch, night. Better warmth, bending double, pressure and friction.
Bufo Rana
Special action on nervous system. Painful paralysis. Pain in loins, numbness and cramps. Staggering gait. Feels as if a peg is driven into joints. Worse—Warm room. Better bathing or cold air. Putting feet in cold water.
Remarkable nervous phenomena. Chorea, extreme restlessness and Paralysis agitans.Must keep in constant motion even though walking aggravates. Numbness of legs with twitching and jerkings.Extraordinary contractions and movements.
Plumbum Metalicum
Paralytic agitans. Paralysis of single muscles. Cannot raise or lift anything. Extension is difficult. Paralysis from over-exertion of extensor muscles in piano players. Wrist drop. Loss of patellar reflex. Pain in right big toe at night. Hands and feet cold. Infantile paralysis and neuritis.
Heavy, weary and paralyzed limbs. Trembling and unsteady hands. Muscular weakness especially of lower extremities. Perspiration of hands. Putting feet on chair relieves.Ascending paralysis ending in death by failure of respiration. Worse by lying down, turning or rising in bed, cold, exertion. Better by darkness, limbs hanging down, motion, pressure.
For More Details :-

1 comment:

  1. hello - thanks for the above. going through the systoms it seems that most of what is prescribed is for classic parkinsons. I am looking for something for vascular parkinsons - something for freezing when walking, shuffling feet, problems with gait, day sleepiness, constipation, cold hands, mouth open, angry when irritated. thanks so much for any advice. siobhan