Parkinson's syndrome

Parkinson's syndrome or hypokinetic-rigid or hypokinetic-hypertonic syndrome is one of the extrapyramidal syndromes and occurs when there is a nigrostriatal dopamine deficiency, when dopamine receptors are blocked or when the putamen is damaged.

There is damage to the substantia nigra (pars compacta) and a decrease in dopamine production. This causes a decrease in nigral neurons and a decrease in dopamine supply to the striatum. (nigrostriatal dopamine deficit)

Etiology

 * Primary – Parkinson's disease and other neurodegenerative diseases;
 * Secondary – drug, vascular, toxic, in metabolic diseases(Wilson's disease), endocrinopathy (Fahr's disease – hyperparathyroidism), post-traumatic (boxers), in normotensive hydrocephalus.

Clinical picture



 * Hypokinesia = reduction in range and amplitude of movements;
 * bradykinesia = slowed movement;
 * akinesia = difficulty starting movements;
 * hypomimia to amimia = mask-like facial expression;
 * micrography = shrinking of the font along the line;
 * walking = short steps, movements of the upper limbs are missing, hesitation, instability often appear;
 * speech = slow and monotonous, hushed;
 * rigidity = increased muscle tone in both the agonist and antagonist regions, more in the flexor muscle groups, which leads to a flexed posture of the body and limbs;
 * pulse = inability to maintain balance smoothly - the patient compensates for the deviated center of gravity by accelerating short steps forward or backward (propulsion, retropulse) until he catches a solid object or falls;
 * tremor = mainly resting, static.

Drug-induced parkinsonism
Drug-induced parkinsonism is caused by blocking dopamine receptors in the striatum. Most often caused by typical neuroleptics. It can be caused by atypical antipsychotics (haloperidol), antihistamines, antiemetics (thiethylperazine, promethazine), prokinetics (metoclopramide), antihypertensives (reserpine, alpha-methyldopa).

Treatment

 * Levodopa (L-3,4-dihydroxyphenylalanine).

Related articles

 * Extrapyramidal syndrome
 * Hyperkinetic extrapyramidal syndrome
 * Hypo- a hyperkinetick movement disorders/PGS
 * Surgical treatment of Parkinson's disease