Text Book Reading

PARKINSON DISEASE : Management in on-off

phase

Pembimbing:
dr . Untung, Sp.S
Disusun oleh:
Alif Budiyani A
1410221142
FAKULTAS KEDOKTERAN UPN VETERAN
JAKARTA
KEPANITERAAN KLINIK DEPARTEMEN SARAF
DALAM RUMAH SAKIT MARGONO SEOKARJO
PERIODE

Definition
Parkinsons Disease is a progressive
neurodegenerative
disorder
characterized
by
bradykinesia,
tremor at rest, and rigidity

Classification

Duus Topical Diagnosis Neurology,

2011

Sign and Symptom

They affect the
craniofacialmuscul
ature to produce a
masklike facies
(hypomimia),
defective mouth
closure, reduced
blinking,
dysphagia,
salivation
(drooling),

Elevated muscle tone

of fine as
is Impairment
felt by the patient
motor control
muscle
tensionimpairs
or
activities
of by
daily
spasm and
theliving
such as as
fastening
examiner
increased
buttons,to
writing
resistance
passive
(micrographia),
movement
across the
eating with knife and

Postural changes include stooped posture, a mildly

flexed and adducted posture of the arms, and postural
instability or loss of balance. Related phenomena
include involuntary acceleration of the gait (festination),
difficulty in stopping walking, gait instability, and

Depression. The range of

depressive manifestations
includes worry, anxiety,
avoidance of social contact,
general unhappiness,
Anxiety.
Tension, worry,
listlessness
mental agitation, lack of
concentration, and dizziness
are relatively common
complaints.
The development of
dementia in PD is
correlated with an increase
in the number of Lewy
Blood pressure changes side effect of
bodies
antiparkinsonian medications

Constipation as a manifestation of the

disease, or as
a side effect of medication (anticholinergic

Patofisiologi
Loss of pigment in the
substantia nigra can be seen
macroscopically. The most
prominent neurochemical
abnormality is a deficiency
of dopamine in the
striatum,
Lewy bodies is an eosinophilic
intracytoplasmic inclusions in
neurons

patophysiology

diagnostic

Encyclopedi
a of
Gerantology,
2014

The higher the score the greater the

disease severity and disability
Early ilness 1- 10, Moderate 11- 20
Severe 21 - 30

 Screening Questionnaire
Have you been getting slower in your usual daily activities?
Is your handwriting smaller?
Is your speech slurred or softer?
Do you have trouble arising from a chair?
Do your lips, hand, arms and/or legs shake?
Have you noticed more stiffness?
Do you have trouble buttoning buttons or dressing?
Do you shuffle your feet and/or take smaller steps when you
walk?
Do your feet seem to get stuck to the floor when walking or
turning?
Have you or others noted that you don't swing one arm when
walking?
Do you have more trouble with your balance?
Have you or others noted that you stoop or have abnormal
posture?
the Scientific Advisory Board for the Michael J. Fox Foundation for Parkinsons Research (Jankovic, 2016).

Treatment
Symptomatic Treatment
Transplant Surgery
Stereotactic Neurosurgical
Procedures, Deep Brain
Stimulation
Genetics of PD

Drug Effect in Parkinson

Diseases

ON TIME
OFF TIME
WEARING OFF
DELAYED ON
ON-OFF PHENOMENON
FREEZING EPISODES

 Fluctuations in drug effect (onoff

phases, end-ofdose akinesia) can often
be improved by the use of sustainedrelease L-DOPA preparations, division of
the daily dose into smaller individual
doses at more frequent intervals
(perhaps with the use of liquid
preparations), and/or the addition of
dopamine agonists or COMT inhibitors.