PARKINSON’S DISEASE TREATMENT

Parkinson's Disease Treatment

PARKINSON'S DISEASE TREATMENT

Definition

This is a progressive neurological disorder causing destruction and degeneration of nerve cells in the basal ganglia that affect extra pyramidal system characterized by difficulty in control and regulation of movement.

It’s also called Parkinsonism, paralysis agitans or shaking palsy. It affects more men than women. Affects about 1 out of 100 person older than age 60.

Causes

The etiology is unknown suspected causes included:

  1. Viral infection
  2. Chemical; toxicity e.g. manganese carbon monoxide and dust.
  3. Cerebra vascular accident
  4. Effects of drugs e.g. Major tranquilizer
  5. Genetic susceptibility

 

"Parkinson's Disease Treatment"

Pathophysiology

Dopamine, a neurotransmitter is responsible for normal function of extra pyramidal system; the extra pyramidal system includes the corpus striatum globus pallidum and substantial Nigra of the brain. There is a dopamine releasing pathway that connects the substantial nigra to the corpus striatum known as basal ganglia.

In Parkinson’s disease, a dopamine deficiency occurs in the basal ganglia leading to reduction of dopamine in the corpus striatum. This elevates the level of excitatory acetylcholine neurotransmitters thereby impairing the inhibitory function of the dopamine and brain cells in the CNS leading to Parkinson’s symptoms such as tremor, bradykinesia rigidity and postural abnormalities.

 

"Parkinson's Disease Treatment"

 

Parkinson's Disease Treatment

Clinical manifestation

  • Tremors in hands and fingers (pill rolling)
  • Akinesia
  • Bradykinesia (slow activity)
  • Shuffling steps and gait
  • Restlessness
  • Impaired verbal fluency (monotone)
  • Muscles rigidity
  • Fatigue
  • Oily skin
  • Increased perspiration
  • Insomnia
  • Mood swing (Depression and withdrawal)
  • Dysphagia
  • Drooling
  • Muscles cramps
  • Constipation

Diagnostic evaluation

  1. CT scan and MRI to rule out other disorder such as intracranial tumor
  2. Observation of clinical symptoms
  • Favorable response to a single dose of levadopa
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"Parkinson's Disease Treatment"

 

Management

The treatment of Parkinson’s disease consists of drugs, physical therapy and surgery in extreme cases.

The drugs are called antiparkinsonia agents; e.g. Cholinergic medications (anticholinesterase)

  • They help relieve the muscles weakness and they block acetylocholine break down Examples are
  • Prydostigmine (mestinon)
  • Neostimine (Prostigmine)
  • Edrophonium chloride (Tensilon)
  • Dopaminergics e.g. Levadopa. This is a dopamine replacement. Its given until symptoms are reduced. It’s the drug of choice.
  • Bromocryptine activities dopamine in the brain
  • Amantidine an antiviral agent is used early in the treatment to reduce rigidity, tremors and akinesia.

Physical therapy: This helps to maintain the patient’s normal muscle tone and function. It includes both passive and active range of motion exercises, routine daily activities, walking and bath and massage to help relax muscles.

Neurosurgery nursing: This is used to destroy ventrolateral nucleus of the thalamus to prevent involuntary movement.

 

"Parkinson's Disease Treatment"

 

Nursing Management

  • Promote measures to maintain adequate airway
  • Encourage patient in daily exercise e.g. walking and postural exercise to off set shuffling gait.
  • Massage and warm baths to relax muscles.
  • Promote methods to ease difficulty in swallowing e.g. chew slowly, conscious effort to control accumulation of saliva.
  • Use stabilize, secure dishes and eating, Utensils
  • Suggest smaller meals.
  • High fibre with enough water prevent constipation
  • Monitor weight
  • Teach facial exercise and breathing methods to obtain appropriate pronunciation, volume, and intonation e.g. deep breathe before speaking increase volume.
  • Encourage use of raised toilets to encourage normal position.
  • Provide emotional support and encourage verbalization of feeling.
  • Have patient take active role in activity planning and evaluation of treatment plan to reduce depression
  • Asses and encourage safety in environment to reduce risk of falls at home e.g. grab rails in the tub or showers, raised toilets hand rails on both sides of the stairway, use of ground floor.
  • Instruct patient and family in medication regimen and adverse effect and encourage follow-up and monitoring.
  • Encourage good personal hygiene.
  • Assist patients to set realistic goals.
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"Parkinson's Disease Treatment"

 

Nursing Diagnoses

  1. Impaired physical mobility related to bradykinesia rigidity and tremor.
  2. Impaired nutrition less than body requirements related to motor difficulties with feeding chewing and swallowing evidence weight loss.
  3. Impaired verbal communication related to decreased speech volume.
  4. Constipation related to diminished motor function and inactivity.

Complication

  • Aspiration
  • Injuries from falls
  • Dementia
  • Skin breakdown
  • Urinary tract infections.

 

"Parkinson's Disease Treatment"

 

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