It contains the Management of Parkinson's disease and i think it will be most useful to medical students to refer.

1. MANAGEMENT OF PARKINSON’S
DISEASE
AAM. AMJATH
MEDICINE 4TH BATCH
FHCS-EUSL

2. Objectives
• To Understand the Goals in Management of
Parkinson’s Disease.
• Describe the Pharmacological Intervention in
Parkinson’s Disease.
• Describe the Non-Pharmacological
Intervention in Parkinson’s Disease.
• Describe the Surgical Treatments in
Parkinson’s Disease.

5. Goals of Management
• Maintain the function
• Avoid drug-induced complications
• In the Tx of PD,
Bradykinesia
Tremor
Rigidity
Abnormal posture
Respond Early in illness

6. • But…
Cognitive symptoms
Hypophonia
Autonomic dysfunction
Balance difficulties
Respond Poorly

7. Pharmacological Management of
Parkinson’s Disease.
Drugs used in PD
1. Levodopa and Carbidopa
2. Anticholinergics(Trihexyphenidyl, Benztropine)
3. Amantadine
4. Catechol-O-methyltransferase inhibitors (COMT
inhibitors
5. Monoamine oxidase type B (MAO-B)
(Give temporary relief from the symptoms of the disorder, but
not arrest or reverse the neuronal degeneration. )

8. Pharmacological Therapy in early PD
• ‘Early disease’ refers to PD in people who have
developed functional disability and require
symptomatic therapy.
• There is no single drug of choice in the initial
pharmacotherapy of early PD.

9. Options for initial pharmacotherapy in early PD

10. • The dose of levodopa should be kept as low as
possible to maintain good function in order to
reduce the development of motor complications.
• Beta blockers used in the symptomatic treatment
of selected people with postural tremor in PD.
• Anticholinergics may be used as a symptomatic
treatment typically in young people with early PD
and severe tremor

11. Pharmacological therapy in later PD
• ‘Later disease’ refers to PD in people on
levodopa who have developed motor
complications.
• There is no single drug of choice in the
pharmacotherapy of later PD.
• So, Adjuvant drugs are taken alongside with
Levodopa for it.
• Ex: COMT inhibitors, MAO-B inhibitors,
Dopamine agonist, Amantadine… etc.

12. Options for adjuvant pharmacotherapy in later PD

13. • Modified-release levodopa preparations may
be used to reduce motor complications in
people with later PD, but should not be drugs
of first choice.
• MAO-B & COMT inhibitors may be used to
reduce motor fluctuations and Amantadine
may be used to reduce dyskinesia in people
with later PD.

15. Non-Pharmacological Management of
Parkinson’s Disease.
• It includes,
 Rehabilitation.
Diet.
Physiotherapy
Speech & Language therapy
Occupational therapy

16. Rehabilitation
• Physiotherapy
It helps to improve the,
a. Mobility.
b. Flexibility.
c. Strength.
d. Gait speed.
e. Aerobic capacity.
f. Quality of life.

17. • Speech and language therapy
 Particular consideration should be given to :
a. improvement of vocal loudness and pitch range.
b. Ensuring an effective means of communication is
maintained throughout the course of the disease.
c. review and management to support safety and
efficiency of swallowing and to minimise the risk of
aspiration.

18. • Occupational therapy
 Particular consideration should be given to :
a. maintenance of work and family roles, home care
and leisure activities.
b. improvement and maintenance of transfers and
mobility.
c. improvement of personal self-care activities, such as
eating, drinking, washing and dressing.

19. Diet
• Diet should include high fibre foods and
plenty of water.
• When levodopa is introduced excessive
proteins are discouraged due to competition
between them to cross the BBB and intestine.
• So, To minimize interaction with proteins,
levodopa is recommended to be taken 30
minutes before meals.

20. Surgical Treatment
• In refractory cases, Surgical Tx is considered.
• Deep-brain stimulation (DBS) is presently the
most used Sx method.
• Here Subthalamic nucleus(STN) or Globus
pallidus interna (GPi) is stimulated.
• I˚ : Patients who suffer disability resulting from
levodopa-induced motor complications.
• CI : a) Cognitive Impairment.
b) Major Psy.illnesses
c) Substantial medical comorbidities
d) Advanced age