Parkinson Disease.ppt

ParkinsonDisease,Introduction,ParalysisAgitansIdiopathicParkinsonismShakePrevalence1%60yearsBasalganglionextrapyramidal,Symptoms,1.Tremor(震颤)(1)Themusclesofdistallimbsasymmetrical(2)Frequency:4-8/secondrhythmical(3)Resttremor(静止性震颤),differentfromintentiontremor(意向性震颤)imbalancebetweendopamine()andacetylcholine()Transmitter(递质，介质),BiochemicalChange,DiagnosisCriteria,1.Thetypicalsymptoms2.Asymmetrical3.Onsetgraduallyandprogressivelyworseandworse4.GoodeffectafterantiPDdrug,5Laboratoryexamination(1)HVA(productofdopamine)inCSF&urinemaydiminished.(2)ThefunctionofDATmaybediminishedinSPECTorPET.,DiagnosisCriteria,Exclude:SecondaryparkinsonismParkinsonsymptomsinducedbytoxin,Vasculardiseaseorpost-encephalitisetc.,DiagnosisCriteria,ParkinsonPlusSyndrome(帕金森叠加综合征)PDsymptomsisjustapartofthesymptomsinthisdisease.,Treatment,1.Drugs(1)Toincreasedopamine()：Madopar(美多巴),Sinemet(息宁)(2)Todecreaseacetylcholine()：anticholinergicdrugs(抗胆碱能药)，suchasArtane(安坦),Treatment,(3)Dopamineagonist(多巴胺受体激动剂)dopaminereceptor：Trastal(泰舒达),Pramipexole(森福罗）(4)MAOBI（单胺氧化酶-B抑制剂）(5)Amantadine(金刚烷胺）(6)COMTI（儿茶酚氧位甲基转移酶抑制剂）DosageandtimingIndividualization,sideeffect,neurologicalpsychologicaldigestivecardiovascular,NeurologicalSideEffect,1.Fluctuation(波动)(1)Earlymorningoff(晨僵)(2)Endofdosewearingoff(剂末衰竭)theeffectofdrugmaintainshorterandshorter,NeurologicalSideEffect,(3)OnandoffphenomenonComfortablerelaxationsometimeDifficultytomovesometimeNoregularity,NeurologicalSideEffect,2.Dyskinesia(运动不良)TheotherunvoluntarymovementexcepttremorChorea(舞蹈),myoclonus(肌阵挛),Treatment,2.Neuroprotectives(神经保护剂)Toretardtheprogressofneuronsdegeneration：VitE,VitC,Co-enzymeQ10,Treatment,3.SurgicaltherapyDeepBrainStimulation(DBS,深部脑刺激术)Indications,DeepBrainStimulation,Treatment,DeepBrainStimulation(DBS,深部脑刺激术),DBS,DBSof