Parkinson’s disease | Epilepsy | Multiple sclerosis

What is Parkinson’s disease?

Parkinson’s disease is basically a neuro degenerative disease. Balance between excitatory and inhibitory neurotransmitters is disturbed. Dopamine producing cells in substantia nigra dies off.

Excitatory and Inhibitory neurotransmitters balance:

There is a balance in our brain for excitatory neurotransmitters and inhibitory neurotransmitters. When we perform body movements muscles excitation occurs. This excitatory phase is not persistent. When we will stop that movement at that phase inhibitory neurotransmitters get activated. Inhibitory neurotransmitters prevent movements. So, this is balance between excitatory and inhibitory neurotransmitters in brain which makes our movements smooth.

Parkinson’s disease | Epilepsy | Multiple sclerosis

Neurotransmitters in Substantia nigra:

Excitatory NeurotransmitterInhibitory Neurotransmitter
AcetylcholineDopamine

In Parkinson’s disease degeneration of substantia nigra occurs. Dopamine producing cells in substantia nigra dies off. Due to this cell death in substantia nigra a balance between excitatory and inhibitory neurotransmitters is disturbed. Therefore, muscles remain in excitatory phase and inhibition becomes impossible. Example: A normal person will stop movement after seeing any barrier on his way, but it would be hard for Parkinson’s patient to stop movement. It is a degenerative disease, neurons in substantia nigra degenerates.

Clinical Presentation:

  • Facial expressions deteriorates
  • Mask like face (no expressions)
  • Rigid movements
  • Rigid tone (Cog-wheel rigidity)
  • Jerky movements
  • Postural instability
  • Pill rolling tremors
  • Gait disturbance
  • Small steps

Examination of Patient:

Parkinson’s disease is clinically examined. No lab tests are required. As substantia nigra is a small area in brain. It is very hard to examine it under MRI, CT scan or X-RAY. Though in advanced radiology departments it can be confirmed under PET scan.

Age of onset:

It is basically an old age disease. At later stage of life many kinds of proteins start accumulating in substantia nigra and cause cell death.

Treatment:

Due to the death of cells in substantia nigra. Dopamine secretion is inhibited. We need to replace dopamine. We need to provide dopamine externally. It is a lifetime disease because substantia nigra can not be recovered. Parkinson’s patients need to take dopamine supplements throughout their life. Quitting intake of dopamine will make the symptoms appear again. Parkinsonism is incurable but we can control or suppress symptoms by dopamine supplements and physiotherapy.

  • Levodopa
  • Carbidopa
  • Physiotherapy

Carbidopa inhibits dopamine decarboxylase enzyme. It prevents degradation of dopamine and prolongs dopamine life. There are some medicines as well which enhance the function of dopamine receptor agonist.

What is Epilepsy?

Epilepsy is a brain disorder in which all circuits in the brain moves into excitatory phase, and all neurons start firing. Due to excessive firing patient experiences fits. Excitatory and inhibitory neurotransmitters balance is disturbed.

Excitatory NeurotransmitterInhibitory Neurotransmitter
AcetylcholineDopamine
Catecholamine’s Glutamine
HistamineGABA

There is a complete circuit in brain containing neurons which transmit signal throughout the body. All signals in brain are generated through an impulse. Each area in brain is responsible for particular movements, and impulse is generated only in that area which is responsible for performing that activity.

Example: While speaking impulse is generated in Wernicke’s area of brain and signal moves from Wernicke’s area to broca’s area and then into vocal cords. Only a particular area is excited. While in epilepsy whole brain (each circuit and all neurons) moves into excitatory phase.

Types of epilepsy:

Partial epilepsyGeneralized epilepsy
Fits in focal area of brainFits in whole brain
Particular body part is involvedWhole body is involved
Less severeMore severe

History and examination:

Patient at the onset of fits have violent muscular contraction. After fits subsides patient have normal appearance, normal reflexes and tone. CT scanning is suggested in patients suffering from epilepsy to find the root cause of fits. Sometimes fits might be due to brain tumor or scar which can be removed surgically and patient can get rid of epilepsy. EEG (electroencephalogram) records brain activity. Alpha and beta waves activity is recorded by placing electrodes over head. Serum calcium and parathyroid level should be tested because any disturbance in serum calcium level may produce tetanic contractions.

Treatment:

Our first and foremost duty is to to control fits. Because, fits can cease respiration and can cause death.

  • Clean airway using suction machine
  • Maintain IV line
  • IV Diazepam (sedative, slows down brain activity)
  • Epival (valproic acid, slows down brain activity)

Multiple sclerosis:

Multiple sclerosis is a slowly progressive autoimmune disease of brain and spinal cord. Myelin sheath progressively damage in multiple sclerosis. In about 5 to 10 years complete damage of myelin sheath occurs and patient is disabled, and paralyzed.

Parkinson's disease | Epilepsy | Multiple sclerosis

Diagnosis of multiple sclerosis:

Patient visits the physician with attack on a body part and after treatment gets normal. On second attack again visits the physician and gets normal and so on. Attacks continue and each time different area is involved. Involvement of different area each time points towards multiple sclerosis.

Examination:

MRI of brain and brain stem is performed. Demyelination is found which shows white spots in brain and brain stem.

Treatment:

We can use steroids, immunosuppressants and physiotherapy to prevent symptoms getting worse at a quick rate, but ultimately patient is disabled:

  • Immunity suppressants
  • Steroids at slow dose
  • Interferon therapy
  • injectable steroids

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