Sunday, January 15, 2006

Parkinsonism (paralysis agitans, Parkinson's disease)

Parkinsonism is the third most common neurologic problem in the elderly. This disease affects one in 100 persons over the age of 55 of both sexes and of all races.
The cause of Parkinsonism is unknown, although some cases are induced by the use of drugs and encephalitis (inflammation of the brain).
Symptoms of Parkinsonism include tremors that disappear with sleep, rigidity of muscles, slowness of voluntary movement, dizziness, infrequent blinking, expressionless face, distorted posture, drooling, dermatitis, depression, constipation, urinary incontinence, shuffling gait, small cramped handwriting, and hoarse low voice.
Treatment of Parkinsonism is palliative (reducing severity) and symptomatic and depends on the pharmacologic manipulation of the pathophysiologic state. The drug treatment to be used is determined by the severity of the symptoms and the presence of associated diseases. The preferred anticholinergic agents are Artane, Cogentin, Kemadrio, and Akineton. These drugs act selectively on the central anticholinergic activity. The side-effects that may occur include blurring of vision, dryness of mouth and throat, constipation, urinary urgency or retention, ataxia (loss of muscle coordination), and mental disturbances.
Levodopa therapy has dramatically changed the management of Parkinsonism. The side effects associated with Levodopa include nausea, vomiting, orthostatic hypotension, insomnia, and mental confusion. Frequently an enzyme inhibitor will diminish the side effects of Levodopa, and that too, may be prescribed. Usually a neurologist or internist, familiar with Levodopa, can properly adjust the dosage of Levodopa and enzyme inhibitors so that the disease is controlled with few side effects.
Surgery is another alternative in the treatment of Parkinson's disease. This experimental surgery consists of adrenal cortex transplantation to the basal ganglion. Many people, however, cannot be surgically treated. The results are best when the person is younger and has unilateral involvement. The progress of Parkinson's disease may be slowed by improving the general health of the patient. The cure for Parkinson's disease has not been found but several treatments are available that help to decrease the degree of symptoms.
Scherer, I. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.


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