Parkinson disease

Clinic

• PD or simply Parkinson's, is a long-term degenerative disorder of CNS that mainly affects the motor system.
• Symptoms usually emerge slowly, and as the disease worsens, Non-motor symptoms become more common.

Sign / Symptoms

Parkinsonism

It is the most obvious and early symptoms of PD including

• Tremor: Which disappears during voluntary movement of the affected arm and in the deeper stages of sleep
• Rigidity:
  • Caused by increased muscle tone, an excessive and continuous contraction of muscles / Lead-pipe rigidity / Cogwheel rigidity.
  • It is often asymmetrical and affect Neck / Shoulder muscles
  • With the progression of the disease, rigidity typically affects the whole body and reduces the ability to move.
• Bradykinesia
• Difficulty with walking / Postural instability / Impaired handwriting
• Slurred / Monotonous / Quiet voice
• Mask-like facial expression

Cognitive problems / Dementia

• Executive dysfunction: Planning, Cognitive flexibility, Abstract thinking, Rule acquisition, Inhibiting inappropriate actions, Initiating appropriate actions, Working memory, and Control of attention.
• Slowed cognitive processing speed, impaired recall, and impaired perception and estimation of time
• Visuo spatial difficulties: Facial recognition, Perception, Orientation

Behavioral problems

• Psychosis /Hallucinations / Delusions 50%/: Psychosis is now believed to be an integral part of the disease.

• Minor hallucinations:
  • Sense of passage : Something quickly passing beside the person
  • Sense of presence: Something /someone standing just to the side or behind the person
• Full blown vivid, formed visual hallucinations and paranoid ideation.
• Auditory hallucinations are uncommon, and are rarely described as voices.

Emotional problems

• Behavior / Mood alterations are more common in PD without cognitive impairment than in the general population and are usually present in PD with dementia.
• The most frequent mood difficulties are depression, apathy, and anxiety.
  • Anxiety 30–40%
  • Panic attacks
  • Apathy 16.5–40%
  • Anhedonia 5-75%
• Impulse-control disorders including pathological gambling, compulsive sexual behavior, binge eating, compulsive shopping, and reckless generosity
• Dopamine dysregulation syndrome – with wanting of medication leading to overuse – is a rare complication of levodopa use.
• Punding: Repetitive, aimless, stereotyped behaviors occur for many hours, is another disturbance caused by anti-Parkinson medication

Autonomic dysregulation

• Orthostatic hypotension
• Oily skin
• Excessive sweating
• Urinary incontinence
• Impotency

Sleep problems

• Daytime drowsiness (Narcolepsy)
• RBD: REM behavior disorder (PD or dementia with Lewy bodies)

Sensory systems problems

• Anosmia: Impaired sense of smell
• Disturbed vision
• Hyperstasia / Tingling
• Paresthesia (Numbness)

Gastrointestinal problems

• Constipation
• Gastroparesis
• Salivation
• Oropharyngeal dysphagia
• Small intestinal bacterial overgrowth

Patophysiology

• Motor symptoms result from the death of cells in the substantia nigra, leading to a dopamine deficit.
• The cause of this cell death is poorly understood, but involves the build-up of misfolded proteins into Lewy bodies in the neurons.

• Causation is unknown
• Diagnosis of typical cases is mainly based on symptoms
• No cure for PD is known

Classification

• Parkinson's disease is the most common form of parkinsonism and is sometimes called idiopathic parkinsonism.
• There are other Parkinson-plus syndromes that can have similar movement symptoms including:
  • Lewy body dementia: Motor symptoms + Early onset of cognitive dysfunction + Hallucinations
  • Multiple systems atrophy which has three forms
    • Autonomic predominance
    • Cerebellar predominance
    • Parkinsonian predominance
  • Progressive supranuclear palsy (PSP): Rigidity + Early falls + Bulbar symptoms + Vertical gaze restriction. It can also be associated with frontotemporal dementia.
  • Corticobasal syndrome (CBS). Asymmetric parkinsonism + Dystonia + Alien limb + Myoclonic jerking

Entities

Parkinson Disease is a clinical syndrome characterized by

• Tremor
• Bradykinesia
• Rigidity
• Postural instability: Ataxia

Parkinsonism Entities / Miasms

	JE	WNE	CJD	RBS
Rigidity	+++	+++	+++	+++
Tremor	+++	+++	+	+++
Bradikinesia		+++	+++
Ataxia	+++	+++	+++
Parkinsonism	+		+

Point

Parkinson’s Disease and ataxia are certainly related, but it depends on which meaning of ‘ataxia’ you are referring to. Ataxia in the sense of uncoordinated movement is a primary symptom of Parkinson’s Disease, while Ataxia as shorthand for Spinocerebellar Ataxia refers to a set of genetic conditions with which Parkinson’s Disease has some symptoms in common.

	WNE	JE	CJD	RBS	WEE	FFI	HSV-1
Parkinsonism	+++	+++	+++	++	+	+	+
Dementia		+++	+++			++
Psychosis		+++	+++	+++			+++
Depression		+++			+++	+++	+++
Anxiety				+++		+++
Apathy		+++
Orthostatic Hypotention							+++
Incontinence
Impotency							+++
Paresthesia			+++	+++			+++
Hyper Stasia							+++
Anosmia							+++
Constipation						+++	+++
Dysphagia			+++			+++
Salivation				+++
Gastric palsy

Remedies

Banerji protocols
First line	Gels C200 two doses daily Rhus-t C30 two doses daily
Second line	Lach C200 one dose every 2 days KP 6X two doses daily Cupr C200 two doses daily
Third line	Zinc C200 two doses daily Hydr-ac C30 two doses daily

• Manish Bhatia suggested these remedies in Hpathy.com
• Merc
• Zinc
• Rhus-t
• Aur
• Nux-v
• Gels
• Arg-n
• Agar
• Cocc
• Lathyrus
• Phys
• Ambr
• Heloderma
• Mag-p
• Bufo
• Taren
• Plb
• Con

Merc

• Weakness of limbs, trembling of extremities, especially hands.
• Paralytic agitans.
• Lacerating pain in joints.
• Cold and clammy sweat on limbs.
• Oily perspiration.
• Tremors everywhere in body.
• Weakness with trembling from least exertion.
• All symptoms are aggravated at night, warmth of bed, Damp, cold, rainy weather and during perspiration.
• Complaints increase during sweating and rest.
• All symptoms always associated with weariness, prostration and trembling.
• Slow in answering questions.
• Memory weakened and loss of will power.
• Skin always moist and freely perspiring. Itching worse warmth of bed

Zinc

• Violent trembling (twitching) of the whole body esp after emotions.
• Twitching in children.
• Chorea. 
• Paralysis of hands and feet.
• Trembling of hands while writing.
• Lameness, weakness, trembling and twitching of various muscles.
• Feet in continued motion, cannot keep still.
• Worse touch, between 5-7 pm., after dinner, better eating, discharges.

Rhus-t

• Tremors start with pain and relieved by motion.
• Stiffness of affected parts
• Numbness and formication, after overwork and exposure.
• Paralysis; trembling after exertion.
• Limbs stiff and paralyzed.
• All joints hot and painful.
• Crawling and tingling sensation in the tips of fingers.
• Worse during sleep, cold, wet rainy weather and after rain, night, during rest, drenching and when lying on back or right side.
• Better warm, dry weather, motion, walking, change of position, rubbing, stretching out limbs.

Gels

• Gels is a neurological remedy. nervous system, causing Dizziness / Drowsiness / Dullness.
• Trembling, weakness of all limbs ranks the highest in this remedy
• Weakness and motor paralysis, esp in the muscles of the head, Eyes, Throat, Chest, Sphincters and Extremities.
• Head remedy for tremors. Mind sluggish and muscular system relaxed.
• Staggering gait. Loss of power of muscular control.
• Cramps in muscles of forearm.
• Excessive trembling agg by dampness, excitement, bad news. Better by bending forwards, profuse urination, continued motion and open air.

Arg-n

• It is complimentary to Gels.
• Memory impaired; easily excited and angered; flatulence and greenish diarrhea.
• Incoordination, loss of control and imbalance with trembling and general debility.
• Paralysis with mental and abdominal symptoms.
• Rigidity of calves.
• Walks and stands unsteadily.
• Numbness of body. Specially arms.

Agar

• Trembling, itching and jerking, stiffness of muscles
• Itching of skin over the affected parts
• Extreme sensitiveness of the spine. Cannot bear touch.
• Jerking and trembling are strong indications.
• Chorea and twitching ceases during sleep.
• Paralysis of lower limbs with spasmodic conditions of arms.
• Numbness of legs on crossing them.
• Paralytic pain in left arm followed by palpitation. Stiffness all over with pain over hips.

Cocc

• Head trembles while eating and when it is raised higher.
• Knees sink down from weakness.
• Totters while walking with tendency to fall on one side.
• Cracking of the knee when moving.
• Lameness worse by bending.
• Trembling and pain in limbs.
• One-sided paralysis worse after sleep.
• Intensely painful, paralytic drawing.
• Limbs straightened out and painful when flexed.
• It shows special affinity for light haired females especially during pregnancy.

Lathyrus

Tremors of the upper extremities with paralytic weakness of the lower limbs. Feels as if limbs are hard and contracted; limbs feel heavy. Feels as if floor is irregular and is obliged to keep his eyes on the ground to guide his feet. Affects the lateral and anterior columns of cord. Does not produce pain. Reflexes always increased. Lateral sclerosis and Infantile paralysis. Finger tips numb. Tremulous, tottering gait. Excessive rigidity of legs with spastic gait. Knees knock against each other while walking. Cannot extend or cross legs when siting.Stiff and lame ankles.

Physostigma

Marked fibrillary tremors and spasms of the muscles, worse from motion or application of cold water. Palpitation and fluttering of the heart felt throughout the body. Depresses the motor and reflex activity of the cord and causes the loss of sensibility to pain, muscle weakness and paralysis.  Paralysis and tremors, chorea. Meningeal irritation with rigidity of muscles. Pain in right popliteal space. Burning and tingling in spine. Hands and feet numb with sudden jerking of limbs on going to sleep. Crampy pain in limbs.

Ambr

Tremors with numbness, limbs go to sleep on the slightest movement, coldness and stiffness of limbs. The finger nails become brittle and are shriveled. Cramps in hands and fingers. Worse grasping anything. Cramps in legs. Extreme nervous hypersensitiveness. Dread of people and desire to be alone. Music causes weeping. One sided complains call for it.

Heloderma

Trembling along nerves in limbs. Tired feeling, very weak and nervous, fainting, numb sensation. It causes locomotor ataxia. The eyes become more prominent and corneal opacities visible. Very depressed and sensation as if would fall on right side. Sensationas if walking on sponge. As if the feet were swollen. When walking, lifts feet higher than usual and puts down heel hard. Stretching relieves pains in muscles and limbs.

Mag-p

Trembling; shaking of hands, involuntary. Paralysis agitans. Cramps in calves, feet very tender. Twitching, Chorea, cramps. Numbness of finger tips. Worse right side, cold, touch, night. Better warmth, bending double, pressure and friction.

Bufo

• Special action on nervous system.
• Painful paralysis.
• Pain in loins, numbness and cramps.
• Staggering gait. Feels as if a peg is driven into joints. Worse—Warm room. Better bathing or cold air. Putting feet in cold water.

Tarent

• Remarkable nervous phenomena. Chorea, extreme restlessness and Paralysis agitans. Must keep in constant motion even though walking aggravates. Numbness of legs with twitching and jerking. Extraordinary contractions and movements.

Plb

• Paralytic agitans. Paralysis of single muscles. Cannot raise or lift anything. Extension is difficult. Paralysis from over-exertion of extensor muscles in piano players. Wrist drop. Loss of patellar reflex. Pain in right big toe at night. Hands and feet cold. Infantile paralysis and neuritis.

Con

• Heavy, weary and paralyzed limbs.
• Trembling and unsteady hands.
• Muscular weakness especially of lower extremities.
• Perspiration of hands. Putting feet on chair relieves.
• Ascending paralysis ending in death by failure of respiration.
• Worse by lying down, turning or rising in bed, cold, exertion. Better by darkness, limbs hanging down, motion, pressure.