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

Mental

Parkinsonism	Cognitive problems / Dementia	Behavioral problems	Emotional problems
It is the most obvious and early symptoms of PD including Tremor: Which disappears during voluntary movement and in 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, it affects whole body and reduces the ability to move. Bradykinesia Difficulty with walking / Postural instability / Impaired handwriting Slurred / Monotonous / Quiet voice Mask-like facial expression	Executive dysfunction: Planning, Cognitive flexibility Abstract thinking, Rule acquisition Inhibiting inappropriate actions Initiating appropriate actions Working memory Control of attention. Slowed cognitive processing speed, impaired recall, and impaired perception and estimation of time Visuospatial difficulties: Facial recognition, Perception, Orientation	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.	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: Anxiety 30–40% Panic attacks Apathy 16.5–40% Anhedonia 5-75% Depression Impulse-control disorders including pathological gambling, compulsive sexual behavior, binge eating, compulsive shopping, and reckless generosity

Physical

Autonomic dysregulation	Sleep problems	Sensory systems	Gastrointestinal problems
Orthostatic hypotension Oily skin Excessive sweating Urinary incontinence Impotency	Daytime drowsiness (Narcolepsy) RBD: REM behavior disorder (PD or dementia with Lewy bodies)	Anosmia: Impaired sense of smell Disturbed vision Hyperstasia / Tingling Paresthesia (Numbness)	Constipation Gastroparesis Salivation Oropharyngeal dysphagia Small intestinal bacterial overgrowth

• 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

Phatophysiology

• 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	+++	+++	+	+++
Bradykinesia		+++	+++
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 BD Rhus-t C30 BD
Second line	Lach C200 one dose every 2 days KP 6X BD Cupr C200 BD
Third line	Zinc C200 BD Hydr-ac C30 BD

Manish Bhatia suggested remedies

	Parkinsonism	Generality / Modalities
Merc	Weakness of limbs, trembling of extremities, esp hands. Paralytic agitans Lacerating pain in joints. Slow in answering questions. Memory weakened and loss of will power. General weariness, prostration and trembling. Tremors everywhere in body. Weakness with trembling from least exertion.	Cold and clammy sweat on limbs. Oily perspiration, always moist and freely perspiring General agg Night, Warmth of bed Damp, cold, rainy weather During perspiration Complaints increase during sweating and rest. Skin itching worse warmth of bed
Zinc	Violent trembling (twitching) of 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. Agg by Touch 5-7 pm. After dinner After emotions Amel with Eating and Discharges
Rhus-t	Tremors start with pain and relieved by motion. Stiffness of affected parts Paralysis; trembling after exertion. Limbs stiff and paralyzed. Crawling and tingling sensation in the tips of fingers. Numbness and formication, after overwork and exposure.	All joints hot and painful. Agg: During sleep, Night, during rest, drenching Lying on back or right side. Cold, wet rainy weather and after rain Amel: Warm, dry weather Motion, walking, change of position Rubbing, stretching out limbs.
Gels	A neurological remedy: Dizziness / Drowsiness / Dullness Weakness/ Motor paralysis esp in Head, Eyes, Throat, Chest, Sphincters and Extremities. Top remedy for Tremors / Trembling / Weakness of all limbs Mind sluggish and muscular system semi paralyzed. Staggering gait. Loss of power of muscular control. Cramps in muscles of forearm.	Excessive trembling agg by Dampness Excitement / Bad news Amel by Bending forwards Profuse urination Continued motion Open air
Arg-n	Complementary remedy of Gels. Ataxia: Incoordination, loss of control and imbalance Trembling and general debility. Rigidity of calves. Walks and stands unsteadily. Numbness of body esp arms.	Memory impaired Easily Excited / Angered Flatulence Greenish diarrhea Paralysis with mental and abdominal symptoms.
Agar	Trembling, itching and jerking, stiffness of muscles 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.	Itching of skin over the affected parts Stiffness all over with pain over hips. Extreme sensitiveness of the spine. Cannot bear touch.
Cocc	Head trembles while eating and when it is raised higher. Totters while walking with tendency to fall on one side. Trembling and pain in limbs. One-sided paralysis worse after sleep. Intensely painful, paralytic drawing. Limbs straightened out and painful when flexed.	Knees sink down from weakness Cracking of the knee when moving Lameness worse by bending Special affinity for light haired females esp during pregnancy.
Plb	Paralytic agitans Paralysis of single muscles. Wrist drop. Cannot raise or lift anything. Extension is difficult. Paralysis from over-exertion of extensor muscles in piano players. Loss of patellar reflex. Infantile paralysis and neuritis.	Plb has both Flaccid and spastic paralysis, but spastic is more common. Cold + Weak + Heavy/ Paralysis / Slow Pain in right big toe at night Hands and feet cold
Con	Heavy, weary and paralyzed limbs. Trembling and unsteady hands. Muscular weakness esp lower extremities. Ascending paralysis ending in death by failure of respiration.	Perspiration of hands. Putting feet on chair relieves. Aggby lying down, turning or rising in bed, cold, exertion. Better by darkness, limbs hanging down, motion, pressure.
Lath	Tremors of upper extremities + Paralytic weakness of lower limbs. Feels as if limbs are hard and contracted; limbs feel heavy. Ataxia: 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. Reflexes always increased. Lateral sclerosis and Infantile paralysis. 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.	Does not produce pain Finger tips numb
Phys	Marked fibrillary tremors and spasms of the muscles 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. Agg Motion Cold water application
Ambr	Tremors with numbness, limbs go to sleep on the slightest movement Coldness and stiffness of limbs 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.
Helo	Trembling along nerves in limbs. It causes locomotor ataxia. Eyes become more prominent and corneal opacities visible. Very depressed and sensation as if would fall on right side. Sensation as if walking on sponge. As if the feet were swollen. When walking, lifts feet higher than usual and puts down heel hard.	Tired feeling, very weak and nervous, fainting, numb sensation. 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.	Amel Warm application Bending double Pressure 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.	Agg in Warm room Amel with 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.
Aur
Nux-v