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PARKINSON
Tinjauan Umum
SISTEM MOTORIK
1. Sistem piramidal
2. Sistem ekstrapiramidal
3. Serebelum
Interaksi ketiganya menghasilkan
gerak
Types of Movements
Automatic movement
Learned motor behaviors performed without
conscious effort (walk, speak)
Voluntary movement
Intentional planned or self initiated, or externally
triggered
Involuntary movement
Not suppressible (tremor, myoclonus)
Semi-voluntary (un-voluntary) movement
induced by inner sensory stimulus, move to suppress
unpleasant sensation, suppressible for short time
(tic, akathisia, RLS)
Extrapyramidal System
Facilitation
Physiology: function by
Suppression
Facilitate
Pathophysiology: failure to
Extrapyramidal dysfunction
Suppress
MOVEMENT DISORDER
MOVEMENT DISORDER
Definition
Movement disorder Is a neurological syndrome in
which there is
either an excess of movement, or a paucity of
voluntary and
Automatic movement.
Unrelated to weakness or spasticity
It is a term for:
1. A physical sign
2. Describing a specific syndrome / condition
Failure to Facilitate
Failure to Suppress
HYPOKINESIA
HYPERKINESIA
(Involuntary movement)
- Akinesia/Bradykinesia
- Rigidity
Myoclonus
- Diminished postural response
- Tics
- Dyskinesia
- Tremor
HIPOKINESIA
PARKINSONISM
Parkinsonism adalah suatu sindroma yang ditandai
oleh gejala-gejala klinis yang terdiri dari rest
tremor , rigiditas, akinesia, dan instabilitas postural.
Jenis-jenis Parkinsonism
I. Idiopathic/Primary parkinsonism
Parkinsons disease, juvenile parkinsonism
II. Symptomatic /secondary parkinsonism
Infectious, drugs, toxin, vascular, trauma, others (hypothyroidism,
tumor, NPH, obstructive hydrocephalus)
III. Parkinson plus syndrome / Multiple system degenerations
PSP, MSA (SNA, OPCA, SDS), Parkinsonism-dementia- ALS
complex of Guam (PDACG), progressive pallidal atrophy.
IV. Hereditary parkinsonism
Hereditary juvenile dystonia parkinsonism, Lewy body disease,
Huntingtons disease, Wilsondisease
PENYAKIT PARKINSON
5 % bersifat familial
2. GEJALA NON-MOTORIK
Bisa timbul beberapa tahun sebelum diagnosis Parkinson
ditegakkan.
a. Disfungsi saraf otonom
Orthostatic hypotension, kulit berminyak , keringat berlebihan,
inkontinensia urin, disfungsi seksual, konstipasi, gangguan motilitas
lambung.
b. Gejala neuropsikiatrik
Mood, kognisi, perilaku, pikiran.
c. Gejala sensori
nyeri otot, kesemutan
d. Gangguan tidur
Parkinsonism Types
Primary Parkinsonism
Parkinsonism
Idiopathic Parkinsons disease
Dementia with Lewy bodies
Gentic Parkinsonism
Frontotemporal dementia
With Parkinsonism
Alzheimers disease
MSAp and MSAc
PSP, CBD
Neuroacantocythosis
syphilis
Huntingtons disease
Creutzfeld-Jacob disease
Spinocerebellar degeneration
infarction
Secondary
Iatrogenic:
Phenothiazines, butyrophenones,
lithium,
Na valproate, Ca-blockers, reserpine
tetrabenazine, -m-dopa
Toxic:
MPTP, CO, Mg,Cyanide,methanol,
organophospates
Infectious:
Encephalitis lethargica, CJD, AIDS,
Metabolic:
Hypoparathyroidism, Wilsons diseae
Structural:
NPH, CNS trauma, tumor,
PARKINSONS DISEASE:
CLINICAL DIAGNOSTIC CRITERIA
1. Historical Diagnostic Criteria
Symptoms: Tremor, Rigidity, Akinesia, Postural Instability
(TRAP)
Two of three cardinal symptoms (2/3 TRA)
- Tremor, Rigidity, A kinesia / bradykinesia
OR
Three of four symptoms (3/4 TRAP)
Tremor, Rigidity, Akinesia, Postural instability
OR
Responsive to L-DOPA.
PARKINSONS DISEASE:
NEW CLINICAL DIAGNOSTIC CRITERIA
(UK Parkinsons Disease Society Brain Bank /
UKPDSBB)
Step 1. Diagnosis of Parkinsonism
Step 2. Exclusion criteria for Parkinsons
disease
Step 3. Supportive prospective positive criteria
for
Parkinsons disease
1. Diagnosis of
PARKINSONISM
BRADYKINESIA
+
At least ONE of the following:
RIGIDITY
REST TREMOR (4-6 Hz)
POSTURAL INSTABILITY not caused by
primary
visual, vestibular, cerebellar, or
proprioceptive