Parkinson's Disease Overview

Parkinson's Disease

• Slowly progressing neurological movement disorder
• Caused by decreased dopamine levels due to the destruction of cells in the substantia nigra of the basal ganglia
• Manifestations: Tremor (at rest), rigidity (resistance to movement), bradykinesia (slowed movement, shuffling gait, mask-like face), postural instability (forward flexion), depression, dementia, autonomic symptoms, sleep disturbances, and micrographia (small handwriting)
• Medical Management: Treatment focuses on symptom control and function management
• Antiparkinsonian Agents: Sinemet (levodopa, carbidopa) prevents dopamine breakdown; long-term use can cause dyskinesia (involuntary movements)
• Interventions: Enhance swallowing (e.g., proper food positioning), encourage assistive devices to prevent falls, improve communication (due to slowed speech and jaw rigidity), support coping abilities, improve mobility (gentle ROM, rest breaks), enhance self-care, improve bowel elimination, and improve nutrition (monitor intake, soft foods)

Huntington's Disease

• Chronic, progressive, hereditary disease
• Autosomal dominant trait (50% risk of inheritance)
• Characterized by progressive involuntary movements (chorea) and dementia
• Clinical Signs & Symptoms: Abnormal involuntary movements (chorea), intellectual decline, emotional disturbances, constant writhing/twisting movements, speech/visual impairment, and voluntary movement impairment
• Early Symptoms: Mood swings, depression, irritability, trouble with driving, learning, memory, and decision-making
• Late Symptoms: Difficulty concentrating, feeding/swallowing problems, uncontrolled movements
• Home Teaching: Focus on high-calorie, high-protein diet (soft or pureed), passive ROM exercise, and home safety (no door alarms)

Amyotrophic Lateral Sclerosis (ALS)

• Also known as Lou Gehrig's disease
• Onset typically in the 50s-60s
• Loss of nerve cells controlling muscles leads to progressive weakness and atrophy (primarily in extremities and trunk)
• Swallowing and respiratory function are impaired (risk of aspiration)
• Chief Symptoms: Fatigue, progressive muscle weakness, cramps, fasciculations (twitching), incoordination, and eventually, compromised respiratory function

Seizures

• Episodes of abnormal neural activity
• Classifications: Generalized seizures (bilaterally distributed), focal seizures (one hemisphere origin)
• Specific Causes: Cerebrovascular disease, hypoxemia, fever (especially in children), head injury, hypertension, infections, metabolic/toxic conditions, brain tumors, drug/alcohol withdrawal, allergies
• Generalized Seizures: Intense body rigidity, followed by alternating muscle relaxation and contraction
• Focal Seizures: Possible impairment of consciousness/awareness
• Interventions: Anticonvulsant medications (e.g., valproic acid, benzodiazepines)
• Status Epilepticus: Continuous seizures without full recovery between attacks (medical emergency)

Guillain-Barré Syndrome

• Autoimmune disorder affecting peripheral nerves' myelin
• Often follows a viral infection
• Manifestations: Weakness, paralysis, paresthesias (numbness/tingling), pain, diminished/absent reflexes (initially in lower extremities) and tachycardia, hypertension
• Medical Management: Intensive care, continuous monitoring, respiratory support, plasmapheresis, and IVIG to reduce antibodies; recovery rates vary but most people recover completely.