1 2012 7 24
Parkinson disease :10 50 100, 65 10 200
tremor rigidity (pill rolling) Cogwheel rigidity Akinesia Bradykinesia
Resting tremor in Parkinson disease
Parkinson disease: camptocormia
Parkinson's disease normal midbrain Lewy body Parkinson's disease normal midbrain Lewy body Ubiquitin staining
Tyrosine Dopa Dopamine DA DA DA DA MAO DA DA COMT D1 D2
MIBG MRI
123 123 I- I-MIBG H/M 2.5 2.0
MRI/CT
SPECT ( DLB, AD)
Modified Yahr Parkinson disease 0 1 2 3 4 5 1 1 1 2 3 4 5
REM
320 30 7 8
0.25mg, 7.5-10mg, 5-10mg 1-2mg L-dopa, REM (0.5-1.5mg) (0.375-0.75mg) 1
25-75mg/day SSRI 25-100mg 150mg/day 1.5-4.5mg/day
40 10
32-56%
L-/ / Punding 2.6-8.0% 2.4-8.4% L- 3.4-4.0% L-
Punding SSRI,
3 20mmHg 10mmHg 60 L- 0.1-0.3mg/day 300-900mg/day
27-64 %
( 1-3 0.5-3g/day) (0.5-1g 12-24mg 30mg/day 15mg/day
Off Off On
: MPTP 90 95%) (5-10%)
Locus PARK1 Inheritance AD Locus 4q Gene - Synuclein No. of Families 13 Clinical Features Early onset, rapid progression Lewy Bodie s Yes PARK2 PARK3 PARK4 PARK5 PARK6 PARK7 PARK8 AR AR AD AD AR AR AD 6q 2p13?4p 4p14 1p36-35 1p36 12p11.2-q13.1 Parkin Unknown Unknown UCH-L1 Unknown DJ-1 Unknown >60 6 1 1 9 2 1 Juvenile onset, dystonia Late-onset PD Early onset, dementia, postural tremor Typical PD Early late onset, slow progression Early onset Typical PD No Yes Yes??? No AD = autosomal dominant; AR = autosomal recessive; UCH-L1 = ubiquitin hydrolase L1; PD = Parkinson's disease.
Autosomal Recessive Juvenile Parkinsonism (ARJP) 40 25 L-dopa Levy parkin (1998 6
arteriosclerotic parkinsonism Binswanger, Parkinson Parkinson L- Binswanger disease
drug-induced parkinsonism PZC : : : :, : :
PD-Plus PD PDL- Progressive Supranuclear Palsy=PSP Multiple System Atrophy=MSA Shy Drager PD PD 15-30 Corticobasilar Degeneration=CBD 3-6 )
Progressive Supranucelar Palsy; PSP)
Corticobasal degeneration Bradykinesia/Akinesia ( Rigidity ( dystonia
Diffuse Lewy body disease
Shy-Drager Multiple System Atrophy glial cytoplasmic inclusion
MSA-P Glial cytoplasmic inclusion
-We are with you-