ABSTRACT– Parkinson’s disease (PD) is defined as common neurodegenerative disease. Early concepts of looking PD was as purely a motor disorder have led the way to seeing it as a much more widespread neurological disease with affective, cognitive, and autonomic manifestations. PD is caused by the death of dopaminergic neurons of the substantia nigra within the midbrain. This article deals with an overview of Parkinson’s disease, focusing upon its various aspects along with Homoeopathic management.
KEYNOTES- Parkinson’s disease, Homoeopathy
INTRODUCTION– Parkinsonism is a clinical syndrome characterized primarily by bradykinesia, with associated increased tone (rigidity), tremor and loss of postural reflexes. There are many causes of the same but the most common is Parkinson’s disease.
PREVELANCE– This has an annual incidence of about 18/100 000 in the UK and a prevalence of about 180/100 000. Age has a marked influence on incidence and prevalence, the latter rising to 300–500/100 000 after 80 years of age. Average age of onset is about 60 years, and fewer than 5% of patients present under the age of 40.
PATHOPHYSIOLOGY– The pathological hallmarks of PD are depletion of the pigmented dopaminergic neurons in the substantia nigra and the presence of α-synuclein and other protein inclusions in nigral cells (Lewy bodies). It is considered that environmental or genetic factors alter the α-synuclein protein, rendering it toxic and leading to formation of Lewy body within the nigral cells. Lewy bodies are found in the basal ganglia, brainstem and cortex, and they increase with disease progression. PD is known as a synucleinopathy alongside multiple system atrophy and dementia with Lewy bodies. The loss of dopaminergic neurotransmission is mainly responsible for many of the clinical features.
|Causes of parkinsonism Idiopathic Parkinson’s disease (at least 80% of parkinsonism) |
Cerebrovascular disease Drugs and toxins • Antipsychotic drugs (older and ‘atypical’) • Metoclopramide, prochlorperazine • Tetrabenazine • Sodium valproate • Lithium • Manganese • MPTP
Other degenerative diseases • Dementia with Lewy bodies • Progressive supranuclear palsy • Multiple system atrophy • Corticobasal degeneration • Alzheimer’s disease
Genetic • Huntington’s disease • Fragile X tremor ataxia syndrome • Dopa-responsive dystonia • Spinocerebellar ataxias (particularly SCA 3) • Wilson’s disease
Anoxic brain injury
|CARDINAL MOTOR FEATURES Bradykinesia Rest tremor Rigidity Postural instability||OTHER MOTOR FEATURES Micrographia Masked facies (hypomimia) Reduced eye blinking Drooling Soft voice (hypophonia) Dysphagia Freezing||NONMOTOR FEATURES Anosmia Sensory disturbances (e.g., pain) Mood disorders (e.g., depression) Sleep & Autonomic disturbances G.I disturbances Orthostatic hypotension Genito-urinal disturbances Cognitive impairment/ Dementia Sexual dysfunction|
INVESTIGATIONS – The diagnosis is clinical. Structural imaging (CT or MRI) is usually done for normal age and thus rarely helpful, although it may support a suspected vascular cause of parkinsonism. Functional dopaminergic imaging (SPECT or PET) is abnormal, even found in the early stages, but do not differentiate between the different forms of degenerative parkinsonism and so is not considered as specific for PD. In younger patients, specific investigations may be appropriate for the diagnosis (e.g., exclusion of Huntington’s or Wilson’s diseases). Some patients with family histories might wish to undergo genetic testing, although the role of genetic counselling is also uncertain at present.
HOMOEOPATHIC MANAGEMENT –
- ARGNETUM NITRICUM- Cannot walk with eyes closed. Trembling, with general debility. Paralysis, with mental and abdominal symptoms. Rigidity of calves. Debility in calves especially. Walks and stands unsteadily, especially when unobserved. Numbness of arms. Post-diphtheritic paralysis
- CAUSTICUM- Paralysis of single parts. Dull, tearing pain in hands and arms. Heaviness and weakness. Tearing joints. Unsteadiness of muscles of forearm and hand. Numbness; loss of sensation in hands. Contracted tendons. Weak ankles. Cannot walk without suffering. Rheumatic tearing in limbs; better by warmth, especially heat of bed. Burning in joints. Slow in learning to walk. Unsteady walking and easily falling. Restless legs at night. Cracking and tension in knees; stiffness in hollow of knee. Itching on dorsum of feet.
- MYGALE- Unsteady gait. Constant motion of whole body. Tremulous. Intense redness in streaks, following course of lymphatics. Twitching of limbs. Restless hands. Convulsive, uncontrollable movements of arms and legs. Limbs drag while walking.
- PHOSPHORUS- Ascending sensory and motor paralysis from ends of fingers and toes. Stitches in elbow and shoulder joints. Burning of feet. Weakness and trembling, from every exertion. Can scarcely hold anything with his hands. Arms and hands become numb. Can lie only on right side. Joints suddenly give way.
- PLUMBUM METALICCUM- Paralysis of single muscles. Cannot raise or lift anything with the hand. Extension is difficult. Paralysis from overexertion of the extensor muscles in piano players (Curare). Pains in muscles of thighs; come in paroxysms. Wrist-drop. Cramps in calves. Stinging and tearing in limbs, also twitching and tingling, numbness, pain or tremor. Paralysis. Feet swollen. Pain in atrophied limbs alternates with colic. Loss of patellar reflex. Hands and feet cold. Pain in right big toe at night, very sensitive to touch.
- ZINC METALLICUM- Lameness, weakness, trembling and twitching of various muscles. Feet in continued motion; cannot keep still. Large varicose veins on legs. Sweaty. Convulsions, with pale face. Transverse pains, especially in upper extremity. Soles of feet sensitive. Steps with entire sole of foot on floor.
DISCUSSION AND CONCLUSION- Parkinson’s disease has often impacts people differently. While some patients rapidly develop severe symptoms, others live decades with only minimal impact from their disease. Treatment of the causes of PD can be effective, however in allopathy the drugs used in such cases is immense harmful to the body for long term consumption whereas Homoeopathic Materia-medica is enriched with many such symptoms in their remedies with minimal harmful effects to the human body, so their effectiveness has to be explored further to relief the suffering of mankind as well as research perspective to enrich the homoeopathic literature.
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