Recent advances in management of parkinsons disease, Slides of Pharmacology

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RecentRecent

Advances Advances

in in

Parkinson’ Parkinson’

s Disease s Disease

Dr. Amullya Pednekar Dr. Amullya Pednekar

Department of Pharmacology Department of Pharmacology

INTRODUCTIONINTRODUCTION

• 2 nd^ most common

progressive chronic neuro-

degenerative disorder

• (^) Affects 1% of population

above 55 years of age

• (^) Very limited study available

on prevalence of PD in India

Characteristic Pathological Finding

Clinical featuresClinical features

CARDINAL FEATURES CARDINAL FEATURES

Resting tremorResting tremor

BradykinesiaBradykinesia

Muscle rigidityMuscle rigidity

Postural instabilityPostural instability

NON-MOTOR SYMPTOMSNON-MOTOR SYMPTOMS

DepressionDepression

AnxietyAnxiety

Sleep disturbanceSleep disturbance

Urinary dysfunctionUrinary dysfunction

FatigueFatigue

PainPain

Reduced sense of smellReduced sense of smell

ConstipationConstipation

Orthostatic hypotensionOrthostatic hypotension

The shift from research on symptomatic therapy to the search for Parkinson’s disease- modifying therapy

• (^) Majority of cases with PD (the so-called idiopathic form of PD) were assumed to present an alpha- synucleinopathy
• (^) Drug development shifted its focus from transmitters, transmitter-related receptor agonists and antagonists, and transmitter-synthesizing and -degrading enzymes to the protein chemistry, synthesis, transport, aggregation, and degradation of alpha-synuclein and other proteins related to neurodegenerative disorders

B. Drugs affecting brain cholinergic system

1. Central anticholinergics: Trihexyphenidyl (Benzhexol), Procyclidine, Biperiden
2. Antihistaminics: Orphenadrine, Promethazine C. Numerous pharmacotherapies are available for individual NMSs (for example, using an antidepressant for depression in PD) D. Deep Brain stimulation

New developments in Parkinson’sNew developments in Parkinson’s

disease therapy disease therapy

• (^) With this situation in mind, efforts over the last 20 years to develop new therapies for PD can be divided in two categories:

1. Improving symptomatic therapy of (1a) motor and (1b) non-motor symptoms and
2. Addressing potential causes of PD, with a focus on the protein alpha-synuclein, its chemistry, synthesis, aggregation, degradation, and interaction with other proteins in order to develop a disease modifying treatment.

For motor symptoms and motor

complications by means of dopaminergic

mode of action

1. Levodopa-Carbidopa Infusion Pumps - (^) Gel formulation for continuous intestinal perfusion - (^) Advantages- Fewer fluctuation in plasma levels, Reduction in off time Reduction in incidence of dyskinesia - (^) Limitation- Invasive therapy