DRA.

LOURDES HUERTAS SANCHEZ

 Fotografía de 1850 que
muestra a la
superintendente de un
baño público en Liverpool,
es quizá la primera
fotografía de un paciente
con parkinsonismo, ya que
la cámara no existía en
1817 cuando James
Parkinson describió la
enfermedad.
Se observa la rigidez en su
expresión facial “facies
figeé” y en su actitud.
 DEFINICION

Desorden del
movimiento

• Deterioro cognitivo
Signos no • Disfunción
motores autonómica
• Desorden del sueño
• Depresión
• Hiposmia

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 EPIDEMIOLOGÍA Incidencia: 5->35 x 100000
Prevalencia: 0.3%

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 FISIOPATOLOGIA
Cholinergic and monoaminergic
α-synuclein brainstem neurons and in neurons
in the olfactory system àlimbic and
neocortical brain regions

Neuronas
dopaminergicas

Ventrolateral substantia nigra

àmidbrain dopaminergic neurons

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 NEUROPATOLOGIA
a | Parkinson disease (PD) : depigmentation
of the substantia nigra (SN) Selective loss of
the ventrolateral parts of the SN with sparing
of the more medial and dorsal regions is
evident in the histological section.
b–d | Haematoxylin and eosin.
normal distribution of pigmented neurons in
a healthy control (part b) and diagnostically
significant moderate (part c) or severe (part
d) pigmented cell loss in PD.

e–g Immunohistochemical staining of

α-synuclein shows the round,
intracytoplasmic Lewy bodies (arrow in
part e),
more diffuse, granular deposits of α-synuclein
(part e and part f), deposits in neuronal cell
processes (part f), extracellular dot-like
α-synuclein structures (part f) and
α-synuclein spheroids in axons (part g)
Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER
 FISIOPATOLOGIA

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

CIRCUITO MOTOR

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 CLINICA
• Rigidity
Signos • rest tremor
Bradicinesia cardinales
motores

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 CLINICA
(disfunción ejecutiva
No frontal, déficit de
Regulación del ciclo de despertar Déficit cognitivo
motores memoria, demencia,
alucinaciones)

Desórdenes del sueño Desórdenes del humor y

afecto

Hipotensión Síntomas sensoriales

Disfunción autonómica
ortostática
Disfunción
urogenital
Constipación Dolor
Hiperhidrosis

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 CRITERIOS MDS

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 CRITERIOS MDS

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

 CRITERIOS MDS

Werner Poewe.PARKINSON DESEASESNATURE REVIEWS | DISEASE PRIMER

SIGNOS CLÍNICOS ASOCIADOS CON
LA PROGRESIÓN DE ENF. PARKINSON
IMAGENES
Depleción de dopamina estriatal usando 18 F,
marcado con L-dopa and PET

3I-ioflupane single-photon emission CT (SPECT)

MRI esctructural: difusión, volumétricas,

segmentación de volumen subcortical e imag
multimodal

Myocardial sympathetic denervation, assessed

with PET or SPECT using noradrenergic tracers,
IMAGENES
a | 18F-DOPA-PET images show normal bilateral tracer uptake (a
typical comma-shaped structure) in a healthy control, whereas
uptake is asymmetric
b | Metaiodobenzylguanidine single-photon emission CT (MIBG
SPECT) shows cardiac sympathetic
c | MRI of the substantia nigra (SN). HC demonstrating an ovoid
area of hyperintensity (arrows) within the dorsolateral SN, which
is absent in patients with PD (right panel).
d | Neuromelanin-sensitive MRI of the SN (black circles in the left
panel) shows reduced signal intensity in the lateral part (arrow) in
a patient with early PD (right panel) compared with the HC (left
panel). No changes are observed in the periaqueductal grey
matter (white circle in the left panel).
e | Transcranial ultrasonography (axial plane) shows an enlarged
area of echogenicity in the region of the SN in a patient with PD
(right panel) compared with a HC (left panel). The solid lines mark
the midbrain area, the dotted lines mark the echogenic area at
the anatomical site of the SN on the side of insonation. M,
mediastinum; RN, red nucleus
GENETICA
GENETICA
LCR y test sanguineos

α-synuclein species, in the cerebrospinal fluid

(CSF)

Lower plasma levels of apolipoprotein A1 with

greater severity of motor symptoms
TRATAMIENTO

• Sintomático
– Farmacológico
• Levodopa
• Agonistas dopaminergicos, inhibidores
COMT, inhibidores MAO-B, etc
– Neuroquirúrgico
TRATAMIENTO
AGONISTAS DOPAMINERGICOS
TRATAMIENTO
Complicaciones Motoras de la levodopa
Fluctuaciones Motoras Frecuencia a 5 años
Variación en la respuesta – 47 - 55% c/ fluctuaciones
clínica a cada dosis de
– 49 - 55% c/ disquinesias
levodopa
– 40% fluctuaciones y
disquinesias
Disquinesias
Movimientos involuntarios
generados por levodopa

(*) Ahlskog & Muenter 2001. Revisión de 74 publicaciones