Principles of Management
Dr. Lynch's Research
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Anticholinergics: Drugs that block the action of the neurotransmitter acetylcholine, thus
rebalancing the brain in relation to dopamine. They can reduce tremor and rigidity. Artane and
Cogentin are anticholinergics.
Basal ganglia: Groups of cells in the grey matter of each half of the
brain which coordinate automatic movements. It comprises various specialised
groups of cells, or nuclei, such as the globus pallidus and the substantia
Bradykinesia: A term used to describe slowness of motion and delayed
initiation of movement, which is common in early stages of PD.
Cell line (fibroblasts, glial) cultivation: The development of a line of
the patient's own cells (usually a type of cell known as a fibroblast, which is found
in the brain's connective tissue or glial cells) and their modification into nerve
cells. These would then be implanted in the brain to function in the substantia nigra as
COMT Inhibitor: COMT (catech-o-methyl-transferase) inhibitors are drugs which help to
prevent the mopping up of
dopamine in the brain, thus allowing it to act for longer, and reducing "offs". Comtess
is one such drug.
Dopamine Agonist: A drug which increases neurotransmittor activity by
stimulating the dopamine receptors directly.
Dyskinesia: The most common and disruptive side-effect of PD therapy, dyskinesia
is an involuntary movement that can accompany peak doses of levodopa.
Dystonia: Involuntary spasms of muscle contraction that cause abnormal
movements and postures. The dystonia that occurs most frequently in PD is in
the foot and is a characteristic of PD.
GDNF: Glial Derived Neurotrophic Factor is a nerve cell growth factor which
in animal trials has been shown to stimulate the growth of many types of neurons.
Globus pallidus: A small part of the corpus striatum that is partly
destroyed during pallidotomy. It regulates muscle tone needed for specific
Glutamate (NMDA) Antagonists: In a normal brain, neurons release a common
neurotransmitter called glutamate. It is abundant throughout the brain, playing a role
in communication between the various types of neurons. Without glutamate, the brain would
seize up and cease to function. Researchers have determined over the past few years that for
Parkinson's patients, insufficient levels of dopamine induce one tiny group of cells in the
basal ganglia, called the subthalamic nucleus, to dramatically increase their activity. This
means they produce extra glutamate -- so much that it overloads the glutamate receptors.
Glutamate antagonists work by blocking the activity of some of these receptors, thus
restoring more of a balance.
Hemiparesis: Partial or complete paralysis on one side of the body.
Lewy body: A pink-staining sphere found in the bodies of dying cells, that is
thought to be a marker for Parkinson's Disease
MadoparŪ: A formulation combining levodopa and benserazide.
MadoparŪ is available as a normal-release capsule, which provides rapid
motor control, a controlled release preparation, which allows sustained
control, and as a dispersible preparation that produces a drinkable
MAOI: Monoamine oxidase (MAO) is an enzyme that breaks down dopamine. In PD,
a MAOI-B inhibitor can be taken to help reduce the breakdown of dopamine. Selegiline (Eldepryl,
Clondepryl, Deprenyl) is a MAO-B inhibitor.
Microtubules: Any of the slender, tubular structures found in most cells, which are involved
in maintenance of cell shape.
Mitochondria: These are the principal sites of detoxification, and it is suggested that
in PD these do not work properly.
'On'-time: The period during which patients with PD adequately control
'Off'-time: The period during which patients with PD experience partial
or total immobility.
Pallidotomy: A surgical operation in which surgeons destroy small
areas of the globus pallidus in order to alleviate some of the symptoms
Porcine Tissue Implants: Implantation of embryonic pig cells.
Resting tremor: Shaking that occurs in a relaxed limb. It usually
stops when a voluntary movement of the affected limb is made.
Rigidity: Resistance to manipulation of a limb. Cogwheel rigidity,
a characteristic of PD, occurs when rigidity is combined with tremor.
SinemetŪ: A formulation combining levodopa and carbidopa.
Stereotactic surgery: A surgical technique in which
surgeons use three dimensional co-ordinates to locate specific areas of the
brain. Pallidotomy, thalamotomy and sub-thalamic stimulation use stereotactic techniques to locate the
globus pallidus and thalamus and sub-thalamic nucleus respectively.
Substantia nigra: A region of the basal ganglia that is rich in
dopamine-containing neurones. Its name, literally meaning black substance,
comes from the black appearance seen post-mortem.
Synapse: The synapse is the space between the axon terminal of one neuron and the dendrite
receptor of another (very simply, between the end of one neuron and the beginning of another).
If a signal is to pass from one neuron to another, it must cross this gap. It does this by
means of a chemical called a neurotransmitter, which allows electrical impulses
to pass across the synapse from one neuron to another. Dopamine is one such neurotransmittor,
and the slowing down in the production of dopamine is what causes the symptoms of PD.
Thalamotomy: A surgical operation in which surgeons destroy small
areas of the thalamus in order to alleviate one-sided tremor.
Sub-Thalamic Stimulation: A surgical operation in which a thin wire
probe is inserted into the sub-thalamic nucleus, an area of the brain which
helps to control movement. This wire is connected to a device similar to a
pacemaker, which is placed under the skin of the patient's chest. Electrical
signals are sent from this to the sub-thalamus. The patient may switch the
device on or off.
Thalamus: A small bundle of tissue located in the midbrain grey
matter that is destroyed during thalamotomy. It is the main relay station
for sensory impulses that reach the brain cortex from other parts of the
brain and the spinal cord.
Tremor: Involuntary shaking.
Trophic Agents: These are trophic or growth factors that may help nerve cells,
or parts of them, to grow. If tissue known to have trophic factors is transplanted into the
brain, the trophic factors may help the transplanted tissue to survive.
Unilateral: Occurring on one side of the body.
Wearing off: A phenomenon characterized by a progressive shortening
of 'on'-time following a dose of levodopa.
Section One: Parkinson's Disease |
Section Two: Current Treatments |
Section Three: Starting Treatment