1. Represented by SHIVAJI SINGH SAMEER CHAVAN SOURIMA MUKHERJEE SONAL KULKARNI SUVARNA CHAVAN M.Sc (CLINICAL RESEARCH) (CRANFIELD)GROUP-9

2.  Neuro-degenerative disorder.  caused by a deficiency of dopamine and an excess of acetylcholine within the CNS.  Affects the part of the brain that controls muscle movement, causing symptoms as trembling, rigidity.

3.  Multidisciplinary management is essential 1. Drug therapy 2. Physiotherapy 3. Occupational therapy 4. Speech and language therapy 5. Nursing 6.Surgical treatment 7.Gene therapy

4.  Divided into two broad classes: 1. Dopaminergic drugs 2. Anticholinergic drugs

5.  Divided into six sub classes 1. Dopaminergic precursor - levodopa 2. Peripheral decarboxylase inhibbtor - carbidopa -benserazide 3. MAO-B inhibitor -selegiline -rasagiline

6. 4. Dopamine agonists 4.1. ERGOT DERIVATIVES 4.2. NON ERGOT DERIVATIVES -lusiride -piribedil -bromocriptine -rotigotin -pregolide -ropinirole 5. Dopamine facilitator -amantadine 6. COMT inhibitor (catechol-O-methyltransferase) -entacapone -tolcapone

7.  No change in muscle tone.  Reversal of tremor requires continued therapy.  Changes in mood associated with parkinsonism are reversed.

8.  95% of l-dopa is metabolized in the periphery to dopamine.  Only a small portion entering the brain.

9.  Choreiform or dystonic  movements, anorexia, abdominal pain,  dysphagia, dry mouth, mental  changes, headache, dizziness,  increased hand tremor, peripheral edema,  constipation  hallucinations, confusion,  depression, loss of balance

10.  Contraindicated in patients with narrow-angle glaucoma,those receiving a monoamine oxidase inhibitor.  Used with caution in patients with tachycardia, cardiac arrhythmias, hypertension, hypotension.  Cautious administration in patients with obstructive disease of the urinary system or gastrointestinal tract.

11.  Divided into two sub classes 1. Anticholinergic drugs -benztropine -procyclidine -biperiden 2. Antihistamines drugs -diphenhydramine -orphenadrine -promethzine

12.  Inhibit acetylcholine in the CNS.  Less effective than levodopa.

13.  Dry mouth, blurred vision, dizziness, mild nausea, and nervousness.  Skin rash, urinary retention, tachycardia, muscle weakness, disorientation, and confusion.

14.  Contraindicated in patients with a hypersensitivity to the drugs and during pregnancy and lactation  The COMT inhibitors are used with caution in patients with hypertension,hypotension, and decreased hepatic or renal function

15.  Gives advice and helps maintaining all aspects relating to activities of daily living.  both at work and at home, with the aim of maintaining work and family relationships, encouraging self-care where appropriate.

16.  To help improve gait, balance and flexibility  Improve aerobic activity and movement initiation  Increase independence and provide advice re fall prevention and other safety information.

17.  improving loudness and intelligibility of speech where possible.  Ensuring methods of communication are available as the disease progresses and to help with swallowing.

18. Observe the patient's mood, cognition; organization and general well being.  Observe for features of depression  Patients should not be forced into situations in which they feel ashamed of their appearance.  Encourage the patient to participate in moderate exercises.  Relaxation therapy

19.  Deep brain stimulation  Connected to pacemaker which delivers a constant current.  Is safe and efficacious.

20.  Mutations in the LRRK2, PARK2, PARK7, PINK1, and SNCA genes cause Parkinson disease.  Stem cell therapy hold the promise of treating disease by growing new tissues and organs from stem cells.

21.  Lisuride Patch to Treat Parkinson's Disease  This study has been completed In August 6, 2004 Last Updated: October 25, 2007  Sponsor: National Institute of Neurological Disorders and Stroke (NINDS)  Information provided by: National Institutes of Health Clinical Center (NIHCC)

22.  www.newyorktimes.com  http://www.ncbi.nlm.nih.gov/pubmed/17969557Curr ent ene Ther. 2007 Aug;7(4):239-48  http://www.nature.com/news/full/news.html