leitourgeies eksopiramidikou sistimatos
elegxei kinitikotita (mazi me piramidiko kai paregkefalida),dimiourgia aftomatikwn kinisewn(kataposi) ,avtomatopoiimenwn kinisewn(grafi kai vadisi),miikos tonos,rithmisi ekousias kinitikotitas
anatomikoi sximatismoi eksopiramidikou
prokinitikos floios,vasika gagglia(k+f),ipothalamios pirinas tou luys,melena ousia kai o erithros pirinas
melenoravdoti(melena ousia -kefkoforo kai kelifos fak) sindesi meros tou eksopiramidikou poios o nevrodiavivastis
ntopamini(apo ntopaminergikous nevrwnes melenas ousias)
nosoi eksopiramidikou pws ekdilwnountai
diataraxes kinitikotitas(akinitika diskamptika sindroma parkinson-iperkinitika sindroma-akousies kiniseis: tromos distonia xoreia valismos mioklonos nosos tou wilson )
kliniki ekdilwsi parkinson
TROMOS IREMIAS pou ipoxorei se ekousies kiniseis kai ipno kai kefali kai katw gnathos, DISKAMPSIA logo ipertonias miwn(odontotos -molivdosolinas -kirti thesi somatos) kai VRADIKINISIA (dinoume amantadini)eidika stin enarksi,ipomimia (anekfrasto prosopo) meiwsi aftomatikwn kai aftomatwn leitourgeiwn =>sieloreia ,mikra siromena vimata,mikrografia,argi vadisi xwris aiwrisi twn akrwn,diataraxes osfrisis DIATARAXES ANS, PSIXIKI SFAIRA (katathlipsi diataraxi ipnou) ,diataraxi ANTANAKLASTIKOU STASEWS
oikogenis parkinson
gonidio sto xromosoma 4(epikratitiki metavivasi prwimi enarksi)
ntopamini
sintithete sta vasika gagglia apo tirosini,metatrepete se l dopa kai meta ntopamini ,metavolizete apo tin compt kai tin monoaminoksidasi b
se parkinson exoume pathan
somatia lewy(iosinofila kittaroplasmatika egkeista se nevrwnes pou den exoun ekfilistei) kai ekfilisi basikwn gagkliwn(ntopaminergikwn nevrwnwn)
pote ekdilwnete i parkinson
otan katastrafei to 80% tis melenas
ptwto simptwma parkinson
diskolia na sikwthoun apo xamili karekla (diataraxes antanaklastikwn stasews)—anosmia kai ipnous rem,viwnoun ton ipno tous
therapeia parkinson
l dopa(proima:kanei naftia emeto orth ipotasi) kai anastolea tou enzimou apokarvoksilasi
opsimes parenergeies farmakwn gia parkinson(ntopaminergikwn)
iperkinisies (distonia kai xorioatherwsi) sigxisi psevdaisthiseis kai psixosikomorfes ekdilwseis,ipertonia(on off)
antagwnistes ntopaminis
bromokriptini pergolidi prampeksoli ropiniroli
entakaponi—-selegilini
anastoleas compt=——anastoleas mao
farmaka pou kanoun parkinsonismo
nevroliptika(gia psixwseis),antiemetika kai gia therapeia iligkou afta kanoun vradikinisia-akathisia
pws antimetwpizete o farmakevtikos parkinsonismos
antixolinergikes ousies (antixolinergikes xrisimopoioumai kai sto parkinson tromo seiloreia)
nosos somatiwn lewy(alpha-synuclein and ubiquitin in neurons ston floio kai vasika gagglia)
eksopiramidiki simptwmatologia(akinitikou-diskamptikou tipou, diataraxi isoropias kai ptwseis) ,sinaisthimatiki astatheia (psevdaisthiseis paralirimatikes ides) kai anoia(noitiki ekptwsi)
iperkinitika sindroma (akousies kiniseis logo eksopiramidikis atiologias)
akousies kiniseis ,tromos ,distonia, xoreia ,vallismos ,stereotipes kiniseis(tik ) mioklonos, nosos wilson
vlavi eksopiramidikou -iperkinisies-xoreia huntington
genetikos avksimenos arithmos cag ,kodikopoioun tiin prwteini xantigktini,emfanizei proodevtiki ekptwsi noitikwn leitourgiwn ,psixikes diataraxes kai xoreiomorfes iperkinisies
vlavi se ipothalamio somatio tou luys
kanei vallismo (viaies kiniseis megalou evrous)
nosos wilson ipatofakoeidiki ekfilisi
ekfilisi kittarwn ipatos kai fakoeidous,diataraxi metavolismou tou xalkou,den apovalete mesw xolis … therapeia D penikilamini
nevroakathokittwsi
stomatoprosopikes iperkinisies distonikou tipou ,ekselisontai se xoreia kai noithiki ekptwsi
akinitika -dispamptika sindroma ekopiramidikis sindromis
parkinson,farmakevtiko parkinson,floiobasiki ekfilisi,nosos somatiwn lewy,metegkefalidikos parkinsonismos,proodeftiki iperpiriniki paralisi,polisistimatiki atrofia
aitiopathogeneia parkinson
den einai gnwsti ,pithanon drasi ekswgwgenwn(ioi toksikoi->mptp se toksikomaneis kai perivalintikoi paragontes) klironimikotita…..>
diagnwstika sfalmata gia nosou parkinson
diskampsia kai vradikinisia den einai logo piramidikis aitiologias,tromos einai eksopiramidikos kai oxi idiopathis,oi aisthitikes diataraxes einai ipokeimenikes tou parkinson kai oxi mioskeletikou,diataraxi omilias sielreia sto parkinson den einai psevdopromikiki,katathlipsi einai apo parkinson
poia sindroma apoteloun ta epavksimena parkinsonika sindroma (dld exoun eksopiramidiki diataraxi kai prosvoli nevrikou sistimatos)
proodeftiki iperpiriniki paralisi,polisistimatiki atrofia ,floiovasiki ekfilisi kai nosos swmatiwn lewy,metegkefalitidikos parkinsonismos
proodeftiki iperpiriniki paralisi(mesi epiviwsi 8 y den iparxei therapeia)
diatarasete i ofthalmokinitikotita(arxika katheti kinisi),ipertonia mies afxena kai omiki zoni ,strofi kefalis panw,sixnes ptwseis ,vradikinisia xwris tromo
polisistimatiki atrofia (shy dragger diataraxes ans ,elaiogefiro paregkefalidiki ekfilisi paregkefalidiki diataraxi diskampsia kai vradikinisia,melainoravdwti ekfilisi-amiges eksopiramidiko)
diataraxes anapnois ,simeia piramidikis kai paregkefalidikis prosvolis ,diataraxes egkefalikwn sizigiwn,prosvoli prosthiwn keratwn
floiovasiki ekfilisi
ekfilisi metwpiaiou kai vregmatikou floiou kai vasikwn gaggliwn exoume monoplevri ipertonia vradikinisia apraksia,sindromo ksenou akrou-perierges akousies kiniseis,diataraxi noitikwn leitourgeiwn
eidi tromou
TROMOS IREMIAS:parkinson kai epavksimena ,TROMOS THESEWS:idiopathis(primidoni barvitouriko) ,endokrinika-iperth ipoglikaimia,farmaka trikiklika antikatathliptika agwnistes ntopaminis theofilini ,periferiki nevropatheia TROMOS TELIKOU SKOPOU: paregkefalidiki diataraxi ,skp,aggeiaki vlavi ,nosos wilson
therapeia idiopathous tromou
propranoloni pirimidoni
distonia (idiopathis,flefarospasmos,stomatotraxilii distonia-sindomo meige,spasmwdiko raivokrano,spasmos grafewn,distonia l dopa ,defteropathis-wilson perigenitikes vlaves)
sispaseis miwn poikilis diarkeias kai entasis ,kanoun kiniseis strofikes epanalavanomenes pathologikes theseis melwn swmatos
therapeia distoniwn
benzeksoli ,allantiki otksini
xoreia –athetwsi
aifnidies askopes tinagmoeidis kiniseis —ofioeidi poreia
revmatiki xoreia sydenham
sxetizete me revmatiko pireto se paidia 5-15,ipoxorei me therapeia gia revmatiko pireto