8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 1/41
dr. H.M. Luthf, Sp. SLab./SMF Neurologi
Fakultas Kedokteran UNMULSamarinda
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 2/41
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 3/41
PENDAHULUAN
Sejarah : PENYAKIT PARKINSON PP!:"ames Parkinson #$#% Para&isis A'itans"ean (artin )har*hot #$%+ Peny, ParkinsonTretiakoff #+#+- .reenfie&/- 0osan12et #+34
Lesi s25stansia ni'ra SN!0ein- )ar&sson- 0ar5e2- Hornykie6ien7- #+89 )ort7ias#+8% Do amine DA! ; Le<o/o a(PTP Ne2roto=in SN DAS ee&man an/ 0os*h #++$ s2r'i*a& inter<entions
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 4/41
KLASIFIKASI
#, Primer ata2 i/io atik Penyebab tidak diketahuiSebagian besar kasus penyakit ParkinsonAda peran toksin asal lingkungan
9, Sek2n/er ; Simtomatis ata2 ak2isitaInfeksi penyakit atau zatSlow Virus = pasca encefalitis letargica
Toxic kronis !TPT" !n" #$" !g" #S%" #&Trauma = Petin'u (Pugilistic )ncephalopathia*Sepakbola+ain hipoparatiroid" ,ipothyroid" !ulti infark" -egen",epatoserebral
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 5/41
KLASIFIKASI
$bat = -rug Indiced Parkinsonism Antipsikotik : CPZ, proklorperazin, haloperidolAntiemek metoklopramid, Etanol, Metanol, Reserpin,Lithium, Tetrabezene, Fenotiazin, Butiro enon,Al ametildopa, dialtiazem, !erapamil, "aptopril,!inkristin, !alproat, enitoin, sitosin # arabinosa,putus alkohol
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 6/41
KLASI>IKASI
./ Sindroma parkinson plus0!ultiple Systemdegenerasi
$e%ala parkinson & kelainan neurolo'is lainPro'resi (upranu"lear Pals)Atropi mult) sistem : *e'en, (etrioni'ral, (h)+*ra'er, *e'en-li!o # Pontoserebellar, (indroma Parkinson # Amiotropi*e'en $an'lionik # .ortikobasal
(indroma *emensia : + (indroma .onplek # Parkinsoonism #*emensia .omplek # AL( /$uam0, Pen) Le1) Bod) *i us,Creutz eldt # 2a"ob, bersamaan pen)akit Alzheimer3erediter : 4ilson, 3aller!erdon # (patz, 3untin'ton5euroa"anthosis, Ma"hado # 2oseph, Luba'
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 7/41
KLINIS PENYAKIT PARKINSON
TRIAS PARKINSON
1. !"M#!$. %K&N"S&%'. !&(&)& %S
Hilang REFLEX POSTURAL“FREEZING”
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 8/41
KLINIS PENYAKIT PARKINSON
1. TREMOR :
Rest Tremor / Saat IstirahatMenin !at saat EmosiMen hi"an saat !er#aTan an $ #ari men hit%n %anKa!i & m%"%t
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 9/41
KLINIS PENYAKIT PARKINSON
'. AKINESIA / (RADIKINESIA :) S%"it mem%"ai era!an )Lam*an) S%"it *erhenti
+A,AH : a. M%!a to-en *. Ti a! a a e -resi 0. Ke i-an mata #aran,ALAN : a. Lan !ah !e0i"
*. Ti a! a a "am*aian 0. S%"it mem%tar *a"i!
(I ARA : a. Monoton& "am*an *. Tan-a La % s%ara
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 10/41
REFLEX POSTURAL HILANG :
LAIN2 GEJALA :
Tulisan “ Micrograa” Bicara Monotoon tanpa lagu bicara Reek Postural hilang Saat berdiri bila di DORONG TIDAK ADA reaksi / REFLEX sikap
Retropulsion TESLateropulsion TES
Antepulsion TES “Drolling Salivation” = Ngiler
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 11/41
2. 3e#a"a A4a" Pen5. Par!inson:
#$4 P? @Tremor 1'6 78&9Ri i itas / A!inesia 2 16&7K%ran tram-i" / ; s%"it t%"is ' 1'&23an %an ,a"an '1 11&9
N5eri oto& ram- otot& < A0hin = 19 >&'3an %an Psi!iatri > ?&?3an %an (i0ara 7 &>Ke"emahan %m%m@Fati %eB 9 '&7
N i"er 1&2,a"an tan-a "am*aian 1&2M%!a to-en 1&2D5s-ha ia 1 8&9Parestesia 1 8&9
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 12/41
'. DDC TREMOR PARKINSON:
1. Se!%n er Par!insonism:Infeksi penyakit atau zat
Slow Virus = Pasca Encefalitis letargica Toxic : KRONIS MPTP, Mn, CO, Mg, CS2, CN Trauma = Petinju (Pugilistic Encephalopathi)
Sepakbola
Lain : hipoparatiroid, hipothyroid, Multi infark,Degen. Hepatoserebral,Drug Induced Parkinsonism
'. Par!insonism P"%s @M%"ti Sistem De enerasiB
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 13/41
ORTI AL MOTOR AREAS
THALAMUS(ASAL
3AN3LIA
ERE(ELLUM
(RAINSTEM
SPINALORD
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 14/41
3AN3LIA (ASALIS
Ters%s%n ari !e"om-o! inti:
1. Striat%m @neo;"im*i0 striat%mB Neostriat%m : P%tamen @P%tB ;
N%0". a% at%s @N B'. 3"o*%s Pa"i %s @3PeB ; 3PiB
. S%*stansia Ni ra @SNB?. S%*tha"ami0 N%0"e%s @STNB
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 15/41
NEUROTRANSMITTER DI 3(
Striat%m menerima INPUT ari :
Korte!s @3"%tamaterni!BS%*stantia Ni ra @Do-aminer i!B D1 ; D'Pen %!%"o-ontis @ ho"iner i!B
Striat%m men e"%ar!an OUTPUT !e:,a"%r ire0t @3a*aer i!B,a"%r in ire0t @3a*aer i! ; "%tamater i!B
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 16/41
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 17/41
Re*i ro*a& Inhi5ition STRIATU(
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 18/41
)IR)UIT 0ASAL .AN.LIA
THALA(O )ORTI)AL
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 19/41
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 20/41
"a&2r Dire*t B In/er*t DYSTONIA
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 21/41
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 22/41
Kadar DA, NA, ADR & DERAJATKEPARAHAN GEJALA PP
,%m"ah !as%s DA NA ADR
Tremor:Rin anSe an(erat
17''
'2>.' 1?8.2?8.> ''2.117.2 172.7
'19.1 >'.'1'>.? 188.8'9'.9 188.>
>>.9 188.862.6 > .2
188.? 188.?
Ri i itas:Rin anSe an(erat
12'
6 .9 1?9.>>.9 12 .8
'19.8 7?.1
''1.1 7 .2'12.1 11>.11' .2 '>.1
>1. >6.81'1.8 166.7
97.9 97.9
A!inesia:Rin an
(eratSe an
11>'
?71.1 111.'9>.9 67.7'19.8 7?.1
'?9.9 >1.216?.8 > .91' .2 '>.1
72.> >1.'117. 1'8.8
97.9 97.9
Ke!a!%an *er#a"anRin anSe an
(erat
19?
'
>2.6 191.29.2 19?.8
'19.8 7?.1
'91.6 2>.111>.1 21.?
1' .2 '>.1
18'.' 182.22'.2 78.
97.9 97.9
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 23/41
(ANA.E(EN P,PARKINSON :
Pen o*atan -harma0o"o is an o-erasi ti a !onse- %tama :Sim tomatik-
Unt%! mem-er*ai!i !e"%han e#a"a ; tan a'Protektif-
Unt%! mem-er*ai!i *er asar -ato isio"o is
Restoratif-Meran san -ert%m*%han se" *ar% an -ert%m*%han
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 24/41
O(AT'AN P.PARKINSON :
Do amine Pre*2rsor :G Le o o-a : (en era i e J Ma o-ar
ar*i o-a J Sinemet
Do amine A'onist : G (romo0r5-tin G Per o"i eG Lis%ri e G A-omor-hine G ar*e o"ineG Prami-e o"e G Re-iniro"eDo amine Re&easer : G Amanta ineAnti )ho&iner'i* : G Trihe 5-hene i"G (en tro-ineG Etho-ro-a ine G (i-eri ine G Pro050"i ineG 50rimineAnti Histamini*s : G Di-henh5 ramineG Or-hema ine G Phenin amine G h"or-heno amine
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 25/41
O(AT'AN P.PARKINSON :Inhibitor MAOB (Mono Amine Oxidase) :- Selegiline (Jumex)
Inhibitor COMT ( Catechol – O – Nethyl Transferase) : - Entacapone - Tolcapone
Anti Depressant : - Amitryptilin / Tri- Fluoxetine / SSRI
Muscle Relaxan : - Cyclobenzaprine- Diazepam
Anti Dopamine Perifer : - DomperidoneCholinergic Perifer: - Clozapine
Agonist glutamat : - Amantadine Anti Oksidan : - Vit E, Vit C, Beta carotene
Beta Blocker : - Propanolol
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 26/41
AL.ORITH( (ANA.E(ENT P,PARKINSON
# !
>2n*tiona&Im airment C
(e in S5m-tomati0/ Ne%ro-rote0ti e Thera-5
(e in Ne%ro-rote0ti e Thera-5 Antio i ants
Do-amine A onists Se"e i"ineTremor
Pre ominant
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 27/41
AL.ORITH( (ANA.E(ENT
P,PARKINSON 9 !
Amantan ineAnti0ho"iner i0s
A e 28 5ears A e 28 5ears
De-omine a onist om*ination @ o-amine a onist "o4G
ose "e o o-aB
onser ati e oses o "e o o-a@0onsi ers RB
Le o o-a@0onsi er RB
Amanta ine
Res onseto thera y
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 28/41
AL.ORITH( (ANA.E(ENT
P,PARKINSON 4 !3oo
Res-onsePoor or noRes-onse
<+earin $ O = D5s!inesia
Lo4est ose tomaintain s5m-tom
0ontro"
In0rease ose onsi er other
ia nosi OMT inhi*itor om*ination o-amine
a onist "e o o-a A "e o o-a Amantan ine Se"e i"ine Anti0ho"iner i0 Sma""er& more re %ent
osin Dietar5 a #%stments
@-roteinB S4it0h o-amine
a onist
De0rease "e o o-a ose
A or in0rease ose o o-amine a onist
S4it0h o-amine a onist
onsi er s%r er5
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 29/41
Dosis O*at PP :
Levodopa + Carbidopa 10/100, 25/100,25/250 mg per hari
Levodopa + Benserazid 50/100 mg per hari Trihexyphenidyl3 – 15 mg per hariSelegiline10 mg per hariBenztropine Mesylate1 – 8 mg per hariBiperiden3 – 6 mg per hariChlorphenoksamin 150-400 mg per hariCycrimine 5 – 20 mg per hariOrphenadrine 150-400 mg per hari
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 30/41
Dosis O*at PP :
(romo0ri-tin Mes5"ate 9 $ ?8 m -er hariPer o"i e Mes5"ate8.79 $ 9 m -er hari
a*er o"ine 8.9 $ 9 m -er hariPrami-e o"e 1.9 $ ?.9 m -er hariRo-iniro"e 8.79 $ '.? m -er hariPro050"i ine 7.9 $ 8 m -er hari
Etho-ro-ra ine 8 $ 28 m -er hariA-omor-hine 18 $ >8 m -er hariEnta0a-one '88 $ 1288 m -er hariTo"0a-one 88 $ 288 m -er hari
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 31/41
Dosis O*at PP :
As!or*i0 A0i @ itamine B 988 $ 1888 m -er hari(eta0arotene @Pro itamine AB ?888 IU m -er hari
Pro-rano"o" 18 $ 8 m -er hari
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 32/41
Tin/akan 0e/ah P, PARKINSON :
Thalamotomy
Thalamic Stimulation Pallidotomy Subthalamic Stimulation
Implamantasi Jaringan SN
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 33/41
L $ o-a Meta*o"isme
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 34/41
L $ o-a Pharma0o!ineti0
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 35/41
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 36/41
(otor *om &i*ations erio/
D5s!inesias
A. horei orm / < an0e "i!e= mo ements(. Other orms : D5stonia& M5o0"oni0& et0a%se *5 Le o o-a treatment: F"%0t%ations
G +earin $ o G On $ o -henomenon
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 37/41
Pro'ression of Parkinson /isease
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 38/41
Tin a!an Kom-"i!asi T PP :
3enera" strate ies1B Mo i 5 "e o o-a $ Fra0tionate ose
G S%staine re"ease'B A MAOG( inhi*itor $ se"e i"ine
B A OMT inhi*itor $ enta0a-one $ to"00a-one?B A a onist $ -er o"i e G *romo0ri-tine
G -rami-e o"e G ro-inero"e
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 39/41
DOPA /e*ar5o=y&ase DD)!
inhi5ition
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 40/41
OMT Inhi*ition
8/18/2019 Penyakit Parkinson Fix!1
http://slidepdf.com/reader/full/penyakit-parkinson-fix1 41/41
Recommended