لخّصلي

ABSTRACT
Young onset Parkinson’s disease is a rare
central nervous system disorder which affects
by an age of onset between 21-45 years. Young
onset Parkinson’s disease is characterized by
motor symptoms and non-motor symptoms.
Motor symptoms such as postural instability,
tremor, rigidity, bradykinesia and non-motor
symptoms such as psychosis, confusion, and
hallucinations. We report a case on 28 year old
female with young onset Parkinson’s Disease
and treated with pharmacological management
and adjuvant therapies.
Keywords: Anticholinergics, Bradykinesia,
YOPD
INTRODUCTION
Young onset Parkinson’s disease
(YOPD) is a subtype of Parkinson’s disease
that develops between 21 and 45 years of
age, with specific symptoms, genetic
correlation, and treatment strategies. The
genetic factors play a larger role in youngonset Parkinson’s Disease, and researchers
have found certain genetic mutations like
PRKN, SNCA, Parkin (Park2), PINK1
(Park6), LRRK2 are involved[1]
. Positive
Parkinson’s disease below 21 years of age is
referred to as juvenile Parkinson’s disease.
Young onset Parkinson’s disease is
characterized by motor symptoms and nonmotor symptoms. Motor symptoms such as
postural instability, tremor, rigidity,
bradykinesia and non-motor symptoms such
as psychosis, confusion, and hallucinations
can be present as the early indication of the
disorder. Multiple outsourcing of
bradykinesia such as micrography, mobility
problems, decreased facial expression,
decreased blinking rate, drooling, difficulty
in rising from a low level are present.
Dystonia, hyperreflexia, irregular behavior
and/or clinical symptoms are common
characteristics of young-onset 'classical'
parkinsonism.[2]
The diagnosis of YOPD is
based on the judgment of clinical
symptoms. The recently US Food and Drug
Administration (FDA)-approved DaTSCAN
is being questioned for its accuracy and
overall contribution to the diagnosis of
Parkinson disease[3,4]
. It has been shown that
the overall accuracy of clinical diagnosis is
84% in early Parkinson’s disease and 98%
at later stages of Parkinson disease. There is
a complex treatment decision on the
treatment of young onset Parkinson’s
disease due to functional disability, severity
of the disease .The most effective treatment
for Parkinson disease is levodopa due to its
effective treatment in decreasing
bradykinesia and rigidity. Alternative
treatment options to start therapy in Young
onset Parkinson disease are Dopamine
agonists, inhibitors of monoamine oxidase B
(selegiline hydrochloride, or rasagiline
mesilate), amantadine hydrochloride, or
where tremor is a particular problem,
anticholinergics, surgery like Deep Brain
Stimulation (DBS)[5]
and novel therapies
like cell based therapy and immunotherapy,
gene therapy. All of these drugs can be used
alone or in combination with levodopa to
successfully treat Parkinson’s disease.
Physical and occupational therapy in YOPD
patients should be used with
pharmacological treatment and may assist in
Jashlyn Lijo.J et.al. Case report on young onset Parkinson’s disease.
International Journal of Research and Review (ijrrjournal.com) 325
Vol.7; Issue: 11; November 2020
the rehabilitation process. Initiating an early
exercise program of Parkinson’s disease
will be benefit for the secondary motor
problems involving arm swing, gait, and
posture. Exercise has been shown to
improve physical function, health-related
quality of life, leg strength, balance, and gait
speed in Parkinson’s disease, and is possibly
mediated through increased calcium/CaMdependent dopamine synthesis in the
remaining dopaminergic nigrostriatal cells
[3]
. YOPD patients with speech difficulties
might benefit from intensive voice therapy
to maintain employment and social activity.
We report a case with young onset
Parkinson’s disease that has been
successfully treated with proper counselling,
levodopa and anticholinergics.
CASE PRESENTATION
A 28 year old female admitted in the
tertiary care hospital with the complaints of
drooling of saliva, difficulty in walking and
eating, tremor, slurry speech and her upper
and lower limb has paralysed for past one
week. On the examination of her past
medical history she had two episodes of
seizure before two years her social habits
were normal. On her physical examination
she was conscious and was not dyspneic at
rest. Her vitals and her systemic
examinations were normal. On analysing
motor functions reflex and tone was normal
at right and exaggerated at left and Babinski
was extensor in right and left .On laboratory
investigations haemoglobin was decreased
11.1g/dl, Platelet Distribution width was
15%, renal profile BUN was increased 19
mg/dl, thyroid profile TSH 6.66mIU/L.
hypodensity in the left medial occipital lobe
was found in CT and her ECG report shows
sinus tachycardia with short PR interval.
She was diagnosed as young onset
Parkinson’s disease with hypothyroidism.
The pharmacological treatment in hospital
was T.carbidopa 10 mg and T levodopa
100mg ,T folic acid 5 mg,T.propamolol 10
mg, T.trihexyphenidyl 2mg,T.pantoprazole
40 mg, T.clonazepam 0.5 mg, T bepotastine
10 mg, T.levothyroxine sodium 25 mcg and
the non pharmacological treatment is to do
physiotherapy. Patient felt symptomatically
better and was discharged on the seventh
day of her admission.
DISCUSSION
Young onset Parkinson disease is a
subtype of Parkinson’s disease that affects
the age between 21-45 years and is difficult
to diagnose at early stages. Differentiating
Parkinson’s disease from other forms of
Parkinsonism is difficult as its symptoms
are usually confused. The full range of
cardinal symptoms of Parkinson disease
such as bradykinesia, tremor, rigidity and
postural instability helps to diagnose the
disease. Treatment options to start the
therapy of YOPD are dopamine agonists ,
monoamine oxidase inhibitors, amantadine
hydrochloride, anticholinergics was
described by Natasa Klepac, an update on
the management of young onset Parkinson’s
disease. All these drugs can be used alone or
in the combination of levodopa an dopamine
precursor.
[3] Using levodopa and
anticholinergics trihexyphenidyl shows a
positive result for this patient were it is
associated with a decreased risk of
developing motor complications and
neuroprotective effect described by Ubaldo
Bonuccelli in Role of Dopamine Receptor
Agonists in the Treatment of Early
Parkinson's Disease.[6]
The patient was
discharged on the seventh day as she was
symptomatically felt better. Clinical
Pharmacist plays a great role in young onset
Parkinson disease because parkinsons
disease is slow and chronic course,
pharmacists should see these patients or
their caregivers frequently. Healthcare
professionals involved in the
pharmacotherapy management and
distribution spectrum of Parkinson’s disease
should be concerned about the overall safety
of the medications, the safety of
polypharmacy regimens, drug interactions,
and education of the patient and family
about benefits and risks of the medication
regimen. Pharmacists, in particular, are
traditionally more focused on drug safety
Jashlyn Lijo.J et.al. Case report on young onset Parkinson’s disease.
International Journal of Research and Review (ijrrjournal.com) 326
Vol.7; Issue: 11; November 2020
and interactions as well as on providing
instructions on proper use of medications.
CONCLUSION
Young onset Parkinson’s disease
(YOPD) is a subtype of Parkinson’s disease
that develops between 21 and 45 years of
age. Pharmacological treatment and
adjuvant therapies play a major role in the
treatment for young onset Parkinson
disease. Clinical pharmacist plays an
important role in monitoring the safety of
patients’ medication, drug interactions and
proper use of medications to decrease the
further complications of the
neurodegenerative disorder.
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3. Natasa klepac,Mario Habek,[…],and Ivo
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How to cite this article: Jashlyn Lijo.J, James
PM, Haja Sherief.S et.al. Case report on young
onset Parkinson’s disease. International Journal
of Research and Review. 2020; 7(11): 324-326.