فرآیند بیماری و درمان دارو در بیماری پارکینسون

Parkinson’s disease (PD) belongs to the neurodegenerative brain diseases. These diseases have in common that they usually start insidiously at middle age or late in life, progress relentlessly and affect multiple neuronal systems of the central nervous system. For the various groups of these diseases clinical vignettes exist if the disease has progressed sufficiently. The causes are often not known, but in recent years genetic factors have been detected to seem to play an important role. These factors create either a vulnerability to environmental influences in sporadic cases or are more prominently present in certain families. In general it is thought that disturbances of protein production or breakdown is the common mechanism in these conditions leading to a slow dysfunction and loss of the involved neurons in the brain. It is hoped that eventually a causual or protective treatment may arise from the increasing insights in pathogenetical mechanisms. To date no cure for these severe diseases exists. In some instances however important symptomatic treatment exists, particularly in PD. In that disease the dopaminergic nigrostriatal neurotransmitter system is primarily impaired leading to typical disturbances described below. A general problem in studying brain diseases is the difficulty to obtain functional data directly from the brain tissue. A diagnostic tool which offers a window on brain tissue function in man during life is functional neuro-imaging. This chapter will describe PD and the use of functional neuro-imaging techniques like single photon emission computed tomography (SPECT) and positron emission tomography (PET) in the study of PD. Of special interest are those radiotracer methods which enable measurement of striatal dopaminergic activity.