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35 - Perioperative management of patients with Parkinson's disease

Published online by Cambridge University Press:  12 January 2010

By
Jorge L. Juncos
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Jorge L. Juncos
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction and overview of Parkinson's disease

Patients with Parkinson's disease (PD) face surgery more often than their age-matched counterparts due to injuries provoked by the gait and balance difficulties that characterize the advanced stages of this illness. Recent advances in neurosurgical techniques and an improved understanding of the pathophysiology of motor symptoms in PD has led to a renewed interest and an increase in the number of patients under going various neurosurgical procedures for PD. This chapter provides an overview of the principles and preoperative management of patients with Parkinson's disease (PD) and other parkinsonian states.

Parkinson's disease is an adult-onset neurodegenerative disorder characterized by progressive slowness of movement (bradykinesia), muscular rigidity, tremor, short stepped and stooped gait, and varying degrees of cognitive impairment. It affects close to 1 million mostly elderly Americans with an annual incidence of 20 new cases per 100 000 and a prevalence of 130 cases per 100 000. Its primary pathology is limited to the brain and consists of selective degeneration of the nigrostriatal dopaminergic pathway and the presence of Lewy bodies and Lewy neurites in surviving mesencephalic dopamine neurons, as well as in other brainstem and cortical neurons. Biochemically, the denervation results in striatal dopamine depletion which is linked to the above signs and symptoms. The cause of selective neuronal death, and therefore the etiology of PD is unknown, although hereditary and environmental factors are thought to play a role.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 430 - 438
Publisher: Cambridge University Press
Print publication year: 2006

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