QR Code Creator In Visual C#.NET
Using Barcode printer for .NET Control to generate, create QR-Code image in VS .NET applications.
Generating QR Code ISO/IEC18004 In Visual Studio .NET
Using Barcode maker for ASP.NET Control to generate, create QR Code 2d barcode image in ASP.NET applications.
MAJOR CATEGORIES OF NEUROLOGIC DISEASE
Quick Response Code Generation In .NET Framework
Using Barcode generation for Visual Studio .NET Control to generate, create QR-Code image in .NET applications.
Drawing QR Code JIS X 0510 In Visual Basic .NET
Using Barcode generator for Visual Studio .NET Control to generate, create QR Code image in Visual Studio .NET applications.
Table 39-2 Genetic defects associated with Parkinson s disease
Creating GS1 128 In Visual Studio .NET
Using Barcode generator for ASP.NET Control to generate, create UCC - 12 image in ASP.NET applications.
Making DataMatrix In C#
Using Barcode creation for .NET framework Control to generate, create Data Matrix image in VS .NET applications.
NOTATION CHROMOSOME GENE GENETICS AGE OF ONSET LEWY BODIES SPECIAL FEATURES
GS1 - 12 Generation In Visual Basic .NET
Using Barcode printer for VS .NET Control to generate, create UPC-A Supplement 2 image in VS .NET applications.
Draw UPC - 13 In VB.NET
Using Barcode generation for .NET Control to generate, create EAN / UCC - 13 image in Visual Studio .NET applications.
Encoding GS1 128 In Objective-C
Using Barcode generation for iPad Control to generate, create EAN / UCC - 13 image in iPad applications.
Code 128C Creation In .NET Framework
Using Barcode creator for ASP.NET Control to generate, create Code 128 Code Set C image in ASP.NET applications.
Code39 Decoder In .NET
Using Barcode decoder for Visual Studio .NET Control to read, scan read, scan image in VS .NET applications.
Generate Barcode In None
Using Barcode generation for Font Control to generate, create barcode image in Font applications.
Generate GS1 - 12 In None
Using Barcode creator for Font Control to generate, create UPC-A image in Font applications.
Code 3/9 Encoder In VS .NET
Using Barcode generation for ASP.NET Control to generate, create Code39 image in ASP.NET applications.
Generate GS1 DataBar Stacked In Visual Studio .NET
Using Barcode generation for .NET Control to generate, create GS1 DataBar Limited image in Visual Studio .NET applications.
Code 128 Encoder In None
Using Barcode printer for Software Control to generate, create USS Code 128 image in Software applications.
30 40 years 20 40 years
GS1 DataBar-14 Maker In Java
Using Barcode generation for Java Control to generate, create GS1 DataBar-14 image in Java applications.
Code-39 Decoder In C#
Using Barcode scanner for .NET Control to read, scan read, scan image in VS .NET applications.
Decoding Bar Code In Java
Using Barcode recognizer for Java Control to read, scan read, scan image in Java applications.
GS1-128 Maker In Java
Using Barcode generation for Android Control to generate, create EAN / UCC - 13 image in Android applications.
Park6 Park7 Park 8 NR4A2
1p36 1p36 12 cent 2q22
PINK1 DJ-1 dardarin NURR1
AR AR AD AD
varies 30 s late
Two main mutations: A53T, A30P: promote oligomerization of -synuclein Accounts for 50% of early-onset inherited PD; 20% of sporadic early onset cases Gene is E3 ubiquitin protein ligase; activity is decreased by parkin mutations PET: widespread reductions in dopamine uptake (unlike sporadic PD) Gene is ubiquitin carboxy-terminal hydrolase L1 Mutations decreased recycling of ubiquitin monomers Mitochondrial gene Slow progression; gene plays role in cellular response to oxidative stress Gene is novel kinase Gene is implicated in the formation and identity of dopaminergic neurons
Clinical Features A tetrad of hypo- and bradykinesia, resting tremor, postural instability, and rigidity are the core features of Parkinson disease These are evident as expressionless face, poverty and slowness of voluntary movement, resting tremor, stooped posture, axial instability, rigidity, and festinating gait These manifestations of basal ganglionic disease have been fully described in Chap 4, and only certain diagnostic problems and nuances of the clinical picture need be considered here The early symptoms may be dif cult to appreciate and are often overlooked by family members because they evolve slowly and tend to be attributed to the natural changes of aging The voice becomes soft and monotonous For a long time the patient may not be conscious of the inroads of the disease At rst the only complaints may be of aching of the back, neck, shoulders, or hips and of vague weakness A slight stiffness and slowness of movement or a reduction in the natural swing of one arm during walking are ignored, until one day it occurs to the physician or to a member of the family that the patient has the cast of Parkinson disease Infrequency of blinking, as pointed out originally by Pierre Marie, is often a helpful early sign The usual blink rate (12 to 20 per minute) is reduced in the parkinsonian patient to 5 to 10 per minute, and with it there is a slight widening of the palpebral ssures, creating a stare (Stellwag sign) A reduction in movements of the small facial muscles imparts the characteristic expressionless masked appearance (hypomimia) When seated, the patient makes fewer small shifts and adjustments of position than the normal person (hypokinesia), and the ngers straighten and assume a exed and adducted posture at the metacarpophalangeal joints The characteristic tremor, which usually involves a hand, is often listed as the initial sign; but in at least half the cases, observant family members will already have remarked on the patient s relative immobility and reduction or slowness of movement More-
over, in 20 to 25 percent of cases the tremor is mild and intermittent or evident in only one nger or one hand The tremor of the fully developed case takes several forms, as was remarked in Chap 6 The four-per-second pill-rolling tremor of the thumb and ngers, while most characteristic, is seen in only a proportion of patients and is typically present when the hand is motionless, ie, not used in voluntary movement (hence the term resting tremor) Complete relaxation, however, greatly reduces or abolishes the tremor, and a volitional movement usually dampens it momentarily The rhythmic beat coincides with an alternating burst of activity in agonist and antagonist muscles in the electromyogram (EMG); hence the apt description alternating tremor is also applied The arm, jaw, tongue, eyelids, and foot are less often involved Even the least degree of tremor is felt during passive movement of a rigid part (cogwheel phenomenon, or Negro s sign) The tremor shows surprising uctuations in severity and is aggravated by walking and excitement, but the frequency of the tremor remains constant (Hunker and Abbs) It bears repetition that one side of the body is typically involved before the other, and the classic tremor then remains asymmetrical as the illness advances Lance and associates have called attention to a second common type of tremor in Parkinson disease a ne, seven- to eightper-second, slightly irregular action tremor of the outstretched ngers and hands This tremor, unlike the slower one, persists throughout voluntary movement, is not evident with the limb in a resting position, and is more easily suppressed by relaxation Electromyographically, it lacks the alternating bursts of action potentials seen in the more typical tremor and resembles, if not equates with, essential tremor (page 81, Table 6-1)) It is subject to different medications than those used for the alternating tremor The Parkinson patient may have either type of tremor or both We have been less impressed with rigidity and hypertonus as