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Parkinson's disease

Parkinson's disease (or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, and other functions. Parkinson's disease belongs to a group of conditions called movement disorders. Symptoms: It is characterized by muscle rigidity, tremor, a slowing of physical movement (bradykinesia) and a loss of physical movement (akinesia) in extreme cases.

Tremor The characteristic shaking associated with Parkinson's disease often begins in a hand. The tremors may occur when the hand is at rest. However, not everyone experiences tremors. Slowed motion (bradykinesia) Over time, Parkinson's disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and timeconsuming. When you walk, your steps may become short and shuffling. Rigid muscles Muscle stiffness can occur in any part of your body. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain. People may first notice this sign when you no longer swing your arms when you're walking. Impaired posture and balance Your posture may become stooped as a result of Parkinson's disease. Balance problems also may occur, although this is usually in the later stages of the disease. Loss of automatic movements Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be diminished and even lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak. Speech changes Many people with Parkinson's disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking.

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Dementia In

the later stages of Parkinson's disease, some people develop problems with memory and mental clarity. Mask-like face expression and small handwriting are only examples of the ample range of common motor problems that can appear with the disease Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic and progressive. There are other disorders that are called Parkinson-plus diseases. These include: Multiple system atrophy (MSA), Progressive supranuclear palsy (PSP) and Corticobasal degeneration (CBD).

Causes:
The exact cause of Parkinson's disease is unknown, but several factors appear to play a role, including: A lack of dopamine. Many symptoms of Parkinson's disease result from the lack of a chemical messenger, called dopamine, in the brain. This occurs when the specific brain cells that produce dopamine die or become impaired. Why and exactly how this happens isn't known. Low norepinephrine levels. People with Parkinson's disease also have damage to the nerve endings that make another important chemical messenger called norepinephrine. Norepinephrine plays a role in regulating the autonomic nervous system, which controls automatic functions, such as blood pressure regulation. The presence of Lewy bodies. Unusual protein clumps called Lewy bodies are found in the brains of many people with Parkinson's disease. How they got there and what type of damage, if any, Lewy bodies might cause is still unknown.

Risk factors for Parkinson's disease include:

Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age. Heredity. Having a close relative with Parkinson's increases the chances that you'll also develop the disease, although your risk is still no more than about 4 to 6 percent.

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Sex. Men are more likely to develop Parkinson's disease than women are.

Investigations Physical investigations Rombergs The Romberg test is used to investigate the cause of loss of motor coordination (ataxia). A positive Romberg test suggests that the ataxia is sensory in nature (depending on loss of proprioception.) If a patient is ataxic and Romberg's test is not positive, it suggests that ataxia is cerebellar in nature. Dysdiadokinesia The patient is asked to tap the hand frequently and when there is disorganization it is termed as dysdiadochokinesia. Tandom walking

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Tandem gait is a gait (method of walking or running) where the toes of the back foot touch the heel of the front foot at each step. Neurologists sometimes ask patients to walk in a straight line using tandem gait as a test to help diagnose ataxia. Knee heel test It is a method of assessing coordination of movements of the extremities . A test of voluntary motor coordination in which a person is asked to slowly touch the knee with the heel of the opposite leg, which is altered in cerebellar dysfunction. Finger nose test A test of coordination of the arms and hands in which an individual is asked to touch the tip of his or her nose with the index finger.
The diagnosis of Parkinson's disease is based almost entirely on results of the history and physical examination. Lab investigations may be performed to exclude other causes of parkinsonism. These investigations may include the following:

Plasma ceruloplasmin and copper to exclude Wilson disease Thyrotropin levels if hypothyroidism is suggested

Magnetic resonance imaging (MRI) may suggest the following:


Normal-pressure hydrocephalus (large ventricles) Subdural hematoma Tumor Multiple infarcts Multisystem atrophy (eg, decreased T2 signal in the striatum) Progressive supranuclear palsy (eg, midbrain atrophy)

Kampavatam
Kampavata (Parkinson's disease) is a slowly progressive disease of late adult life and is one of the most prevalent neurological disorders. In Rigveda Vepathu / Kampa (1:8:11, 5:36:3) has been mentioned. It occurs due to Indra Dusti, and even in Atharvaveda description of Vepathu is available. CARAKA SAMHITA:-

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In Ayurvedic texts various synonyms of Kampa is found. One of them is Vepathu which has been described as one of the eighty types of Nanatmaja Vata Vyadhi (Ca.Su-20/9) Kampa has been mentioned as one of the Vata Vikaras. In kampa, stambha etc Pitta is decreased and Kapha and Vata are vitiated (Ca.Su-17/65, 66). The increased Vata affecting the Marma (vital parts) causes Vepathu (ca. Su. 17/61). This concept provides a base for understanding the pathology of tremor relating to brain (Marma). Caraka also mentions that Stambha is a disorder of Snayu. The majority of the symptoms of Kampavata are also mentioned in different Avarana Gatisanga,. Tatha Adhikam Vaksvara Graha, Gurugatrata, Stambhana and Kampanam (Ca.Ci-28/224,225, 228) Caraka has also mentioned about Shiro kampam (Ca. Si- 5/57; Ca.Si- 9/86,87) SUSRUTA SAMHITA:The aggravated Vayu in Snayu, produces numbness, Kampa and when incarcerated in Sira (veins) it produces stiffness and painful condition. (Ni-1/27) It has been mentioned that poisoning due to Kalakuta and Mustaka manifests as Gatrastambha (rigidity) and Vepathu i.e. (tremors) (Su.K-2/12,15). Vepathu is also a long-term complication of Dushivisha (Su. K-2) ASTANGA SANGRAHA AND ASTANGA HRDAYA :The Kampa has been mentioned as one of the symptoms of Vata Prakopa (Ah.Su. -12) and has also been included in Sarvanga Vata (A.H.Ni15/15). Stambha occurs in the condition of Mamsagata Vata, Medogata Vata and Majjagata (A.S.Ni- 15/11,15; A.H.Ni-15/11,15). Kayasya Vepathu is mentioned as a symptom of ageing (A.S.Su. 8/22), and Kampa is noted in Raktakshaya, Pittakshaya and Kaphakshaya condition (A.S.Su- . 17/5)

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MADHAVA NIDANAM:Vepathu is the condition caused by Vata in which all the parts of the body including the head are having tremors. The clinical picture of Kampavata is shown in this way. CAKRADATTA:Explains some remedies useful for Kampavata Dvitiya Masha taila (Vatavyadhi-157-161), Tritiya Masha taila (Vatavyadhi162-164), and Saptaprastha Mahamasha taila (Vatavyadhi-181- 185) are the medications for the treatment of Bahu-Prakampa, Shirokampa, and Hastakampa. SARNGADHARA SAMHITA :Kampa has also been included under the Nanatmaja Vata vyadhi (PV- 7/12) Masadi Nasya it has been mention those relieves Paksaghata (Hemiplegia) associated with Kampa (tremor), Ardita (facial paralysis) and Manyastambha (Ut- 8/36,37)

Symptoms and signs. AVANAMANA (POSTURAL CHANGES) Caraka mentions that (Ca.Su-26/43-44) excessive use of Katu Rasa may lead to the flexed posture of the body (kyphosis). Avanamana is one of the important symptoms of Majjavritta vata. Vagbhata attributed it as sign of aging (A.S.Sha.-8/22), Vinamana symptom is also described in the symptomatology of Vata Jvara (Ca.Ni1/21,A.H.Ni-21/18, A.S.Ni- 2/12) while Vagbhata indicates it as one of the Purvarupa of jvara.

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Trauma to prana vaha srotas can lead to symptoms like vinamana. Caraka, Madhavakara mention that if Vata gets localized in Snayu (tendon) then there will be bow like bending of the body inwards or out ward along with contracture of the finger shortening of the body by curvature of the back or legs and other diseases of either the whole or any part of the body. Thus, here Vata, mamsa and majja dhatu are involved. Caraka says (Ca.Su-20/12) that Stambha is one of disorder of Karmas of Vata. Different parts may be observed in Caraka (Ca.Su- 20/11) as Manyastambha (Stiffness of sternomastoid), Grivastambha (Stiffness of neck), Trikagraha (Stiffness in sacral region) and Prushtagraha (Stiffness in back region). Visada The term Visada its literal meanings are stupor, depression. "Citta Dehayon Glani ( Dal on Su.Su -15/9) means a depressive state in which body and mind gets impaired to work. Cakrapani has explained the term as incapability of mind as well as the body to work (Ca.Ci.- 3/36). S.S A.S A.H C.S included in one of the characteristics of Tamasa Prakriti (1/25) causative factor of vitiation of Vyana Vayu symptom of Garbha bhava originated by tamo guna symptom in dimunition of shukra

KSHINAMATI (Dementia) Impairment in the functioning of the Buddhi or Mati is denoted as Kshinamati which is found as clinical feature in the patient of Kampavata . SMRITIHANI When the retention of true knowledge Tatvajnana is destroyed, that is called the derangement of memory, smritihani. -7-

VAK VIKRITI Vak vikriti is an important symptom of Kampavata. Vaksanga is one of the Nantamaja Vata vyadhi (Ca.Su.20)

Vakvikriti (due to Vata prakopa) produces symptoms like Kshama (low), Jarjar (broken) Ruksha (Dry), Sakkta (obstructed) ,and Sanna (hoarse) voice (Ca.Vi.-8/98) .

Vaksvargraha is a symptom of Kaphavrita Vyana. According to Charaka, vagendriya is governed by Prana Vayu. Disturbances in the rhythm of respiration (disturbances in function of Prana and Udana) may interfere with fluency of speech. This is particularly noted in Kampa Vata. Vibandha (constipation) Constipation is a common accompaniment of Parkinsons disease. The exact cause of this symptom is unknown but some attributing factor such as diminished food and fluid intake, salivary loss, slows gastric motility, swallowing is prolonged; the stomach takes longer to empty and food transverses through the intestine more slowly than normal person. Dushti of Apana and impairment in Majjagni significantly contribute for production of vibandha in Kampavata. Rasakshaya :Rasakshaya either due to its etiological factor or due to old age itself is characterized by Kampa, hritpida and shunyata. Rasakshaya and also other

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dhatus get decreased thats why Rasayana is strongly indicated for all such patients. Sukra Kshaya : Sukra is closely related with Rasa and Majja Dhatu as it gets nutrition from these Dhatus. Sukrakshaya is characterized by dourbalya(weakness), mukhasosha (dryness of mouth), pandu (pallor) , sada (depression), shrama (fatigue) etc. Further Caraka says that excessive indulgence in Sexual intercourse leads to Sukrakshaya, which produces symptoms including Vepathu (tremor), Visada (depression) Jadyata (dullness) Svara sada (feebleness of voice) which are seen in Kampavata. Ojas A dimunition of ojas produces symptoms like disorientation, roughness, constant weakness, affliction of sense organs, emaciation etc. Samprapti Dosha Vata all five types especially Prana, Vyana, Udana Pitta Sadhaka Kapha Tarpaka Dushya Dhatu Rasa, Majja, Shukrra, Mamsa Upadhatu Snayu, Ojas Mala Purisha, Vitsneha

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Srotas Rasavaha Sukravaha Majjavaha Mamsavaha

Type of srotodushti Sanga Agni jataragni Marga madhyama Site of production pakvashaya, shirastha majja Manifestation sarvanga Treatment principle Here Vata is obstructed by Kapha Vata kapha hara chikitsa should be applied

Kayam Cam Avangandha cam 1 teaspoon with milk at night after food (B.Prakasha) Kapkaccu cam 1 teaspoon with milk at night after food Krambu choornam 2 grams bd after food with honey Aavargam kayam 60 ml twice daily before food. (Sahasra Yogam) Badradrvdi kayam 60 ml twice daily before food. (A.H.Sutra sthanam Ganam) Danadanayandi kayam 60 ml twice daily before food. (Sahasra Yogam) Sahcharadi kashayam 60 ml twice daily before food Mashabalaatmaguptadi 60 ml twice daily before food

Siddha Medicines Poonaikali choornam 5 grams with milk at night after food Lashunadi choornam 3 grams with honey twice daily after food Tippali choornam 3 grams with honey twice daily after food Peimooti chorrnam 1 gram with honey twice daily after food - 10 -

Tablet Rasonadi vati 2 tablets twice daily after food Karuppu Vishnu Chakram 2 tablets twice daily after food Poornachandrodayam 1 tablet twice daily after food

Sendhuram Parpam Tailam Ariam Avagandhriam 15 ml bd after food. (Bhaishajya Ratnavali) Balriam - 15 ml bd after food. (Bhaishajya Ratnavali / S.Y) Sahacardi vasti pkam 1 teaspoon with milk at night after food Maha ma tailam 1 teaspoon with milk at night after food Peranda parpam 50 mg with ginger juice twice in a day Thanga parpam 50 mg with ginger juice twice in a day Chandamarutham 50 mg with ginger juice twice in a day (for 5 days) Rasasendhuram 50 mg with ginger juice twice in a day

Rasa ouadi Siddha makaradwajam tablet 1 tablet twice daily after food Bhatvta cinthmai 1 tablet twice daily after food. (Bhaishajya Ratnavali)

Snehapnam Rsna daamldi tailam

Abhyagam with ma svedam Sahacardi kuzhambu (A.H. Vata Vyadhi) Bal lkdi tailam Vatakesari tailam Vatakodari tailam

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Sukumra eradam 25 ml with hot water or hot milk (A.H. Vruddhi chikitsa)

Mmsa kizhi Vasti Dravyam Makshikam Lavanam Sneham Kshirabala tailam Sukumara ghrtam Kalkam Kshira Kashayam Mamsa rasam Total Nasyam karpooradi tailam 2 drops in each nostril poondu thailam 2 drops in each nostril nochi tailam 2 drops in each nostril chukku tailam 2 drops in each nostril Mustdi rjaypana vasti 900 ml Quantity 200 ml 15 grams 100 ml 100 ml 30 grams 400 ml 100 ml 900 ml

Rasyanam Pippali rasyanam 1 teaspoon bd after food. Lana rasyanam 15 ml with 15 ml of tailam

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