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MPTP toxicity is due to inhibition of complex‐1 of the mitochondrial electron transport chain, leading to lack of ATP and cell death.
In Parkinson’s disease, there is a 30–40% decrease in complex‐1 activity in the substantia nigra pars compacta which may contribute to energy failure and hence predispose the pars compacta to toxic insults and increase its susceptibility to cell death.68 Oxidative stress may be caused by an increase in the number of reactive species including hydrogen ions, superoxide, peroxyl radicals, nitric oxide, and hydroxyl radicals.
1).58 The nigrostriatal pathway projects from the substantia nigra pars compacta to the striatum, where it makes two kinds of synapses on the projection neurones.In Parkinson’s disease, acetylcholine is present in normal amounts in the striatum.However, dopamine deficiency produces imbalance in the dopamine:acetylcholine ratio, thereby aggravating the symptoms of Parkinson’s disease.The syndrome of (clinical conditions which resemble idiopathic Parkinson’s disease) may have a number of different causes such as arteriosclerosis, diffuse central nervous system degenerative disease, repeated head trauma, tumour, metabolic defects such as Wilson’s disease, heavy metal, or carbon monoxide poisoning.Drug‐induced parkinsonism results from dopamine receptor block by drugs such as phenothiazines, butyrophenones, and metoclopramide.
This highlights the difficulty of diagnosis and emphasizes that many elderly hospital patients may have undiagnosed Parkinson’s disease.