2: Movement Disorders - Parkinsons Disease Flashcards
Define Parkinsonism
Syndrome caused by extra-pyramidal triad of tremor, hypertonia and bradykinesia
Define Parkinson’s Disease
Disease caused by degeneration of dopaminergic neurons in substantia nigra
Explain prevalence of parkinson’s disease with age
Increases
Which gender is PD more common
Male
What can cause Parkinsonism
- Wilson’s disease
- Anti-dopaminergic medications (Antipsychotics, Metclopramide)
- MTTP
- Post-encephalitis
- Dementia Puglistica
- CO poisoning
What is dementia pugilistica
Dementia caused by repetitive head trauma
What causes Parkinson’s disease
Idiopathic
Genetic (PINK1)
What are 4 risk factors for Parkinson’s disease
- FH
- Pesticide exposure
- Genetics (LRRK2)
- Diet - vitamin D Deficiency
If PD unilateral or bilateral symptoms
Unilateral
What is the triad of symptoms on PD
- Tremor
- Bradykinesia
- Rigidity
Explain bradykinesia in PD
- Difficultly initiating movement
- Movements are slow and decrease with amplitude with repetitive movement = micrographia
- Shuffling gait, stops when reaches objects
- Expressionless face
What tremor is present in PD
Pill-rolling tremor, present at rest
When is tremor worse in PD
Worse at rest. Exacerbated when stressed or tired
What are the two types of rigidity in PD
Lead-pipe
Cog wheel
What is lead-pipe rigidity
No tremor present
What is cog-wheel rigidity
Mix of hypertonia and tremor
What are 5 other symptoms of PD
- Drooling
- Unhabituated glabella reflex
- Psychiatric disturbance
- REM sleep disorder
- Postural hypotension
What psychiatric features are common in PD
Depression (40%)
Psychosis
When does REM sleep disorder occur in PD
Before motor symptoms
When does impaired olfaction occur in PD
Before motor symptoms
Why does postural hypotension occur in PD
Autonomic dysfunction
What are Parkinson plus syndromes
Syndromes that occur with Parkinsonism
What are the 4 Parkinson plus syndromes
- Multiple System atrophy
- Lewy body dementia
- Progressive supra nuclear palsy
- Cortical-Basal degeneration
What is multiple system atrophy also referred to as
Shy Drager
Explain presentation of multiple system atrophy
Presents with:
- Early autonomic symptoms
- Cerebellar signs
- Parkinsonism
What are 3 symptoms of early autonomic involvement
Erectile Dysfunction
Postural hypotension
Bladder atony
What is the mnemonic to remember cerebellar signs
DANISH
What are cerebellar signs
DDK
Ataxia
Nystagmus
Intention tremor
Slurred/Stacato speech
Hypotonia
What imaging is ordered in MSA
MRI
What sign on MRI is pathognomic of MSA
Hot-Cross Bun Sign
What is progressive supra nuclear palsy also called as
Steele-Richardson-Olszewki Syndrome
What are symptoms of Progressive Supranuclear Palsy
- Impaired vertical gaze. Downward gaze is worse than upward
- Dolls eye reflex is preserved
- Parkinsonism
- Trunk rigidity
- Slurred speech
What may patients with PSP struggle with
Reading
Walking down stairs
What is dolls-eye reflex
Eyes remain still when head moves
What imaging is ordered in PSP
MRI
What sign is pathognomic of PSP
Humming bird sign
What is problem,w with managing PSP
Poor response to L-Dopa
What is classic presentation of cortic-basal degeneration
Akathisia of a limb = causing alien limb syndrome
Dementia
Apraxia
Cortical sensory loss
Explain presentation of drug-induced parkinsonism compared to PD
Bilateral
Quicker onset of symptoms
Rigidity and tremor are rare
What is offered to treat PD
Levo-dopa and dopa decarboxylase inhibitor
When is levodopa and peripheral dopa decarboxylase inhibitor offered
If symptoms are impacting a patient’s QOL
What may be given with Levodopa to improve compliance
COMT inhibitor
What is second-line in PD
Monoamine Oxidase Inhibitor
Name a monoamine oxidase inhibitor
Selegiline
When are MAOI indicated
If symptoms are not impacting patient’s QOL
What is third-line for PD
Dopamine agonist
Name a dopamine agonist
Pramiprexole, Ropinirole
When are dopamine agonists preferred
Younger patients
What is offered for dyskinesia in PD
Amantidine
What is the MOA of amantaidine
NMDA antagonist
What surgical treatment can be used in PD
DBS of sub thalamic nucleus
When is deep brain stimulation of sub thalamic nucleus indicated in PD
Advanced Parkinson’s disease refractory to medical treatment
What drug is given for postural hypotension in PD
Midodrine
What is the MOA of midrodrine
Acts on peripheral a-receptors to increase vascular resistance
What is used to manage drooling in PD
Glycopyronium bromide
