24 - Neurological Disorders Flashcards
What are some clinical features of Parkinsonism?
Motor: resting/pill rolling tremor, bradykinesia, rigidity, postural instability, shuffling gait
Non-motor: mood changes (depression), cognitive change, urinary symptoms, sleep disorders, sweating, pain
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After 15 years, what clinical features will patients with PD have during follow up?
- Dyskinesia (94%) (secondary to LDopa treatment)
- Falls (81%)
- Cognitive decline (84%)
- Somnolence (80%)
- Swallowing difficulties (50%)
- Severe speech problems (27%)
How do you make a diagnosis of idiopathic Parkinson’s Disease?
- Clinical features
- Exclude other causes of Parkinsonism
- Response to treatment
- Normal structural neuro-imaging e.g PET
What are some non-idiopathic causes of Parkinsonism?
- Drug induced
- Vascular
- Progressive supranuclear
- Corticobasal degeneration
What is the pathology of idiopathic parkinson’s disease?
- When over 50% loss of pigment this is when symptoms occur
- Lewy body deposition in pars compacta of substantia nigra causes neurodegeneration
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How is the basal ganglia circuit affected in Parkinson’s disease?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/433/744/302/a_image_thumb.jpeg?1583681873)
How is dopamine synthesised and degraded?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/433/744/306/a_image_thumb.jpeg?1583681948)
What are the six different classes of drugs used to treat IPD?
- Levodopa (L-DOPA)
- Dopamine receptor agonists
- MAOI type B inhibitors
- COMT inhibitors
- Anticholinergics
- Amantidine
Why is L-DOPA used to treat IPD instead of Dopamine?
- Dopamine receptor agonists
- It is given orally and must be taken up by dopaminergic cells in the substantia nigra to be converted to dopamine
- Given up to 5 times a day as short half life of 2 hours
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How is L-Dopa absorbed when taken orally?
Don’t eat big protein meals with Levodopa as there will be more competition for absorption
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What is L-Dopa administered with?
- Peripheral DOPA decarboxylase inhibitor (co-careldopa/co-beneldopa)
- Reduces the dose required, reduces side effects and increases amount of L-Dopa reaching the brain
![](https://s3.amazonaws.com/brainscape-prod/system/cm/433/744/314/a_image_thumb.jpeg?1583685280)
What are the advantages and disadvantages of using L-Dopa in IPD?
+ Highly efficacious
+ Low side effects (e.g nausea, vomiting, hypotension, tachycardia, psychosis)
- Needs enzyme conversion
- Involunrary movements
- Loses efficacy as disease progresses as loss of neurones
- Motor complications e.g freezing, dystonia
What DDIs does L-Dopa have?
- Pyridoxine (Vit B6): increases peripheral breakdown of L-DOPA
- MAOIs: risk hypertensive crisis
- Antipsychotic drugs: lead to parkinsonism (block dopamine receptors)
What are some different subtypes of dopamine receptor agonists and give some examples in each subtype?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/433/744/321/a_image_thumb.jpeg?1583685726)
What are the advantages and disadvantages of using dopamine receptor agonists as treatment for IPD?
+ direct acting
+ less motor complications/dyskinesias
+ possible neuroprotection
- less efficacy than L-Dopa
- impulse control disorders
- more psychiatric side effects
- expensive