Challenges w/ Medical Management - Parkinson's

Question 1

sinemet can cause

Answer 1

DYSKINESIA

orthosatic hypotension

behavioral signs

Question 2

behavioral signs –> sinemet

Answer 2

confusion

hallucinations

paranoia

psychosis

Question 3

do all pts respond to sinemet

Answer 3

no!

1/3 respond for a lifetime

1/3 for 3-5 years

1/3 for 5-7 years

Question 4

on/off phenomenon

Answer 4

short duration therapeutic response followed by rapid decline in symptomatic relief

Question 5

what is the on/off phenomenon d/t

Answer 5

PD meds are toxic to the receptor sight

Question 6

what does the on/off phenomenon do overtime

Answer 6

grows more dramatic

“on” time becomes shorter

Question 7

what does the “off” time have

Answer 7

dyskinesia or severe bradykinesia

Question 8

what other phenomenon is there

Answer 8

“wearing off”

Question 9

when is PT attempted

Answer 9

“on” times

Question 10

how can we manage hypertonia

Answer 10

botox injections

Question 11

botox injection effects

Answer 11

are temporary

Question 12

surgical approaches

Answer 12

ventrolateral thalamotomy

pallidotomy

intracranial electrical stimulation

Question 13

ventrolateral thalamotomy

Answer 13

used for pts that have severe motor sxs

refractory to medical tx

Question 14

B thalatomy

Answer 14

tried for pts w/ B tremor

resulted in severe speech deficits

Question 15

intracranial electrical stimulation

Answer 15

experimental use of low level stimulators w/ promising results

Question 16

deep brain stimulation

Answer 16

surgical placement of electrodes into brain regions that control movement

Question 17

what does DBS allow

Answer 17

electrical stimulation to the area of altered brain activity

Question 18

what does DBS normalize

Answer 18

pattern of electrical activity w/in specific brain motor circuits

Question 19

how are the brain regions chosen –> DBS

Answer 19

specific brain sites chosen for specific problems

Question 20

DBS on one side of the brain

Answer 20

mainly affects sxs on the opposite side of the body

can have B/L DBS if sxs on both sides

Question 21

DBS inclusion criteria (1)

Answer 21

Dx of IPD

response to L-dopa

medical therapy optimized or limited

disabling tremor, dyskinesia or motor fluctuations

Question 22

DBS inclusion criteria (2)

Answer 22

no dementia or unstable co-morbid medical problems

appropriate pt expectations

adequate support & compliance

tremor is the primary symptom

Question 23

DBS exclusion criteria

Answer 23

absolute and relative

Question 24

absolute DBS exclusion criteria

Answer 24

atypical parkinsonism

lack of response to L-dopa

dementia

unstable co-morbid conditions including behavioral problems

Question 25

relative DBS exclusion criteria

Answer 25

presence of other CNS dz or brain atrophy

cognitive dysfxn

coagulopathies

unrealistic expectations for outcome

Question 26

when is first programming for DBS begin

Answer 26

1 month post implantation

Question 27

when does programming occur

Answer 27

every month until optimized

Question 28

what is required –> DBS management

Answer 28

annual maintenance checks

Question 29

what could switch off the DBS generator

Answer 29

any magnetic field

Question 30

what are contraindicated post implantation

Answer 30

MRI and diathermy

Question 31

PD is

Answer 31

progressive

death usually occurring secondary to complications

Question 32

how could outcomes be divided

Answer 32

postural instability/gait disturbed

tremor pre-dominant

Question 33

tremor pre-dominant

Answer 33

better prognosis

reflecting a slower progression of the destruction of the substantia nigra cells

Question 34

recent theories in management

Answer 34

fetal nigral or adult adrenal medulla transplants

stem cells from umbilical cord blood or fetal cells