Clinical: Parkinson's

Question 1

What are the cardinal clinical features of someone with Parkinson’s?

Answer 1

Asymetrical condition (at least starts that way)

• Rest tremor, slow frequency
• Bradykinesia, reduced arm swing, reduced rapid alternating movement, movements start with arge amplitude and peters out *(decrement)
• Rigidity (cogwheel rigidity)
• Postural abnormalities: stooped posture, difficulty arising from chair

Question 2

How do you diagnose Parkinsons?

Answer 2

Must have atleast two of the cardinal features

May do a response to levodopa

Question 3

Non motor symptoms of Parkinsons

Answer 3

Anosmia; constipation; REM sleep behaviour disorder; depression

Onset is insidious

Question 4

Pathology of Parkinsons

Answer 4

Depletion/degeneration of dopaminergic neurons of the substantia nigra.
Can be due to an accumulation of misfolded proteins (alpha synuclein?)
May have Lewy bodies

Question 5

Pathogenesis

Answer 5

Typically a genetic susceptibility, such as mutation on c4 causing early onset. Viral infectionencephalitis lethargica

Question 6

What are the types of drug treatment?

Answer 6

L-DOPA- precursor for dopamine that crosses BBB. Don’t use dopamine for peripheral side effects.

May also use MAO B inhibitor and COMT inhibitors to prolong the half life of dopamine

Question 7

What are some surgical treatments?

Answer 7

Stereotactic thalamotomy an pallidotomy.

Deep brain stimulation to inhibit overactive neruons.

Question 8

What are some late complications of Parkinsons?

Answer 8

• Cognitive abnormalities- confusion
• Depression
• Postural hyopotension
• Fluctuations: Due to short half life of drug and neurodegeneration get a mix of effects such as dyskinesia

Question 9

REM sleep behaviour disorder

Answer 9

Acting out of dreams, and can precede motor symptoms of Parkinsons by years. Does dont respond to L-DOPA but clonazepan works