CNS - PARKINSONS

Question 1

What are the motor symptoms?

Answer 1

• Hyperkinesia
• Bradykinesia
• Rigidity
• Tremor
• Instability

Question 2

What are the non-motor symptoms?

Answer 2

• Dementia
• depression
• sleep disturbance
• speech and language change
• swallowing problems
• weight loss
• bladder problems

Question 3

What is the treatment for parkinsons disease?

Answer 3

• If motor symptoms impact quality of life - co-careldopa (carbidopa, levodopa), co-beneldopa ( carbidopa, benserazide)
• If motor symptoms do not affect quality of life - levodopa OR dopamine receptor agonists (e.g. ropinirole) OR MAOIs (e.g. rasagaline)

Question 4

What motor complications are associated with levodopa?

Answer 4

• response fluctuations - variation in motor performance
• dyskinesias
• motor complications are less likely to occur with dopamine-receptor agonists than with levodopa

Question 5

What ADRs are more likely to occur with domapine-receptor agonists than with levodopa?

Answer 5

• excessive sleepiness
• hallucinations
• impulse control disorders

Question 6

How would you avoid potential neuroleptic malignant syndrome?

Answer 6

avoid abrupt drug withdrawal

Question 7

What would you do if a parkinsons patient developed dyskinesia or motor fluctuations?

Answer 7

adjuvant therapy with levodopa

Question 8

What would you offer people with advanced parkinsons disease?

Answer 8

• Apomorphine hydrochloride - domperidone may also be needed to control n&v associated with taking this
• if domperidone is taken do cardiac tests - combo of both drugs can prolong QT

Question 9

What would you do if a patient was experiencing daytime sleepiness?

Answer 9

• inform the DVLA
• adjust parkinsons meds under specialist guidance
• consider drug treatment e.g. modafinil

Question 10

How would you treat nocturnal akinesia (loss of voluntary movement)?

Answer 10

• first line - levodopa OR dopamine receptor agonists

- second line if both ineffective - rotigotine

Question 11

How would you treat postural hypotension?

Answer 11

• First line - midodrine hydrochloride

- Second line as alternative - fludrocortisone

Question 12

How would you treat psychotic symptoms e.g. hallucinations?

Answer 12

• If well tolerated - do not treat
• figure out what drugs triggered and possibly reduce dose
• Patients with no cognitive impairment - use quetiapine
• Alternative = clozapine

Question 13

How would you treat rapid eye movement sleep behaviour disorder?

Answer 13

• Clonazepam OR melatonin

- both unlicensed

Question 14

How would you treat drooling of saliva?

Answer 14

• only consider drug treatment if non-drug treatment like speech/language therapy is not appropriate
• First line - glycopyrronium bromide
• Second line - botulinum toxin type A