Epilepsy and Parkinsons

Question 1

What are the cardinal signs of Parkinsons Disease?

Answer 1

BRADYKINESIA plus at least one of:
Rigidity
Rest Tremor
Postural Instability

Question 2

How should motor complications be managed in patients on levodopa?

Answer 2

Fractionate doses of levodopa (smaller doses more frequently)
Reduce the dose and give adjuvant treatment

Question 3

Why are the ergot derived dopamine agonists e.g. bromocriptine and cabergoline rarely used now in the treatment of Parkinsons Disease?

Answer 3

Serosal Complications e.g. pleural and pericardial effusions

Also fibrotic valve abnormalaities

Question 4

List some of the common adverse side effects associated with anti-cholinergics

Answer 4

Dry mouth, constipation, blurred vision, dizziness, urinary retention, glaucoma

Question 5

Describe the three types of generalised and three types if partial sezires

Answer 5

GENERALISED = tonic clonic, absence, myoclonic

PARTIAL - simple, complex, secondary generalised

Question 6

Describe the mechanisms underlying seizures

Answer 6

EXCESS EXCITATION - glutamate, aspartate

INADEQUATE INHIBITION - GABA

Question 7

List some of the epileptogenic stimuli

Answer 7

Fever - febrile convulsions in children
Flickering lights
Lack of sleep
Alcohol Abuse
Drugs which lower seizure threshold  e.g. tri-cyclics, some Abx
Abrupt withdrawel of medication

Question 8

Describe the drug typically given in acute alcohol withdrawel

Answer 8

A reducing dose of chlordiazepoxide over 5-7 days is commonly used

Question 9

Describe the drug used for prophylaxis of Wernicke’s Encephaolpathy in patients undergoing alcohol detoxification.

Answer 9

IM or IV Pabrinex (parenteral high potency B complex vitamins)

Question 10

Describe the two main types of symptoms patients with Delerium Tremens experience

Answer 10

PSYCHIATRIC
Hallucinations, Confusion, Delusions, Severe Agitation
HYPERADRENERGIC
Tachycardia, Hyperthermia and excessive sweating, hypertension, tachypneoa, tremor, myadriasis, ataxia, cardiovascular collapse

Question 11

Describe the drugs common implicated in drug induced Parkinsonism

Answer 11

HIGH RISK
Dopamine Antagonists, Traditional Anti-Psychotics e.g. haloperidol, risperidone, Anti-emeteics e.g. metaclopramide and prochorperazine (dopamine anatgonists)
OTHERS
Valproate, Lithium, Calcium Channel Blockers, SSRIs

Question 12

Describe the management of drug induced parkinsonism

Answer 12

Stop the offending drug
Symptoms make take 3 or 4 months to resolve
Levodopa may be useful for symptomatic relief while symptoms wear off

Question 13

What is the worry about giving benzodiazepines in status epilepticus?

Answer 13

Respiratory Depression

Question 14

What is the worry about IV Phenytoin in status epilepticus?

Answer 14

Bradycardia