Lecture 31: Parkinsons Disease Flashcards
What is the cardinal manifestation of parkinsons?
- Rest tremor
- Rigidity
- Bradykinesia
- Postural instability and gait disturbance
Pre-motor and post motor symptoms ie depression and the cognitive deficits are the worst part
Describe the onset of PD
Asymmetrical onset - progresses to bilateral
Write some notes on the tremor:
Common presenting complaint but not universal
- Pill rolling (4-5hz)
Write some notes on the rigidity:
- Velocity independent increased tone (leadpipe, slow passive movements at write, elbow)
- Cogwheel phenomenon
- Brought out by coactivation of ‘synkenesis’
Write some notes on the akinesia/bradykinesisa:
- SLOWNESS and poverty of movement with FATIGUING and DECREMENT
- Global
- Reduced blink Hz
Write some notes on the gait and postural changes:
- Slow, reduced stride length (SHUFFLING GAIT)
- Forward flexion / stooping, reduced arm swing
- FREEZING GAIT (‘feet stuck to ground’, difficulty initiating, turning around)
- Postural instability and falls
What are the non-motor features of PD?
- ANOSMIA
- RSBD
- MOOD DISORDERS, depress, anxiety
- Autonomic dysfunction i.e Constipation
- Cognitive decline
What is the pathology of PD?
- Loss of dopaminergic neurons in the SNc
- Presence of Lewy Bodies (aggregates) in the brainstem, basal ganglia and cortex
Write some notes on L-dope:
- Replaces dopamine in brain
- Combined with dopa decarboxylase to prevent peripheral conversation
Adverse
- Nausea
- low BP
- Levidopa induced dyskinesia
- Can worsen confusion
- Tolerance
What are some other drugs given in PD?
- Dopamine agonists
- MAO-B inhibitors
- COMT inhibitors (Prolongs L-Dopa)
- Amantadine (reduces dyskinesia)
What are some advanced therapies?
- Apomorphine pumps
- DBS
- Duodopa intestinal gel infusion
Write some notes on subcutaneous apomorphine:
- Dopamine agonist
- Single injections result in sudden offs, but a continuous infusion… (much like insulin)
Downside can cause nausea, nodules at injection sites
Write some notes on DBS for PD:
- Increases on time without dyskinesia
- Targets GPi (Dyskinesia) or STN (motor symptoms)
BUT STN targeting can worsen ON freezing, postural instability, speech
Write some notes on duodopa:
- Levodopa/carbidopa intestinal gel
- Requires peg tube with duodopal extension
- Reduces fluctuations related to absorption (Delayed GI emptying, diet related competition for absorption)
- Can have extra bolus
- Common to have complications related to tubing
Good alt. to DBS
