Movement Disorders

Question 1

What is the general overall disease-causing process of Parkinson’s disease?

Answer 1

• Degeneration of medium spiny DAergic neurons in the basal ganglia

Question 2

What are the classic motor symptoms of Parkinson’s disease? What are some non-motor effects?

Answer 2

• T - tremor (eases on movement)
• R - rigidity
• A - akinesia or bradykinesia
• P - postural instability
• Non motor
  
  • Orthostatic hypotension, anxiety, depression, insomnia, sexual dysfunction, urinary frequency, constipation

Question 3

Parkinson’s disease often co-exists with an element of orthostatic hypotension. How is the latter managed?

Answer 3

• Teach safe rising strategies, elevate head of bed, compression garments
• Salt supplements, fludrocortisone (fluid retention)

Question 4

What classes of pharmacological agents are used in the treatment of Parkinson’s disease?

Answer 4

• Dopamine replacement (L-DOPA and peripheral decaroxylase inhibitor)
• Dopamine agonists (bromocriptine, pramipexole)
• COMT inhibitors (entacapone)
• Anticholinergics, amantadine