Movement disorders

Question 1

Features of Parkinsonism

Answer 1

Akinesia, rigidity, tremor
Axial -postural instability, gait freezing

Essential feature -akinesia

Question 2

Commonest cause of Parkinsonism

Answer 2

Parkinsons disease

Atypical Parkinsonism -MSA,CBD,PSP

Question 3

Reversible parkinsonism

Answer 3

Drug induced
Metal deposition -copper, Mn
NPH

Question 4

Features suggestive of Parkinsons disease

Answer 4

Anosmia
REM sleep disorder -acts out dreams
Substantial response to L-dopa (upto 50%)
Drug induced dyskinesias

Question 5

New explaination of pathogenesis of Parkinsons disease

Answer 5

Exhibits protein self templating progression -similar to prion disease

Question 6

Test to diagnose congnitive impairment in Parkinsons

Answer 6

Visuospatial impairment

Draw intersecting pentagons -if cannot -poor prognostic sign

Question 7

Cognitive syndromes in Parkinsons

Answer 7

1.Frontal executive syndrome -present at diagnosis
Correlates with dopamine depletion
Does nor correlate with dementia
Responds to dopamine replacement

2.Posterior visuospatial syndrome
Sinister sign- correlates with dementia.
Cannot draw intersecting pentagons

Question 8

Dopaminergic therapy for Rx

Answer 8

MAO -B inhibitors -selegiline, rasagiline
Dopamine agonists-Pramipexole, rotigotine,apomorphine
Levodopa(+/-COMT) -Sinemet, Kinson,Madopar (Entacapone)

Question 9

Characteristics of MAO -B inhibitors

Answer 9

Simple dosing
Modest benefit
S/E insomnia
Low chance of serotonin syndrome with SSRI

Question 10

Dopamine agonist characteristics

Answer 10

Benefit -improve mood,mood and motivation
S/E: Impulse control disorder*-hypersexuality,gambling
Sleeping, psychosis

Question 11

Levodopa

Answer 11

Most effective drug for movement

S/E -motor fluctuations -10% per year from starting Rx

Question 12

Risk factors for development of motor fluctuations

Answer 12

Age, duration of disease

Question 13

Management of motor fluctutations with L dopa

Answer 13

Fractionation -smaller doses, frequent intervals

Question 14

Advanced therapies for motor fluctations

Answer 14

Apomorphine via s/c infusion
Levo dopa via PEJ . Risk of peritonitis
Deep brain stimulation -subthalamic nucleus and GB interna

Question 15

Dementia in Parkinsons - management

Answer 15

Cholinesterase inhibitor

Question 16

Psychosis in Parkinsons

Answer 16

First cease anticholinergic or dopamine agonist before commencing antipsychotics
Clozapine is ideal treatment, not used much because of agranulocytosis, cardiomyopathy
Currently Rx is with quetiapine

Question 17

Depression in Parkinsons

Answer 17

Consider dopamine agonist before commencing SSRI/TCA

Question 18

MOA of amantadine

Answer 18

Increase dopamine release, inhibit reuptake and stimulate dopamine receptors

Question 19

ET criteria

Answer 19

Bilateral symmetrical action tremor
Absence of other neurological signs except cog wheeling
Head tremor, no dystonia
Secondary criteria: Long duration, family history, benefit with alcohol

Question 20

Most common symptom of levodopa excess

Answer 20

Nausea and vomiting

Question 21

Tauopathies

Answer 21

FTD, CBD, PSP