Movement disorders Flashcards
Features of Parkinsonism
Akinesia, rigidity, tremor
Axial -postural instability, gait freezing
Essential feature -akinesia
Commonest cause of Parkinsonism
Parkinsons disease
Atypical Parkinsonism -MSA,CBD,PSP
Reversible parkinsonism
Drug induced
Metal deposition -copper, Mn
NPH
Features suggestive of Parkinsons disease
Anosmia
REM sleep disorder -acts out dreams
Substantial response to L-dopa (upto 50%)
Drug induced dyskinesias
New explaination of pathogenesis of Parkinsons disease
Exhibits protein self templating progression -similar to prion disease
Test to diagnose congnitive impairment in Parkinsons
Visuospatial impairment
Draw intersecting pentagons -if cannot -poor prognostic sign
Cognitive syndromes in Parkinsons
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
Dopaminergic therapy for Rx
MAO -B inhibitors -selegiline, rasagiline
Dopamine agonists-Pramipexole, rotigotine,apomorphine
Levodopa(+/-COMT) -Sinemet, Kinson,Madopar (Entacapone)
Characteristics of MAO -B inhibitors
Simple dosing
Modest benefit
S/E insomnia
Low chance of serotonin syndrome with SSRI
Dopamine agonist characteristics
Benefit -improve mood,mood and motivation
S/E: Impulse control disorder*-hypersexuality,gambling
Sleeping, psychosis
Levodopa
Most effective drug for movement
S/E -motor fluctuations -10% per year from starting Rx
Risk factors for development of motor fluctuations
Age, duration of disease
Management of motor fluctutations with L dopa
Fractionation -smaller doses, frequent intervals
Advanced therapies for motor fluctations
Apomorphine via s/c infusion
Levo dopa via PEJ . Risk of peritonitis
Deep brain stimulation -subthalamic nucleus and GB interna
Dementia in Parkinsons - management
Cholinesterase inhibitor
Psychosis in Parkinsons
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
Depression in Parkinsons
Consider dopamine agonist before commencing SSRI/TCA
MOA of amantadine
Increase dopamine release, inhibit reuptake and stimulate dopamine receptors
ET criteria
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
Most common symptom of levodopa excess
Nausea and vomiting
Tauopathies
FTD, CBD, PSP
