Movement Disorders Flashcards
What are the key features of akinesia/bradykinesia in the diagnosis of Parkinsonism?
Slowness, but most importantly, fatiguing and decrement in size of repetitive movement.
What are the diagnostic criteria for Parkinsonism?
(1) Akinesia AND one of: A. Rigidity OR B. Tremor
(2) Absence of absolute exclusion criteria.
(3) Two supportive criteria
(4) No red flags
What are the absolute exclusion criteria for idiopathic Parkinson’s disease (9)?
(1) Cerebellar abnormalities
(2) Downward vertical gaze palsy/slowing of vertical saccades.
(3) Diagnosis of frontotemporal dementia
(4) Exclusively limited to the lower extremities for > 3 years
(5) Treatment with a dopamine receptor blocker
(6) Absence of observable response to levodopa
(7) Cortical sensory loss, apraxia or aphasia
(8) Normal functional neuroimaging of the dopaminergic system
(9) Documentation of an alternative diagnosis that can cause Parkinsonism
What are the supportive criteria for Parkinson’s disease (4)?
(1) Clear response to L-dopa
(2) Presence of L-dopa induced dyskinesia
(3) Rest tremor of a limb
(4) Documented olfactory loss or cardiac sympathetic denervation on MIBG scintigraphy.
What are the red flags that would suggest an alternative diagnosis to Parkinson’s disease (10)?
(1) Rapid gait impairment requiring wheelchair within 5 years of onset
(2) Complete absence of progression of motor symptoms
(3) Early bulbar dysfunction
(4) Stridor
(5) Severe autonomic failure in the first 5 years of onset
(6) Recurrent falls within 3 years of onset
(7) Anterocollis
(8) Absence of common non-motor symptoms despite 5 years of disease
(9) Pyramidal signs
(10) Bilateral symmetric parkinsonism
What are the symptoms that commonly precede a diagnosis of Parkinson’s disease (3)?
(1) Anosmia
(2) REM-Behavior Sleep Disorder
(3) Constipation
What medication used in Parkinson’s disease will turn urine orange?
Entacapone
What are the two most common dopamine agonists used to treat Parkinson’s disease motor symptoms?
(1) Pramipexole
(2) Ropinorole
Which Parkinson’s medications are most known to cause compulsive behaviours (gambling, sexuality, shopping, eating, etc.)?
Dopamine agonists, including pramipexole and ropinorole
What are the 2 most common MOA-B inhibitors used in the management of Parkinson’s disease motor symptoms?
Selegiline
Rasagiline
What treatment can help with drooling associated with Parkinson’s disease?
Botulinum toxin A
What treatments can be considered for management of orthostatic hypotension in Parkinson’s disease?
(1) Midodrine
(2) Fludricortisone
(3) Domperidone
What are the typical clinical features of multi-system atrophy (8)?
(1) Symmetrical rigidity and bradykinesia without tremor.
(2) Early falls
(3) Dysautonomia (orthostasis, erectile dysfunction, incontinence)
(4) Ataxia
(5) Pyramidal Signs
(6) Stridor
(7) Distal myoclonus
(8) No response to L-dopa
What are the typical clinical features of progressive supranuclear palsy (8)?
(1) Symmetrical rigidity/bradykinesia without tremor
(2) Axial rigidity more than limb
(3) Early falls
(4) Vertical supranuclear gaze paresis
(5) Hyperfrontalis (wide-eyed stare)
(6) Severe dysarthria
(7) Mild dementia (frontal lobe dysfunction)
(8) Poor response to L-dopa
What are the clinical features of corticosteroids-basal degeneration?
(1) Markedly asymmetric rigidity and bradykinesia.
(2) Dystonia
(3) Myoclonus (action or tactile stimulated)
(4) Apraxia
(5) Aphasia
(6) Cortical sensory loss
(7) Alien limb phenomenon
(8) No response to levodopa
