Neuro - Parkinson

Question 1

What is the histology of Parkinson Disease?

Answer 1

Lewy Bodies which are filamentous aggregates seen in the substantia nigra compose of melanin. The synthesis of catecholamines to melanin causes oxidative stress.

The Locus Ceruleus and the Dosal vagal nucleus is also affected.

Question 2

What percentage of SN cells die before symptoms occur?

Answer 2

80-90%

Question 3

What is a treatment for MPTP poisoning?

What is structurally similar to MTPT?

Answer 3

MAO-B inhbitors that convert MTPT into MPP+ MTPT looks a lot like certain pesticides like paraquat

Question 4

Risk factors for PD?

Answer 4

Age, Toxins, Trauma (M. Ali), stress, genetics, infections (von economo encephalitis), anxiety disorders

Question 5

What are actually non-risk factors for PD?

Answer 5

Caffeine and smoking

Question 6

What are the two hypotheses for PD?

Answer 6

Intrinsic Dopamine synthesis - that synthesis of catecholamines actually causes oxidative stress that damages cells

Extrinsic Toxin-Induce - compounds will cause mitochondrial damage

Question 7

Risks for oxidative stress in neurons.

Answer 7

High
High lipid concentration (lipid peroxidation)
High oxygen metabolism creates free radicals
Large amounts of iron runs fenton reaction
Neurons have few protective mechanisms
Neurons do not regenerate

Question 8

What is the Myerson’s sign?

Answer 8

Also known as the Glabellar Sign

Frontal release. Tapping of the forehead the patient continuously blinks eyes

Question 9

What drugs can induce Parkinsonian symptoms?

Answer 9

Drug Induced Parkinsonian is cause by anti-psychotics, anti-emetics, or alpha-methyl Dopa

Question 10

Do MRIs pick up Parkinson?

Answer 10

Only if cause from stroke or Normal Pressure Hydrocephalus

Question 11

What are the neuroprotective drugs for PD?

Answer 11

Selegiline an MAOb inhbitor and the newer Rasagiline that helps preserve the mitochondria.

Question 12

What drugs are given for symptomatic treatment?

Answer 12

Anticholinergic such as benztropine and trihexyphenidyl (contraindicated in elderly)

Dopaminergic Drugs
Amantadine (weak dopaminergic)

Dopamine Agonist - Bromocriptine, pergolide, ropinirole, pramipexole, rotigotine and carbergoline

COMT inh - entacapone and tolcapone

Levodopa-Carbidoa (Sinemet)

Question 13

How much carbidopa is required to effective DOPA decarboxylase inhibition?

Answer 13

70 mg/day

Question 14

What are adverse sideaffects of Dopamine agonists?

Answer 14

Compulsivity, Sleep attacks (fall asleep without warning), hallucinations, confusion,

Question 15

What are the symptoms with Progressive Supranuclear palsy?

Answer 15

Supranuclear Opthalmeplegia, no tremor, peudobulbar palsy, baninski, hyperreflexia, and dementia

Always a surprised look on their face

Question 16

How do you tell what a patient has by the way they fall?

Answer 16

Will tend to fall early and backward (eyes always going backward). Parkinson patients fall late and forward (shuffling gait cannot catch them)