Neurology 6 - Parkinson's Disease

Question 1

classic Parkinson’s triad

Answer 1

resting tremor
rigidity
bradykinesia

Question 2

cause of Parkinson’s

Answer 2

progressive reduction in substantia nigra dopaminee

Question 3

key presenting features of Parkinson’s

Answer 3

unilateral 4-6Hz pill-rolling tremor (worse if distracted)

cogwheel rigidity

bradykinesia (micrographia, shuffling gait, difficulty starting a walk, hypomimic face)

depression
insomnia
anosmia
postural instability
memory problems

Question 4

compare Parkinsonian tremor to benign essential tremor

Answer 4

Parkinson’s - asymmetrical, 4-6Hz, worse at rest, improves with intentional movement, no change with alcohol

BET - symmetrical, 5-8Hz, improves at rest, worse with intentional movement, improves with alcohol

Question 5

Mutiple System Atrophy

Answer 5

rare, affects basal ganglia and autonomic areas

autonomic dysfunction - postural hypotension, constipation, abnormal sweating, sexual dysfunction)

cerebellar ataxia

Question 6

4 Parkinson’s + syndromes

Answer 6

Multiple System Atrophy

Lewy Body dementia

Progressive Supranuclear Palsy

Corticobasal Degeneration

Question 7

diagnosing Parkinson’s

Answer 7

by specialist

Question 8

management of Parkinson’s

Answer 8

MAO-B inhibitors - Selegiline, Rasagiline (block dopamine breakdown)

Dopamine agonists - Bromocriptine, Cabergoline

COMT inhibitors - entacapone (prolongs levodopa duration)

Levodopa - synthetic dopamine (combined with carbidopa to block body enzymes pre brain)

Question 9

risk of excess dopamine with levodopa treatment

Answer 9

dyskinesia

dystonia - abnormal postures + exag moves
chorea - jerking involuntary movements
athetosis - writhing