Parkinson's disease

Question 1

in who should you suspect Parkinson’s?

Answer 1

bradykinesia plus one of the following…

Tremor
Rigidity
Postural instability

Question 2

what are investigations to consider for Parkinson’s disease?

Answer 2

• diagnosis is clinical
• investigations can include the following;

MRI brain: may help exclude other causes of neurological disease but should not be used to diagnose PD

SPECT (DaT scan): single-photon emission computed tomography (SPECT) will show reduced dopamine uptake in the basal ganglia

Question 3

what is the pathophysiology of Parkinson’s disease?

Answer 3

loss of dopaminergic neurone in the substantial nigra of the basal ganglia

Question 4

what is the appearance of an individual with Parkinsons?

Answer 4

• facial masking
• forward tilt
• reduced arm swing
• shuffling gait
• stooped posture

Question 5

what type of hypotension is present in PD?

Answer 5

Parkinson’s can lead to postural hypotension due to autonomic failure, which is why there was no compensatory tachycardia on standing.

Question 6

what is multisystem atrophy?

Answer 6

1. Features parkinsonism
2. autonomic disturbance
   - erectile dysfunction: often an early feature
   - postural hypotension
   - atonic bladder
   - cerebellar signs

Question 7

what are the risks of taking high dose of dopamine?

Answer 7

Dystonia: This is where excessive muscle contraction leads to abnormal postures or exaggerated movements.

Chorea: These are abnormal involuntary movements that can be jerking and random.
Athetosis: These are involuntary twisting or writhing movements usually in the fingers, hands or feet.

Question 8

why are dopamine agonists trialed first before levodopa?

Answer 8

to hold off levodopa and extend the time in which PD may be treated effectively

they tend to be less effective than levodopa

Question 9

what are examples of dopamine agonists?

Answer 9

Bromocryptine
Pergolide
Carbergoline

Question 10

what is the risk of taking long term dopamine agonists?

Answer 10

pulmonary fibrosis

Question 11

which drugs can be used in conjunction with levodopa to reduce the dose which may be required?

Answer 11

Monoamine Oxidase-B Inhibitors

Monoamine oxidase enzymes break down neurotransmitters such as dopamine, serotonin and adrenaline.

• Selegiline
• Rasagiline

Question 12

what are features of benign essential tremor?

Answer 12

Fine tremor
Symmetrical
More prominent on voluntary movement
Worse when tired, stressed or after caffeine
Improved by alcohol
Absent during sleep

Question 13

which medications may be given to benign essential tremor?

Answer 13

Propranolol (a non-selective beta blocker)

Primidone (a barbiturate anti-epileptic medication)