Parkinson's disease

Question 1

Clinical signs

Answer 1

• Mask-like, expressionless face
• infrequent blinking
• low-volume monotonous speech
• resting pill rolling tremor
• lead pipe and cogwheel rigidity
• bradykinesia
• Asymmetry
• Freezing
• shuffling, narrow based gait
• Reduced arm swing

Question 2

Parkinsonism

Answer 2

Bradykinesia, rigidity and tremor

Question 3

Causes of Parkinsonism

Answer 3

• Idiopathic
  -Drugs - Chlorpromazine, Metoclopramide, Prochlorperazine, Valproate
• Tumours of the basal ganglia
• Lewy body dementia
• Normal pressure hydrocephalus

Question 4

Features of multisystem atrophy

Answer 4

• Parkinsonism
• autonomic failure
• cerebellar dysfunction
• pyramidal signs

Question 5

Features of Progressive supranuclear palsy

Answer 5

Abnormal vertical gaze and horizontal saccades
Difficulty opening eyes
Prominent falls
Speech and swallowing difficulties
Frontal symptoms - depression, apathy and cognitive impairment
Survival 5-7 years

Question 6

Features of corticobasilar degeneration

Answer 6

Atypical Parkinsonism and associated higher cortical abnormalities
Limb apraxia and sensory loss
Myoclonus and dementia

Question 7

Essential tremor versus Parkinson’s tremor

Answer 7

Essential - symmetrical, worse with movement, affects voice and head

Question 8

Investigations

Answer 8

Parkinson’s = clinical diagnosis
Can use Dopamine transporter SPECT - but doesn’t differentiate between PD and PD +

Question 9

Medications for PD

Answer 9

Dopaminergics:
- Levodopa - SEs N+V, postural hypotension
- dopmine agonists - rotigotine
- MAO-B inhibitors - rasagiline
- Anticholinergics to reduce tremor - procyclidine
- COMT inhibitors - reduce GI breakdown of levodopa
- Apomorphine - reduces off periods
- Amantadine