Parkinson's Disease

Question 1

Is diplopia atypical or typical for Parkinson’s?

Absence of tremor?

Impotence?

Answer 1

Convergence insufficiency is a common finding in patients with PD (in this answer PD = idiopathic PD). It usually presents with diplopia while reading and is not a sign of atypical PD.

Tremor is absent in up to 30% of PD, but should raise the suspicion of atypical Parkinsonism.

Autonomic dysfunction is common in PD. Issues include constipation, urinary urgency, incontinence, impotence, orthostasis and temperature instability. However, if the autonomic dysfunction overshadows the rest of the signs, then consider MSA.

Question 2

Within 5 years of treatment with dopamine agonist or levodopa, 50% of patients experience one of two major complications. What are these complications of anti-PD treatment?

Answer 2

1. motor fluctuations - this is “wearing off”, a return of parkinsonism within 3 hours of medication
2. dyskinesias - choreic twisting, writhing movements. Can be severe to cause ballism. Amantadine has been used to treat these in some patients

Question 3

Describe the 3 main Parkinson-Plus syndromes

Answer 3

1. Progressive supranuclear palsy - distinctive eye findings (most notably vertical gaze), facial dystonia, axial rigidity
2. corticobasal ganglionic degeneration - asymmetric dystonic syndrome with apraxia, cortical sensory loss, tremor, myoclonus and dementia
3. Multiple system atrophy - has a number of subtypes, most common = Shy-Drager - significant autonomic failure