Parkinson's disease

Question 1

what are the classical motor sx

Answer 1

Bradykinesia- hypomimia, micrographia, stooped posture
rigidity- smooth, lead-pipe, cogwheeling
tremor- low frequency resting tremor usually asymmetrical

Question 2

what are the non-motor sx

Answer 2

1. mental health- dementia
2. sleep disorders (REM sleep disorder)
3. postural instability
4. autonomic disorders

Question 3

Name 4 ‘Parkinson plus’ syndromes

Answer 3

1. Progressive supranuclear palsy (younger, rapid, abn eye movements and righting reflex)
2. multisystem atrophy- autonomic symptoms predominant
3. corticobasal degeneration- ‘alien limb’
4. encephalitic parkinsonism

Question 4

name 5 important differential diagnoses

Answer 4

1. drug induced parkinsons (anti-psychotics)
2. normal pressure hydrocephalus (magnetic gait, urinary incontinence, dementia)
3. Wilson’s Disease (chorea)
4. Essential Tremor (postural and symmetrical)
5. ‘dystonic’ tremor

Question 5

Pathophysiology

Answer 5

Deficiency of dopamine in the substantia nigra following pre-synaptic neuronal degeneration

• characterised by lewy bodies in SN
• relative overstimulation of cholinergic transmission

Question 6

Management of Parkinsons

Answer 6

• Mainstay of tx is levo-dopa + DCC (carbidopa/madopal) +/- COMTi
• other tx: dopamine agonists (amantidine, pramipexole, ropinirole)
• MAOBi (selegiline)
• Vitamin D supplements
• sx relief- anticholinergics for bladder sx, antidepressants, anxiolytics, night sedation

Question 7

Side effects of L-Dopa

Answer 7

• nausea
• vomiting
• postural hypotension
• sleepiness/fatigue
• hallucinations, confusion, addiction