Parkinson's disease

Question 1

What is Parkinson’s disease?

Answer 1

Progressive neurodegenerative condition caused by degeneration of dopaminergic neurones in the substantia nigra

Question 2

What is the classic triad of features in parkinsons?

Answer 2

1. Bradykinesia
2. Tremor
3. Rigidity

Question 3

Are the features of parkinson’s characteristically symmetrical or asymmetrical?

Answer 3

Asymmetrical

Question 4

What is the epidemiology of parkinsons?

Answer 4

• 2 x more common in med

* mean age 65

Question 5

What is the characteristic gait seen in parkinsons?

Answer 5

Short shuffling steps with reduced arm swinging

Question 6

How would you describe the characteristic parkinson’s tremor? Worse when?

Answer 6

• Pill-rolling i.e. the in the thumb and index finger

* Worse when stressed or tired, improves with voluntary movement

Question 7

What is cogwheel rigidity?

Answer 7

Muscular rigidity in which passive movement of limbs elicit ratchet like start and stop movements through the range of motion of the joint

Question 8

What are some other characteristic presentation of parkinson’s other than the triad?

Answer 8

• mask-like facies
• flexed posture
• micrographia
• drooling of saliva
• psychiatric features: depression, dementia, psychosis and sleep disturbance
• impaired olfaction
• REM sleep behaviours disorder
• fatigue
• autonomic postural hypotension

Question 9

How is a diagnosis of parkinson’s made?

Answer 9

• Usually clinical
• Diagnosis made by specialist
• if difficulty differentiating between essential tremor and Parkinson’s, consider SPECT

Question 10

What is the first line treatment for parkinson’s if motor symptoms are affecting their quality of life?

Answer 10

Levodopa

Question 11

What alternative treatment options to Levodopa are there? Used when?

Answer 11

• Monoamine oxidase B (MAO-B) inhibitor
• Dopamine agonist

Used when motor symptoms are not affecting a patients QOL or in addition to Levodopa if symptoms have not controlled on levodopa or dyskinesia develops

Question 12

What adverse side effects can occur on levodopa?

Answer 12

• Excessive sleepiness
• hallucinations
• impulse control disorders; dyskinesia
• psychosis

Question 13

What other side effects can develop with levodopa?

Answer 13

• dry mouth
• postural hypotension
• anorexia

Question 14

Why is it important to not acutely stop levodopa? and if a patient cannot take it orally give it IV?

Answer 14

To prevent acute dystonia

Question 15

When are antimuscarinics used like procyclidine or benzotropine?

Answer 15

To treat drug-induced parkinsonism