Parkinson's Disease and other Movement Disorders

Question 1

Define Parkinson’s disease

Answer 1

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

Question 2

Parkinson’s disease pathophysiology

Answer 2

Basal ganglia coordinates habitual movements

Part of basal ganglia called substantia nigra produces dopamine

Dopamine essential for functioning of basal ganglia

In PD there is progressive decline in dopamine production

Question 3

Risk factors for Parkinson’s disease

Answer 3

Increasing age

Family history (in younger-onset disease)

Mutation in gene encoding glucocerebrosidase

Question 4

Clinical features of Parkinson’s disease

Answer 4

Bradykinesia, tremor, rigidity

Asymmetrical

Typically man >70

“Cogwheel rigidity”

Question 5

Characteristics of Parkinson’s tremor

Answer 5

“Pill rolling” (fingertips + thumb)

Pronounced when resting

Improves on movement

Worse when distracted

Question 6

Signs of bradykinesia in Parkinson’s

Answer 6

Handwriting smaller and smaller

Shuffling gait

Difficulty initiating movement

Difficulty turning around

Reduced facial movements/expressions (hypotonia)

Question 7

Differentiating Parkinson’s and essential tremor

Answer 7

Essential tremor is:

Symmetrical

Improved at rest

Worse on movement

Improves with alcohol

Question 8

Management of Parkinson’s disease

Answer 8

Levodopa

Dopamine agonists if symptoms not affecting QOL

Question 9

Side effects of L-dopa

Answer 9

Hypotension

Restlessness

GI upset

Acute psychosis (rare)

Becomes less effective with time (end-of-dose effect)

Question 10

How long does it typically take to develop complete loss of response to L-dopa?

Answer 10

2-5 years

Question 11

What is “parkinsonism”?

Answer 11

A group of conditions that has symptoms similar to those of Parkinson’s disease

Question 12

What are “movement disorders”?

Answer 12

A group of neurological conditions that cause abnormal increased movements, which may be voluntary or involuntary

May also cause reduced or slow movements

Question 13

What is ‘ataxia’?

Answer 13

Affects part of the brain that controls coordinated movement (cerebellum)

May cause uncoordinated or clumsy balance, speech or limb movements, and other symptoms

Question 14

What is ‘cervical dystonia’?

Answer 14

Causes long-lasting contractions (spasms) or intermittent contractions of the neck muscles, causing the neck to turn in different ways

Question 15

What is ‘chorea’?

Answer 15

Repetitive, brief, irregular, somewhat rapid, involuntary movements that typically involve the face, mouth, trunk and limbs

Question 16

What is ‘dystonia’?

Answer 16

Sustained involuntary muscle contractions with twisting, repetitive movements

May affect entire body (generalised dystonia) or one part of body (focal dystonia)

Question 17

What is ‘Huntington’s disease’?

Answer 17

Inherited progressive, neurodegenerative disorder that causes uncontrolled movements (chorea), impaired cognitive abilities and psychiatric conditions

Question 18

What is ‘multiple system atrophy’?

Answer 18

Uncommon, progressive, affects many brain systems

Causes a movement disorder, such as ataxia or parkinsonism

Can also cause low blood pressure and impaired bladder function

Question 19

What is ‘myoclonus’?

Answer 19

Causes lightning-quick jerks of a muscle or a group of muscles

Question 20

What is ‘progressive supranuclear palsy’?

Answer 20

Rare neurological disorder that causes problems with walking, balance and eye movements

Question 21

What is ‘restless legs syndrome’

Answer 21

Causes unpleasant, abnormal feelings in the legs while relaxing or lying down, often relieved by movement

Question 22

What is ‘tardive dyskinesia’?

Answer 22

Caused by long-term use of certain drugs used to treat psychiatric conditions (neuroleptic drugs)

Causes repetitive and involuntary movements such as grimacing, eye blinking and other movements

Question 23

What is ‘Tourette syndrome’?

Answer 23

Starts between childhood and teenage years and is associated with repetitive movements (motor tics) and vocal sounds (vocal tics)

Question 24

What is ‘Wilson’s disease’?

Answer 24

Rare inherited disorder that causes excessive amounts of copper to build up in the body, causing neurological problems