Parkinson's Disease Early Tx

Question 1

Parkinson’s Disease (PD)

Answer 1

Chronic progressive neurodegenerative disorder

Characterized by loss of dopaminergic neurons in the substantia nigra pars compacta

Question 2

Clinical Presentation

Answer 2

Motor dysfxn: resting tremor, rigidity, bradykinesia, postural imbalance in late disease
Non-motor dysfxn:
Autonomic - impotence, orthostasis, constipation
Neuropsychiatric - depression, dementia

Question 3

When to initiate tx

Answer 3

As soon as dx is confirmed

The earlier therapy is started, the better the clinical outcome (ELLDOPA study)

Question 4

Selegiline Tx

Answer 4

Slows progression of PD symptoms
Delays time needed to initiate levadopa tx
Rasagiline 2nd generation

Question 5

Amantadine

Answer 5

Weak N-methyl-D-aspartate (NMDA) receptor antagonist
Efficacy in early dz
Can cause anticholinergic-like adverse events and livedo reticularis and pedal edema
Effective in late dz to treat dyskinesia

Question 6

Dopamine Agonist Agents

Answer 6

Ropinirole, pramipexole, rotigotine (patch), bromocriptine
Early tx with dopamine agonists decreases risk of developing motor fluctuations and including dyskinesias and wearing off vs tx with l-dopa

Question 7

Dopamine Agonist Adverse Effects

Answer 7

Nausea, orthostasis, pedal edema, daytime somnolence,
Cardiac valvulopathy, pulmonary/retroperitoneal fibrosis (ergot-derived agonists)
Compulsive/impulsive dyscontrol behaviors: gambling, eating, shopping, hypersexuality