Parkinson's Disease & movement disorders Flashcards
What are the basal ganglia responsible for?
Involved in initiation and modulation of movement
What is the mechanism of the basal ganglia?
1- Receive input from cerebral cortex
2- process it
3- relay back to cerebral cortex via thalamus
What does hypokinetic mean?
Too little movement
What does hyperkinetic mean?
Too much movement
Does Parkinson’s disease come under hypo- or hyperkinetic disease?
Hypokinetic
What is characteristic of a hypokinetic disease?
Stiffness, slow movement and loss of amplitude of movement
What percentage of Parkinson’s disease is idiopathic and familial (genetic)?
95% idiopathic
5% familial
What characterizes Parkinson’s disease?
Bradykinesia - (slowness of initiation of movement & performing movement as well as loss of amplitude)
What are the pathological hallmark’s of Parkinson’s disease?
- Loss of pigmentation in substantia nigra and locus coeruleus
- Lewy bodies
What are the motor symptoms of Parkinson’s disease?
- Involuntary tremors
- Bradykinesia
- Rigidity
- Postural instability
What are the non-motor symptoms of Parkinson’s disease?
- Sleep disorders
- Hallucinations
- GI dysfunction
- Cognitive impairment / Dementia
- Anosmia
How is Parkinson’s disease diagnosed?
Clinical diagnosis
What is the mechanism of symptomatic treatments in Parkinson’s disease?
Enhance intracerebral dopamine concentrations or stimulate dopamine receptors
Does tremor respond well to typical symptomatic treatment?
NO
What is the main drug used for Parkinson’s?
Levadopa
When are dopamine agonists/MAOB inhibitor considered?
- Patient is young
- Mild motor symptoms
- Parkin mutation (avoid early dyskinesia)
- Patient preference
What are some side effects of dopamine agonist and levodopa?
- Nausea
- Daytime drowsiness
- Oedema
What are some long term complications of dopaminergic treatment for PD?
- Motor fluctuations
- Non-motor fluctuations
- Dyskinesia
- Drug induced psychosis
When is deep brain stimulation indicated?
Marked motor fluctuation despite levadopa
What would indicate drug induced parkinsonism?
Symmetrical postural tremor
How is an essential tremor identified?
Symmetric, postural tremor
Much higher frequency
Also have an action tremor
Name the Parkinson plus conditions?
- Multiple system atrophy
- Progressive supranuclear palsy
When is Parkinson’s Disease most common?
50’s-60’s
What is the core triad of multiple system atrophy?
- Dysautonomia
- Cerebellar features
- Parkinsonism
Does multiple system atrophy respond to levadopa?
NO
What are some symptoms of progressive supranuclear palsy?
- Gait & balance issues (falls)
- Inability to move eyes
