Parkinson's Disease & Movement Disorders (Exam V) Flashcards
What symptom is the hallmark of Parkinson’s disease?
What are the TRAP symptoms with Parkinson’s disease? essay question
Tremor at rest (rhythmic movement around a joint)
Tremor
Rigidity
Akinesia - loss of ability to move muscle voluntarily
Postural instability.
What is Chorea?
What is Ballismus?
- Muscle jerking in various areas
- Violent abnormal movements (extreme version of chorea)
What is Athetosis?
Is this indicative of Parkinson’s disease?
- Slow, writhing movement
- Not typical of Parkinson’s
What is Dystonia?
What are Tics?
- Abnormal posture w/ no movement, jointed locked, usually seen with cerebral palsy.
- Single, repetitive movements (especially facial)
What collection of neurons regulates motor activities?
- Basal Ganglia/Nuclei
Communication from the motor cortex to the thalamus goes through the _____ ______.
Basal Ganglia
What are two movement disorders related to basal ganglia dysfunction?
Parkinsons: Destruction of Dopaminergic Neurons
-Need Dopamine (L-Dopa)
Huntingtons: Destruction of GABAnergic Neurons
-Need to decrease dopamine (Tetrabenazine)
What is damaged in Parkinson’s.
The pars compacta in the substanstia nigra is damaged. No dopamine release to provide a negative feedback to the thalamus, this will lead to movement disorders.
What is the pathogenesis of Parkinsonism?
Decrease in Dopamine Levels in the Nigro-striatal pathway
What are protective environment factors for Parkinsonism?
What are harmful environment factors for Parkinsonism?
Protective factors: Cigarette smoking, Coffee, Anti-inflammatories, Uric Acid
Harmful: Lead, Manganese Exposure, Vit D Deficiency
What genetic component is often present in Parkinson’s patients?
What is the result of this mutation?
- SNCA - α-Synuclein (NT release)
Misfolding produces Lewey Bodies
What drug is given as firstline treatment for Parkinson’s?
Why this drug?
- Levo-dopa (dopamine precursor)
- Able to cross BBB unlike dopamine
What are the treatments for Parkinson’s? Essay Question
- Exercise/ Physical Therapy
- Levo-Dopa- restore dopamine levels
-Improve uptake with carbidopa- inhibits dopa decarboxylase
-Improve uptake with COMT inhibitors (tolcapone)
-Decrease toxicity (hallucinations) with pimavanserin (Nuplazid) - CNS antimuscarinics- to reduce tremors
- Dopamine receptor agonist
- MAO-B Inhibitors (Selegeline)
What should be avoided when one has Parkinson’s Disease?
Dopamine receptor antagonist (antipsychotics, D2 antagonist, Haldol)
How much of L-Dopa crosses the BBB?
Can this be increased? With what? How much?
- 1-3%
- With Carbidopa (10% uptake of Levo-dopa)