Parkinson's disease + other movement disorders Flashcards
What makes essential tremor worse?
worse on movement
List 4 types of tremor
Resting tremor eg. Parkinson’s disease
Action tremor eg. cerebellar tremor/essential tremor
Postural tremor eg. essential tremor
Kinetic tremor (on movement)
What improves essential tremor (not a drug)?
alcohol
Essential tremor treatment
beta blockers
primidone
Parkinsonism features
TRAP
Tremor
Rigidity
Akinesia (bradykinesia, fatiguing and decrement in size and speed of repetitive movement)
Postural and gait disturbances
Compare Parkinson’s disease and essential tremor
Parkinson’s = tremor at rest, asymmetrical, small handwriting, head tremor rare, no response to alcohol, FH uncommon
Essential tremor = tremor on movement, symmetrical, shakey handwriting, head tremor common, good response to alcohol, FH common
Secondary causes of Parkinsonism
drugs eg. antidopaminergics
toxins
cerebrovascular disease
post-encephalitic
anoxic brain injury
traumatic brain injury
Typical clinical features for Parkinson’s disease
unilateral onset
rest tremor present
progressive disorder
persistent asymmetry affecting the side of onset most
excellent response to levodopa
severe levodopa-induced chorea
levodopa response for over 5 years
clinical course of over 10 years
What pathway degenerates in Parkinson’s disease?
nigrostriatal pathway (pathway between striatum and substantia nigra)
What is different about the Parkinson’s brain?
damage to or loss of dopaminergic neurons
dopamine deficiency
causes reduced movement, stiffness and tremor
What are the approaches to the treatment of Parkinson’s disease?
minimise dopamine breakdown
replace lost dopamine (or mimic)
restore electrical balance in basal ganglia (deep brain stimulation)
supportive therapies
Drug treatments for Parkinson’s disease
main drug classes:
- levodopa
- monoamine oxidase B (MAO-B) inhibitors
- Catechol-O-methyltransferase (COMT) inhibitors
- Dopamine agonists
What dopamine agonists are available?
Ropinirole and Pramipexole tablets
Rotigotine patch
Apomorphine injection or infusion
What are some general problems with dopaminergic drugs?
nausea
ankle swelling
orthostatic hypotension
somnolence
hallucinations and confusion (suggests early dementia/infection)
What are some red flags in diagnosis of Parkinson’s disease?
symmetrical symptoms and signs
predominance of axial symptoms
poor therapy response
rapid progression
Early falls
Early dementia
Early pronounced autonomic features
Sudden onset of symptoms
could be due to a ‘Parkinson Plus’ disorder
