Parkinsonism

Question 1

A. Resting tremor + muscular rigidity + slow decreased movement + postural instability. What’s your diagnosis?

Answer 1

Parkinsonism

Question 2

A.what’s the treatment for Parkinsonism?

Answer 2

Levo-dopa + Carpidopa ( best for old ptn & advanced cases )
/ symptomatic treatment as anticholinergics (benztropine & Amantadine) /
Dopamine agonist is given to young ptn to delay the need to treatment with levodopa
/+/- surgery

Question 3

Q.what is the drug of choice for mild stage of Parkinson?

Answer 3

Amantadine

Question 4

N. What are the causes of Parkinsonism?

Answer 4

Medications as neuroleptic agents & antiemetics ect. / poisoning/ structural lesions as tumor, trauma/ postencephalitic Parkinsonism

Question 5

What’s the C/P Of Parkinson? Mnemonic BRITISH.

Answer 5

1. Bradykinesia ( slow movement, mask facies, ⬇️ Autonomic movement)
2. Rigidity (cogwheel)
3. Instability ( postural)
4. Tremor (resting)

Question 6

Parkinsonism + vertical gaze palsy =……….?

Answer 6

supranuclear palsy

Question 7

Parkinsonism + prominent ataxia =…………?

Answer 7

olivopontocerebellar atrophy

Question 8

Parkinsonism + prominent orthostatic hypotension

Answer 8

Shy-Drager syndrome. ( now called multiple-system atrophy)

Question 9

N. What’s the principle of Parkinson’s treatment?

Answer 9

imbalance of dopaminergic ( too little) & cholinergic ( too much) tone on the basal ganglia. Thus treatment is either directed to ⬆️ Dopaminergic tone or ⬇️ Cholinergic tone on basal ganglia

Question 10

Explain the available treatment for Parkinson’s?

Answer 10

1. Directly Stimulate dopamine receptors: carpidopa, levodopa, dopamine agonist
2. Indirectly as COMT inhibitors, selegiline, amantadine
3. Block acetylcholine stimulation of the basal ganglia ( Benztropine, trihexyphenidyl)
4. Direct acting dopamine agonist as pramipexole or ropinirole: can be used alone or in combination with small doses of levodopa/ carpidopa , other dopamine agonist: bromocriptine, cabergoline the last two can cause ❤️ Toxicity ( but dopamine agonist is general have less dyskinetic side effects)

Question 11

N. What’s the best ttt for a mild case of Parkinson’s who is less than 60 years of age? And the ttt for ptn more than 60 years of age?

Answer 11

start with anticholinergics for < 60 /
but after 60 TOC is amantadine ( anticholinergics are relatively contraindicated in elderly because of its side effects as dry mouth, ect.

Question 12

A.Where’s the dysfunction in case of intention tremor?

Answer 12

Cerebellum

Question 13

Q. Thalamotomy and pallidotomy are a surgical treatment for which disease?

Answer 13

Parkinson’s