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Week 13 - neurology > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

What are the clinical features of Parkinsonism?

A
  • Bradykinesia - slowness in initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions
  • Muscular rigidity
  • 4-6Hz rest tremor
  • Postural instability (pull test)
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2
Q

What are the non motor symptoms of Parkinson’s?

A
  • Dementia
  • depression
  • Anxiety
  • constipation
  • urinary urgency/nocturia
  • Erectile dysfunciton
  • Excessive salivation
  • Low BP/postural hypotension
  • Speech difficulty
  • hallucination and delusion
  • Seborrheic dermatitis/sweating
  • REM sleep behaviour disorder
  • Restless legs syndrome
  • Reduced olfactory funciton
  • Fatigue/daytime somnolence
  • Pain and sensory symptoms
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3
Q

What are non Parkinson’s causes of Parkinsonism

A
  • Drug induced
  • PSP - progressive super nuclear palsy - difficulty with vertical gaze
  • MSA - multiple systems atrophy
  • Cortical basal disease - one sided symptoms, dystonia in affected arm
  • Lewy body dementia - visual hallucination and fluctuation in cognition
  • Vascular Parkinsonism
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4
Q

What is the exclusion criteria of parkinsons?

A

• cerebellar signs (MSA)
•Vertical gaze palsy (PSP)
•Parkinsonian features restricted to the legs for >3 years (vascular)
•Absence of L-dopa response
•Cortical sensory loss, ideomotor apraxia or progressive aphasia. CBD.
•Normal FPICT SPECT scan

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5
Q

What are the red flag symptoms in Parkinsons

A
  • Rapid gait impairment requiring wheelchair use within 5 years
  • No progression of motor symptoms/signs over 5 years
  • marked bulbar dysfunction
  • Inspiratory respiratory dysfunction
  • Severe autonomic failure within 5 years
  • Recurrent falls because of impaired balance within 3 years
  • Dystonic anterocollis within 10 years
  • Absence of non-motor features within 5 years
  • Unexplained pyramidal signs or symmetrical presentation
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6
Q

What is the pharmacological aim of the treatment of parkinsons?

A

To restore dopamine levels

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7
Q

What is the clinical aim of the treatment of parkinsons?

A
  • To improve motor symptoms and quality of life

* There is no evidence of neurological-protection

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8
Q

What are the Parkinson disease drug classes?

A
  • L-dopa
  • Dopamine agonists
  • MAO-B inhibitor
  • COMT - inhibitor
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9
Q

Explain the preparations of L-dopa

A
  • L-dopa with a dopa decarboxylase inhibitor:
  • L-dopa and carbidopa = sinemet
  • L-dopa and benserazide = madopar
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10
Q

What is the dosing of L-dopa preparations?

A

200-1000mg/day across 3-5 doses

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11
Q

What are the adverse effects of L-dopa?

A
  • Peripheral: nausea, vomiting, postural hypotension

* Central: confusion, hallucinations

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12
Q

Name the dopamine agonists

A
  • Ropinirole
  • Pramipexole
  • Rotigotine
  • Apomorphine
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13
Q

What are the differences in effect of the dopamine agonists and L-dopa?

A

Dopamine agonists:
•Have a longer half life than L-dopa
• Are less efficacious that L-dopa
• Have fewer motor complications than L-dopa

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14
Q

What are the side effects of the dopamine agonists?

A
  • Dopaminergic side effects
  • Daytime somnolence
  • Impulse control disorders (e.g. pathological gambling, hyper sexuality)
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15
Q

Name the MAO-B inhibitors

A
  • Selegiline

* Rasagiline

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16
Q

Name the COMT inhibitors

A
  • Entacapone

* Opicapone

17
Q

What are the COMT inhibitors prescribed with and why?

A
  • Co prescribed with L-dopa

* Results in a longer half life of L-dopa

18
Q

What are the side effects of COMT inhibitors?

A
  • Dopaminergic

* Diarrhoea

19
Q

What is amantadine prescribe for in parkinsons?

A

Anti-dyskinetic effect

20
Q

What are the side effects of amantadine?

A
  • Confusion

* Livedo reticularis

21
Q

Why are anticholinergics prescribed in Parkinsonism and give an example

A
  • Procyclidine

* Anti tremor effect

22
Q

Why is botulinum toxin used in parkinsons?

A
  • Roles in sialorrhoea, blepharospasm
  • Eyelid-opening
  • Apraxia
  • Other focal dystonia
23
Q

What are the motor problems in advanced parkinsons?

A
  • Motor complications
  • On/off fluctuations
  • L-dopa induced dyskinesia (wearing off effect of L-dopa)
24
Q

What are the axial problems in advanced parkinsons?

A
  • Gait difficulties (including gait freezing)
  • Change in posture
  • Poor balance/falls
  • Speech/swallowing difficulties
25
Q

What are the cognitive problems in advanced Parkinsons?

A
  • dementia

* hallucinations/psychosis

26
Q

What are the treatment options specifically for advanced Parkinsons?

A
  • Apomorphine pen injection or subcutaneous pump
  • Intrajejunal duodopa infusion
  • Deep brain stimulation surgery
27
Q

What is deep brain stimulation?

A
  • allows the electrical stimulation of target nucleus (most commonly Sub Thalamic Nucleus)
  • Provides a targeted, adjustable, non-destructive, and reversible way of modulation pathological brain circuits
  • There are 3 implantable components
28
Q

What are the implantable components of deep brain stimulation?

A
  • Brain leads (containing electrodes at the distal end)
  • Neurostimulator (AKA implantable pulse generator/IPG)
  • Extension wires
29
Q

What are the motor Parkinson disease emergencies?

A
  • Motor- severe off periods
  • Severe dyskinesia
  • Parkinson-hyperpyrexia syndrome
30
Q

What are the non-motor Parkinson disease emergencies?

A
  • Acute psychosis
  • Impulsivity
  • Dopamine dysregulation
  • Dysautonomia (postural hypotension, dysphagia, intestinal pseudo-obstruction)
31
Q

What are the other Parkinson disease emergencies?

A
  • falls

* device related: DBS/apomorphine pump/duodopa pump failure

32
Q

Aside from medications, what are the other things to consider in the management of parkinsons?

A
  • Bone health
  • Exercise
  • Support groups
  • Advanced care planning

Week 13 - neurology (12 decks)

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