Parkinsons

Question 1

What is Parkinsons

Answer 1

progressive neurodegenerative condition caused by the degeneration of dopaminergic neurones in the substantia nigra of the basal ganglia

leading to a triad of movement disorders

Question 2

how does Parkinsons disease present

Answer 2

Triad of:

• pill rolling tremor
• cogwheel rigidity
• bradykinesia (slow, shuffling gait)

can also present with small handwriting, anosmia, sleep problems, hypomimia and cognitive impairment

Question 3

who gets Parkinson’s disease

Answer 3

M>F
mean age 65

affects 0.3% of population

most common neurodegenerative condition after Alzheimer’s

Question 4

what is the pathology/ mechanism of parkinsons

Answer 4

dopamine is produced in the substantial nigra usually

this production is lowered in parkinsons

due to degeneration of dopaminergic neurones in the substantia nigra (idiopathic)

dopamine is important in initiating movement causing the symptoms

Question 5

how do you investigate parkinson’s

Answer 5

clinical history

DaTscan which is a nuclear medicine scan which injects a tracer into the brain that binds to dopaminergic neurones

Question 6

how do you manage Parkinsons

Answer 6

Co-Benyldopa aka madopar/ sinemet
- Levodopa plus bensarazide
- levodopa is synthetic dopamine
- bensarazide inhibits an enzyme which breaks down dopamine
(think Co-Amociclav)

Question 7

what are the complications of having too much dopamine due to L-dopa treatment

Answer 7

Dyskinesia:

• Dystonia= abnormal posture/ exaggerated movements
• Chorea= involuntary jerking movements
• Athetosis= twisting and writhing of hands and feet