Parkinsons

Question 1

OPIC using Quesbook: Parkinson’s diseases tend to affect adults of what age ?

Answer 1

Adults >65 years

Question 2

OPIC using Quesbook: How does Parkinson’s often present?

Answer 2

Asymmetric tremor and bradykinesia

Question 3

OPIC using Quesbook: describe Epidemiology of Parkinson’s disease

Answer 3

Parkinson’s disease is 2nd most common neurodegenerative disorder after Alzheimer’s disease

0.3% of population

Question 4

OPIC using Quesbook: What are the motor features of Parkinson’s disease?

Answer 4

CORE:
bradykinesia, asymmetric 3-5Hz “pill-rolling” tremor, and lead pipe rigidity

OTHER:
Parkinsonian gait
Hypomimic facies

Question 5

OPIC using Quesbook:
What causes cogwheeling?
How does it feel when examining a pt?

Answer 5

What: the combination of lead pipe rigidity and tremor results in cogwheeling

Feel on examination: a jerkiness felt when testing a patient’s tone.

Question 6

OPIC using Quesbook: describe the key features of Parkinsonian gait

Answer 6

small, shuffling steps
slowness of movement (especially on initiating movement and turning)
flexed posture
asymmetric tremor
Festinating gait (stooped during)
Postural instability (late feature of IPD, earlier in Parkinsonian sydnromes)

Question 7

OPIC using Quesbook: What are some psychiatric features of Parkinson’s disease?

Answer 7

Depression (common)
Anxiety (common)
Hallucinations
cognitive abnormalities (later disease stages)
Early and prominent cognitive dysfunction (think LEWY-BODIES)

Question 8

OPIC using Quesbook: what treatment should you give in Parkinsons’s ?

Answer 8

Significant functional impairment: Levodopa

Clinical features of PD but no functional impairment: levodopa, dopamine agonists, monoamine oxidase inhibitors as directed by a specialist.

Question 9

OPIC using Quesbook: What are some adjunctive therapies to help with Parkinson’s disease side effects e.g. motor fluctuations / drug induced dyskinesias

Answer 9

Dyskinesia and motor fluctuations despite levodopa treatment:
consider non-ergotic dopamine receptor agonist (e.g. rotigotine), monoamine oxidase B inhibitor (e.g. rasagiline) or COMT inhibitor (e.g. entacapone)

Ergot derived dopamine- receptor agonist e.g. Bromocriptine) only as adjunct after trying non-ergot.

Dyskinesia not managed by existing therapy- anti-influenza drug amantadine.

Question 10

OPIC using Quesbook: Common side effects of levodopa ?

Answer 10

Hypotension

Restlessness

Gastrointestinal upset

RARE: dopamine excess can result in psychiatric reactions including acute psychosis

Question 11

OPIC using Quesbook: failure to respond to what dose of levodopa virtually excludes diagnosis of IDP ?

Answer 11

Failure to respond to 1-1.5g of levodopa daily virtually excludes a diagnosis of idiopathic Parkinson’s disease

BUT remember : a response to levodopa does not confirm the diagnosis (as many primary parkinsonian syndromes may also respond).

Question 12

OPIC using Quesbook: What is given to reduce peripheral side effects of levodopa?

Answer 12

co-administration of a peripheral dopa decarboxylase inhibitor e.g. carbidopa

Question 13

OPIC using Quesbook: how does response to levodopa change over time ?

Answer 13

Levodoopa becomes less effective over time
- motor activity declines as dose wears off
- ‘on/off’ phenomena (manifests as random fluctuations in drug effect, due to the dosage ‘wearing off’)
- drug induced dyskinesia - get writhing, uncoordinated movement
- 2-5 years to develop complete loss of response