Parkinsons Flashcards
What is the pathophysiology of Parkinson’s disease?
Loss of dopaminergic neurones in the substantia migrates within the basal ganglia
What is the role of the basal ganglia?
Regulates movement
What forms lewy bodies in lewy. Body dementia?
Aggregates of alpha synuclein
What is the classic triad of Parkinson’s?
Brady Kinesia
Pil rolling rest tremor
Lead pipe rigidity
How does Bradykinesia present in a patient with Parkinson’s?
Shuffling gait
Reduced facial movements (hypomimia)
What are some non motor symptoms of Parkinson’s?
Fatigue
Sleep disturbance
Cognitive impairment
Loss of smell
Pain
Depression/anxiety
Constipation
Incontinence
What is the scale used to score the severity of Parkinson’s?
Hoehn and Yahr scale
What are the 4 stages of Parkinson’s?
Early/diagnosis
Maintenance
Advanced/complex Parkinson’s (Drugs less effective/more side effects)
Palliative
What are the 4 types of causes of Parkinsonism?
Idiopathic Parkinson’s disease
Parkinson plus syndrome
Drug induced
Other pathology
What are some types of drugs that can induce Parkinsonism?
Anti-psychotics
Anti-emetics (metoclopramide)
Lithium
Methyldopa
What are some alternate pathologies that can cause Parkinsonism?
Post encephalitis
Tumor
Vascular issue
What is a Parkinson plus syndrome?
A syndrome the affects a wider area of the nervous system not just the basal ganglia
What are the 4 main Parkinson plus syndromes?
Multisystem atrophy (MSA)
Lewy body dementia
Progressive supra nuclear palsy
Corticobasal degeneration
What is multisystem atrophy (MSA)?
Parkinson’s plus syndrome
Neurodgeneration of various areas of the brain including the basal ganglia
+
Autonomic dysfunction
How does multisystem atrophy (MSA) present?
Parkinsonism
+
Autonomic dysfunction = POSTURAL HYPOTENSION, constipation, sexual dysfunction
+
Cerebellar dysfunction = ATAXIA
What is Lewy body dementia?
Type of dementia leading to deposition of Lewy bodies in the hippocampus causing dementia then basal ganglia causing Parkinsonism
What are some symptoms/ presentations of lewy Body dementia?
Parkinsonism
+
Hallucinations
Delusions
REM sleep disorders
Fluctuating consciousness
What is progressive supra nuclear palsy?
Parkinson plus syndrome with vertical gaze dysfunction, dysarthria and cognitive dysfunction
What is corticobasal degenration?
Parkinson’s plus syndrome
Progressive dementia, Parkinsonism and limb apraxia
Can also have alien hand syndrome
How do you make a diagnosis of Parkinson’s?
Done by a specialist
Clinical diagnosis but tmay consider CT/MRI head if unsure or string suspicion of secondary cause
PET or DAT scan?
What are the 4 main types of medications used to manage Parkinson’s?
Levodopa
Dopamine agonists
MAOB inhibitors
COMT inhibitors
Also have glutamate agonists
What is Levodopa?
It is a synthetic dopamine that is used to replace the lack of dopamine in the brain
What is levodopa typically taken with?
What is an example?
Peripheral decarboxylase inhibitor preventing it being metabolised outside of the brain
Carbidopa
Levodopa + Carbidopa = co-carelodopa
What is the brand name of co-carelodopa?
Sinemet -> (levodopa + Carbidopa = co-carelodopa)
Why is levodopa typically saved for when other medications aren’t controlling symptoms ?
It’s very effective but the body develops a resistance/tolerance to it
What are the side effects of levodopa?
Dyskinesia
N+V
Compulsive behaviours
Withdrawal
Anxiety+depression
What is dyskinesia?
Abnormal movements associated with excessive motor. Activity
What are some examples of dyskinetic movements?
Dystonia
Chorea
Athetosis
What is dystonia?
Excessive muscle contraction
What is chorea?
Abnormal involuntary jerky movements
What is athetosis?
Abnormal twisting or writhing movements
What medication is can be given to help manage the dyskinesia associated with giving levodopa?
Glutamate antagonist
What glutamate antagonist can be given to manage the dyskinesia associated with levodopa?
Amantadine
What is the function of a COMT inhibitor?
Inhibits the break down of levodopa peripherally and in the brain extending its function
What are the side effects of a COMT inhibitor?
Orange urine
Worse dyskinesia
N+V
What are some dopamine agonists?
BROMOCRIPTINE
CABERGOLINE
Ropinirole
Rotigotine
What are some side effects of dopamine agonists like rotigotine or BROMOCRIPTINE?
Compulsive behaviours
N+V
Sleepiness
Dizziness
Why would you use dopamine agonists?
Delay having to use levodopa for when symptoms are more severe
What are some MAOB inhibitors?
Rasagiline
Selagiline
How do monoamine oxidase inhibitors work? (MAOB inhibitors)
Prevent breakdown of neurotransmitters like dopamine, serotonin and adrenaline
What medications cant you give MAO-B inhibitors with like rasagaline?
SSRIs Or SNRIs
Serotonin syndrome
Since the medication already leads to higher levels of serotonin
What are the side effects of MAOB inhibitors like rasagiline?
Worsens dyskinesia
Compulsive behaviour
What are some surgical managements of Parkinson’s?
Deep brain stimulation
Duodopa
What are some complications?
Dyskinesia
Freezing of gait
Osteoporosis
Falls
Wearing off phenomena
Aspiration pneumonia
Dysphagia
Sexual dysfunction
Pressure ulcers
Postural hypotension
Depression
Impulsive behaviour
Sleep problems
Nocturia
How does an essential tremor present?
Symetrical
Worse with intentional movement
Goes with rest
No other Parkinson’s/neurological symptoms
Improves with alcohol
How does a Parkinson’s tremor present?
Asymmetrical
Pil rolling tremor
Rest tremor
Improves with movement
No changes with alcohol
What is myoclonus?
Sudden brief involuntary jerks
When are dopamine agonists used to manage Parkinson’s?
Used to delay the use of levodopa
What are some side effects of dopamine agonists like rotigotine, bromocritpine or ropinirole?
Compulsive behaviours
N+V
Sleepiness
Dizziness
What are some MAO-B inhibitors?
Rasagaline
Selegeline
