PARKINSONS

Question 0

Motor Symptoms of PD?

Answer 0

Motor 
Non-specific 
- reduced dexterity gradual onset  
- fatigue 
- join stiffness 

Gait features

• reduced arm swing
• shuffling
• freezing
• stooped posture
• festinations

Resting tremor

• pill-rolling, worsens upon supination/pronation
• disappears with intention

Rigidity

• cogwheel
• lead pipe

Bradykinesia (test with rapid alternation movements)

• lack of facial expressions, reduced blinking
• hypophonia
• dysphagia
• micrographia

Question 1

RFs for PD?

Answer 1

Age
FHx
Exposure to pesticides
Rural living

Question 2

Non-motor symptoms of Parkinson’s?

Answer 2

Autonomic dysfunction
- ortho static hypotension

Dementia
Anosmia
Sensory disturbances 
Mood disorders 
Sleep disorders

Question 3

MSA features?

Answer 3

50 yr old men with autonomic dysfunction 
Urinary incontinence 
Ortho static hypotension 
Early erectile dysfunction 
Cerebellar features (DANISH)

Question 4

PSP features?

Answer 4

Ocular disturbances (vertical gaze palsy) 
Disequilibrium 
Truncal rigidity 
Nuchal dystonia
Abnormal speech

Question 5

Drugs depleting dopamine and inducing Parkinson’s?

Answer 5

Antipsychotics
Metoclopramide
Valproate

Question 6

Ix pd?

Answer 6

CBE EUC LFT
CT of head to rule out secondary causes e.g stroke
MRI if equivocal or poor response to levodopa

Question 7

How do you diagnose PD?

Answer 7

Need Bradykinesia, response to levodopa/dopamine agonist and two of:

• resting tremor
• postural instability
• rigidity

Question 8

Rx of PD?

Answer 8

Non pharm

• exercise with full ROM
• maintain social and intellectual activities
• education

Pharm

• 1st line levopdopa or domaine agonist. Give with carbidopa to prevent peripheral metabolism to dopamine.
• MAO-B inhibitors
• COMT inhibitors (entacapone/tolcapone)

Question 9

How does DBS work?

Answer 9

Given to patients who suffer from levopdopa induced motor complications.

Reduces “off” time and dyskinesia doesn’t prevent development of progression. P

Question 10

Complications of PD?

Answer 10

Motor fluctuations did to wearing off of drug effect.

Dyskinesias from L-dopa
DBS -> haemorrhage, infection, anaesthetic risks

Of disease

• falls
• depression
• loss of mobility

Question 11

Differentials for tremor?

Answer 11

Intention
- cerebellar  
Action
- benign essential tremor  
Resting
- Parkinson's