Parkinsons 3A Flashcards
What is Parkinson’s disease?
Loss of dopaminergic neurones from substantia nigra pars compacta
Is It the MC neurodegenerative disorder?
2nd MC after dementia
RF for Parkinsons
Protective factors?
fHx, males, increased age,
Protective = smoking, caffeine, physical activity
Pathology ?
To initiate movement - nigrostriatal pathway signals striatum to STOP firing to SNpr therefore stop movement inhibition
Degenerated SNpc = Harder to initiate movement
Cardinal Sx of Parkinson’s
Bradykinesia (slow movement, smaller writing, can’t do buttons, small steps, reduced arm swing)
Resting tremor
(At rest, unilateral, U/L pill rolling thumb, 3-5Hz)
Rigidity
(cogwheel, lead pipe)
Postural Instability (Parkinsonism, camptocormia - abnormal posture - bent forwards)
What is often seen early?
anosmia (partial loss of smell)
constipation common
What are some other signs of Parkinson’s?
Hypomimia (expressionless face)
Micrographia (small tailing off writing)
Postural hypotension (autonomic failure)
REM sleep disorder
Seborrhoea (high seborrheic dermatitis - red scaly patches)
Punding (non goal orientated behaviour)
Urinary freq/urge/incontinence
Sweating
Hypersalivation
Erectile dysfunction
Why can’t dopamine be given itself?
Doesn’t cross BBB
What is a Ddx for parkinsons?
Lewy body dementia (associated with parkinsons)
If a patient has Parkinson Sx then dementia?
Dementia then Parkinson Sx?
Parkinson dementia
Lewy body dementia with Parkinsonism
what medications exacerbate Parkinson’s Sx?
Antipsychotics (eg. haloperidol)
Metoclopramide
(drug induced often = bilateral resting tremor - inhibit movement)
what is cogwheel and lead pipe rigidity?
Cogwheel = jerky tremor superimposed on hyperfine, elicited on reinforcement
Leadpipe = smooth tremor throughout movement
Name some Parkinson’s Plus syndromes?
Lewy body dementia
Multiple system atrophy
Progressive supranic palsy
Cortico-basal degeneration
Wilsons disease, drug induced, NPH (Neurogenic orthostatic hypotension)
what Sx do you get in lewy body dementia?
Dementia / hallucination then parkinsons
what Sx do you get in multiple system atrophy?
Parkinsonism + cerebellar + autonomic features - postural hypotension, incontinence, impotence
what Sx do you get in progressive supranic palsy?
Parkinsonism + fixed upwards gaze
what Sx do you get in cortico-basal degeneration?
Parkinsonism + alien limb / loss of control of one hand - moved itself
If parkinsons is suspected in GP, what is done?
urgent referral
Dx of Parkinsons?
what is found?
Clinical
(bradykinesia + 1 other Sx)
MRI = Normal
DaT scan = 2 dots instead of 2 commas (basal ganglia usually 2 commas)
Post excisional biopsy = loss of DA neurones in SN + Lewy bodies (ubiquitin + alpha synuclein)
MDT Tx of parkinsons?
OT
SALT
PT
Vit D suppose
manage complications eg. hyper salivation, constipation
what is the first line medical Tx of parkinsons?
Co-careldopa (L-DOPA + decarboxylase-i)
what does carbidopa do?
how does it help L-DOPA?
Prevents L-DOPA breakdown before reaching brain
L-DOPA = Converted to DA (an amino acid) taken up by serotinergic neurones
Why is a decarboxylase inhibitor given?
enzyme breaks down LDOPA so need inhibitor
What is the problem with LDOPA?
Initially works very well BUT soon body becomes resistant to it, effects were off so dont give LDOPA too early (eg. v mild Sx)
‘on - off’ fluctuations, well controlled periods with sudden decline following
Add MAO-i or COMT-i
L-DOPA is good to give to who?
SE of L-DOPA?
motor Sx impacting QOL
Over 65
Postural hypotension, confusion, psychosis, chorea
What is second line medical Tx of parkinsons?
COMT-i = entacapone
DA Agonisms
Amantadine
what are the SE of entacapone (COMT-i)?
orange urine
dyskinesia (worsens L-DOPA effect)
what are the 2 groups of DA agonist and give examples of each?
Ergot derivatives = Bromocriptine, cabergoline
Non ergot derived = Ropinerole, pramipexole
what is long term tx of parkinsons?
deep brain stimulation
SE of ergot and non ergot derivatives?
Ergot = pulmonary / CV fibrosis
Non ergot = hallucinations
what is the shared care plan?
specialist Dx + starts Tx
GP monitors + refers back if problems
Parkinsons tremor vs benign essential tremor:
U/L or B/L?
Intention or resting?
Hz?
Alcohols effect?
Tx?
Parkinsons:
U/L, resting
3-5Hz
Alcohol worsens
Tx = L-DOPA
Benign Essential:
B/L, Symmetrical, intention
5-8Hz
Alcohol improves
Tx = Propanolol
what type of inheritance is benign essential tremor?
Auto dominant
