Parkinsons Flashcards
What causes Parkinsons?
Gradual onset idiopathic death of cells in substantia nigra (pars compacta) therefore decreasing dopaminergic input from substantia nigra to the striatum. This means the dorsal ganglia don’t process motor programmes properly
Symptoms of Parkinsons?
Pill rolling resting tremor Bradykinesia Rigidity & Spasticity Shuffling gait with reduced arm swing Akinesia (poverty of movement) and blunting of facial expression with reduced blinking Stooped, flexed posture Erectile dysfunction Faints Urgency (30% develop dementia)
Age of onset Parkinsons?
Usually 50+
What kind of dementia is Parkinsons associated with?
Lewy Body Dementia (eosinophilic protein aggregations)
What investigations are done for Parkinsons?
Clinical diagnosis Hand tap Rombergs Postural Reflexes Cogwheel rigidity
What is the difference between rigidity and spasticity?
Rigidity: increased tone all over joint
Spasticity: increased tone initially then overcome
Why can we not just give Dopamine to treat?
Doesn’t cross BBB and causes peripheral side effects
What are the 3 classes of drugs used to treat Parkinsons?
Give an example of each
- Dopamine Precursors- L-Dopa (Levodopa)
- Dopamine Agonists- Bromocriptine, Ropinirole, Pramipexole
- Antimuscarinics- Benzatropin
What is L Dopa usually given with and why?
A dopamine decarboxylase inhibitor to prevent being used up by the peripheral NS
What are side effects of L Dopa?
Nausea and vomiting as D2 receptor triggers gastric emptying & long term involuntary movements.
Nausea treated with Domperidone
What do antimuscarinics help?
Reduce tremor and rigidity but dont help bradykinesia
What are side effects of Benzatropin?
Drowsiness
Confusion
Decreased parasympathetic function
What surgical options are available for Parkinsons?
Deep brain electrode stimulations of globus pallidus and substantia nigra
Pallidotomy
What other conditions cause parkinsonism?
Normal Pressure Hydrocephalus in the elderly Neuroleptic medications Wilsons Disease Diffuse Lewy Body Disease CV Disease Multiple System Atrophy
What are side effects of Dopamine Agonists?
Impulsive gambling, sex and shopping Euphoria Hallucinations Pericardial effusion Insomnia
