PBL discussion of PD

Question 1

Alternating or synchronous contraction of antagonist and agonist muscles is the result of a ….

Answer 1

Tremor

Question 2

Describing the tremor involves 4 things

Answer 2

1. Distribution/topography
2. Relation to movement (rest or action?)
3. Frequency (slow or fast?)
4. Amplitude

Question 3

Action tremors are subdivided into two classes. what are they?

Answer 3

1. Kinetic tremor

2. Postural tremor

Question 4

Intention tremors are a subtype of which class of tremor?

Answer 4

Action - Kinetic tremor

Question 5

Physiologic tremor occurs at low or high frequency?

Answer 5

high 8-12 Hz

Question 6

Cerebellar tremors occur at low or high frequency?

Answer 6

Intention tremor - low frequency - 3-4Hz

Question 7

Describe the frequency of essential tremors

Answer 7

Initially high frequency, later low frequency

Question 8

Parkinsonian tremors are high or low frequency?

Answer 8

Can be 3-6Hz

Question 9

Physiologic tremors are a subtype of which class of tremors?

Answer 9

Postural

Question 10

Describe a key feature of physiologic tremor

Answer 10

“Invisible” so fine amplitude

Question 11

Is Enhanced physiologic tremor a neurological condition?

Answer 11

NO

Question 12

Describe 3 key features of a cerebellar tremor

Answer 12

1. Alcoholic degeneration
2. Posterior circulation stroke
3. MS

Question 13

Cerebellar tremors are a subtype of which class of tremor?

Answer 13

Intention tremor - kinetic

Question 14

How do you treat Essential tremor? (1st line)

Answer 14

1. Propanolol

2. primidone - adverse effect: can cause vertigo, nausea

Question 15

How do you treat Essential tremor? (2nd line)

Answer 15

1. Gabapentin, topiramate, benzos
2. Botox locally
3. Deep brain stimulation

Question 16

Akinesia or bradykinesia is described as

Answer 16

slowed movement

reduced amplitude brought on by continued movement

Question 17

Do you need postural instability to diagnose Parkinson’s?

Answer 17

NO, often absent until later in disease state - EARLY FALLS ARE ATYPICAL!

Question 18

What are the three predictors of idiopathic PD

Answer 18

1. presence of rest tremor
2. Asymmetry of signs in onset and progression
3. Good response to L-dOPA

Question 19

In young onset PD what’s first line?

Answer 19

D agonist

Question 20

How does COMT work?

Answer 20

Prevents breakdown of both L-Dopa and Dopamine