PD + movement disorders (see DM)

Question 1

what is the most common tremor

Answer 1

essential tremor - an autosomal dominant, familial tremor

Question 2

what does essential tremor improve with?

Answer 2

alcohol

Question 3

if a pt has an essential tremor what will a spiral drawn by them look like

Answer 3

shaky, unlike in PD

Question 4

4 features of parkinsonianism

Answer 4

1. akinesia - bradykinese, fatiguing, decrement in size/speed of action on repetitive movement;
2. rigidity - increased muscle tone + resistance to passive movements;
3. tremor;
4. postural/gait disturbances

Question 5

PD tremor (4) vs essential tremor

Answer 5

PD:
1. resting tremor;
2. asymmetrical;
3. low frequency (3-5hz);
4. low-moderate amplitude

essential:
1. postural tremor;
2. symmetrical tremor;
3. high frequency (6-8hz);
4. low amplitude

Question 6

5 primary parkinsonian conditions

Answer 6

1. parkinson’s disease;
2. lewy body disease;
3. progressive supranuclear palsy;
4. multiple system atrophy;
5. cortical-basal degeneration

Question 7

6 secondary causes for parkinsonism

Answer 7

1. drugs (e.g. anti-dopaminergics, lithium, anti-emetics);
2. toxins (e.g. Mn2+, pestacides, MTPTP);
3. cerebrovascular disease;
4. post encephalitic (e.g. spanish flu);
5. anoxic brain injury;
6. traumatic brain injury

Question 8

4 red flags of parkinsonism

Answer 8

1. early falls -> more likley to be progressive supranuclear palsy, MSA, CBD etc.;
2. early dementia -> more likely to be LBD, PSP;
3. early pronounced autonomic features (MSA);
4. sudden onset symptoms (cerebral vascular accident)

Question 9

what is progressive supranuclear palsy

Answer 9

a Tauopathy characterised by vertical gaze dysfunction, dysarthria and cognitive decline(and other parkinsonian features) -> more rapidly progressing than PD

Question 10

4 targets for PD treatment

Answer 10

1. minimise DA breakdown;
2. replace lost DA;
3. restore electrical balance in BG (DBS!)
4. supportive therapies (physio, OT etc.)

Question 11

5 common side effects of levodopa

Answer 11

1. dry mouth;
2. anorexia;
3. palpitations;
4. postural hypotension;
5. psychosis

Question 12

what adverse effects are seen when a steady levodopa dose is not reached

Answer 12

1. symptom worsening towards end of dose;
2. “on-off” phenomoenon - normal function during on period and LOF during off;
3. dyskinesia at peak dose - dystonia, chorea, athetosis (involuntary writhing)

Question 13

what side effects may DA receptor agonists cause

Answer 13

1. impulse control disorders;
2. hallucinations;
3. daytime drowsiness;
4. postural hypotension

Question 14

what is the pathway of M1 fibers -> spinal chord through the brain

Answer 14

M1 -> internal capsule -> cerebral peduncle -> pons -> pyramidal medulla -> medulla spinal chord junction (decussation occurs)

Question 15

what is the normal function of TAU

Answer 15

a microtubule-associated protein that stabilizes neuronal microtubules

Question 16

mgx of pts w cerviacle myelopathy

Answer 16

specialist spinal services (neurosurgery or orthopaedic spinal surgery)