Problem 6: Initiation of Tx for Parkinson's Disease Flashcards
Compare and contrast the potential differential diagnoses for Parkinson’s Disease?
The most common tremor disorders are Parkinson disease and essential tremor. When a patient presents with tremor, the clinician should pay particular attention to the body parts involved, positions/conditions in which the tremor occurs (ie, resting, postural, kinetic, intention), and the frequency of the tremor. It is also critical to look for potential associated signs. The patient should be examined for evidence of parkinsonism (bradykinesia, rigidity, postural instability), dystonia, and other neurologic signs.
Alzheimer Disease Cardioembolic Stroke Chorea in Adults Cortical Basal Ganglionic Degeneration Dementia With Lewy Bodies Dopamine-Responsive Dystonia Essential Tremor Pantothenate Kinase-Associated Neurodegeneration (PKAN) Huntington Disease Lacunar Syndrome Multiple System Atrophy Neuroacanthocytosis Neurological Manifestations of Vascular Dementia Normal Pressure Hydrocephalus Olivopontocerebellar Atrophy Parkinson-Plus Syndromes Progressive Supranuclear Palsy Striatonigral Degeneration
Comment on the pathophysiology and biochemical/neurological abnormalities in PD?
Caused by death of dopamine containing neurones in the basal ganglia. Without these neurones the passing of information from the substantia nigra to the striatum is prevented, thereby affecting movement. It is also associated with the potential accumulation of Lewy bodies in the brain.
Explore the common signs and symptoms of PD
Motor symptoms: tremor, bradykinesia (slow movement), rigidity, drooling, fatigue, loss of facial expression, speech problems, dysphagia.
Non-motor symptoms: mood disorders, (depression and anxiety), sleep disorders, insomnia, cognitive dysfunction, GI dysfunction (constipation), incontinence, pain (muscoskeletal and neuropathic pain), loss of smell.
Discuss whether GPs can make a firm diagnosis or should patients be referred to a specialist before commencing treatment
Studies have found that the diagnosis of Parkinson’s disease was incorrect in about 47% of people diagnosed in the community, 25% of people diagnosed by non-expert secondary care physicians, and 6–8% of people diagnosed by an expert in movement disorders.
Specialist referral allows additional neuroimaging, neurophysiological, or neuropsychological testing to be arranged if needed, to clarify the diagnosis and exclude other causes of parkinsonism in people with suspected Parkinson’s disease. Making an accurate diagnosis of Parkinson’s disease is important in determining the person’s prognosis and treatment regime.
The recommendation to refer a person, even if drug-induced parkinsonism is suspected and the causative drug is stopped, is based on expert opinion in a review article, that people with parkinsonism induced by antipsychotic drugs can take up to 8 weeks to improve when the dose is reduced, or anti-parkinsonian drugs are given
The SIGN guideline highlights that drug treatment for Parkinson’s disease can mask some or all of the important signs needed for diagnosis, therefore people should be referred before treatment is started
