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Yr 5 - Neuro > Revision - Parkinson's, Tremor, MS & MND > Flashcards

Revision - Parkinson's, Tremor, MS & MND Flashcards

1
Q

What triad of features is seen in PD?

A

1) Tremor
2) Bradykinesia
3) Rigidity

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2
Q

Are the symptoms of PD characteristically symmetrical or asymmetrical?

A

Asymmetrical

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3
Q

Is PD more common in men or women?

A

2x more common in men

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4
Q

What is the frequency of the tremor in PD?

A

3-5 Hz

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5
Q

When is the tremor in PD most marked?

A

At rest

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6
Q

When does the tremor in PD improve?

A

With voluntary movement

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7
Q

Frequency of benign essential tremor?

A

6-12 Hz

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8
Q

If there is difficulty differentiating between essential tremor and PD, what investigation can be considered?

A

I‑FP‑CIT single photon emission computed tomography (SPECT).

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9
Q

What type of dementia can be associated with features of Parkinsonism?

A

Dementia with lewy bodies

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10
Q

What are the 4 groups of treatment in PD?

A

1) Levodopa

2) COMT inhibitors

3) Dopamine agonists

4) Monoamine oxidase-B inhibitors

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11
Q

What is levodopa?

A

Synthetic dopamine

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12
Q

What is levodopa usually combined with?

A

A peripheral decarboxylase inhibitor (e.g., carbidopa and benserazide)

Stops levodopa from being metabolised before reaching the brain

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13
Q

1st line treatment option in PD if the motor symptoms are affecting the patient’s quality of life?

A

Levodopa

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14
Q

1st line treatment in PD if the motor symptoms are not affecting the patient’s quality of life?

A

Dopamine agonist, levodopa or monoamine oxidase B (MAO‑B) inhibitor

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15
Q

What are 2 combination drugs given in PD? (i.e. levodopa + peripheral decarboxylase inhibitor)?

A

1) Levodopa + carbidopa –> Co-careldopa

2) Levodopa + benserazide –> Co-beneldopa

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16
Q

What is the main side effect of levodopa?

A

Dyskinesia (abnormal movements associated with excessive motor activity)

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17
Q

Give 3 examples of dyskinesia that may be seen in levodopa use

A

1) Chorea –> abnormal involuntary movements that can be jerking and random

2) Athetosis –> involuntary twisting or writhing movements

3) Dystonia –> excessive muscle contraction leads to abnormal postures or exaggerated movements

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18
Q

What may be given to manage dyskinesia associated with levodopa?

A

Amantadine (a glutamate antagonist)

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19
Q

What are COMT inhibitors?

A

inhibitors of catechol-o-methyltransferase (COMT).

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20
Q

Give an example of a COMT inhibitor used in PD

A

entacapone

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21
Q

What is the role of the COMT enzyme?

A

Metabolises dopamine in the body and brain

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22
Q

Purpose of giving COMT inhibitor (e.g. entacapone) in PD?

A

Entacapone is taken with levodopa (and a decarboxylase inhibitor) to slow the breakdown of the levodopa in the brain. It extends the effective duration of the levodopa.

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23
Q

Give 3 examples of dopamine agonists used in PD

A

1) bromocriptine

2) cabergoline

3) pergolide

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24
Q

When are dopamine agonists typically used in PD?

A

They are typically used to delay the use of levodopa, then used in combination with levodopa to reduce the required dose.

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25
Q

What is a notable side effect of prolonged use of dopamine agonists?

A

Pulmonary fibrosis

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26
Q

Role of monoamine oxidase enzymes?

A

Break down circulating neurotransmitters such as dopamine, serotonin and adrenaline.

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27
Q

Which monoamine oxidase enzyme is most specific to dopamine?

A

Monoamine oxidase-B enzyme

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28
Q

Give 2 examples of Monoamine oxidase-B inhibitors used in PD?

A

1) Selegiline

2) Rasagiline

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29
Q

PD medication can be associated with impulse control disorders.

These can occur with any dopaminergic therapy but are more common which which class of drug?

A

Dopamine agonists

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30
Q

What are 2 risk factors for a patient developing an impulse control disorder on PD medication?

A

1) a history of previous impulsive behaviours

2) a history of alcohol consumption and/or smoking

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31
Q

Common side effects of levodopa?

A

dry mouth
anorexia
palpitations
postural hypotension
psychosis

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32
Q

Some adverse effects are due to the difficulty in achieving a steady dose of levodopa.

Give some examples:

A

1) End of dose wearing off

2) ‘On-off’ phenomenon

3) Dyskinesias at peak dose

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33
Q

What is the end-of-dose wearing off seen in levodopa use?

A

Symptoms often worsen towards the end of dosage interval, which results in a decline of motor activity

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34
Q

What is the ‘on off’ phenomenon seen in levodopa use?

A

Large variations in motor performance, with normal function during the ‘on’ period, and weakness and restricted mobility during the ‘off’ period

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35
Q

If patients with PD taking levodopa are admitted to hospital and cannot take oral meds, what should you do?

A

Prescribe dopamine agonist patch to prevent acute dystonia

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36
Q

What class of drug is used to treat drug-induced parkinsonism?

A

Anticholinergics e.g. procyclidine

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37
Q

What are 2 medications that may be used in benign essential tremor?

A

1) Propanolol

2) Primidone (a barbiturate anti-epileptic medication)

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38
Q

What are the 3 subtypes of MS?

A

1) relapsing remitting (most common)

2) 1ary progressive

3) 2ary progressive

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39
Q

What is 2ary progressive MS?

A

Relapsing-remitting that has DETERIORATED and have developed neurological signs and symptoms between relapses.

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40
Q

What is 1ary progressive MS?

A

progressive deterioration from onset

more common in older people

41
Q

4 features of optic neuritis?

A

1) impaired colour vision (red desaturation)

2) central scotoma (reduced acuity)

3) RAPD

4) pain on eye movement

42
Q

Is optic neuritis unilateral or bilateral?

A

Unilateral

43
Q

Management of optic neuritis?

A

1) Urgent ophthalmology input.

2) High dose steroids.

44
Q

What imaging can help to predict which patients with optic neuritis will go on to develop MS?

A

MRI

45
Q

MS can cause eye movement abnormalities.

Give some features of MS causing eye movement abnormalities

A

1) Diplopia & nystagmus (can lead to oscillopsia): caused by lesions to the oculomotor (CN III), trochlear (CN IV) or abducens (CN VI)

2) Internuclear ophthalmoplegia (characterised by impaired adduction of ipsilateral eye with nystagmus of contralateral abducting eye): caused by lesion to medial longitudinal fasciculus

3) Conjugate lateral gaze disorder: caused by lesion in the abducens (CN VI)

46
Q

What is internuclear ophthalmoplegia in MS caused by?

A

Caused by a lesion in the medial longitudinal fasciculus

47
Q

What characterises internuclear ophthalmoplegia?

A

1) impaired adduction in ipsilateral eye

2) nystagmus of contralateral abducting eye

48
Q

What is a conjugate lateral gaze disorder?

A

When looking laterally in the direction of the affected eye, the affected eye will not be able to abduct. For example, in a lesion involving the left eye, when looking to the left, the right eye will adduct (move towards the nose), and the left eye will remain in the middle.

49
Q

What causes a conjugate lateral gaze disorder in MS?

A

CN VI (abducens) lesion

50
Q

Multiple sclerosis may present with focal weakness.

Give some examples of this

A

1) Incontinence

2) Horner syndrome

3) Facial nerve palsy

4) Limb paralysis

5) Ataxia

51
Q

Multiple sclerosis may present with focal sensory symptoms.

Give some examples of this

A

1) Trigeminal neuralgia

2) Numbness

3) Paraesthesia (pins and needles)

4) Lhermitte’s sign

52
Q

What is Lhermitte’s sign?

A

Electric shock sensation that travels down the spine and into the limbs when flexing the neck.

It is caused by stretching the demyelinated dorsal column.

53
Q

What does Lhermitte’s sign indicate in MS?

A

It indicates disease in the cervical spinal cord in the dorsal column.

54
Q

A lesion where in MS can cause sensory ataxia?

A

Dorsal columns:

+ve Romberg’s
Pseudoathetosis

55
Q

What is pseudoathetosis?

A

Involuntary writhing movements

56
Q

2 important investigations in MS?

A

1) MRI scans
2) Lumbar puncture

57
Q

Purpose of a lumbar puncture in MS?

A

Detect oligoclonal bands in CSF

58
Q

Management of an acute relapse of MS?

A

High dose steroids –> oral or IV methylprednisolone

59
Q

What steroid is indicated in acute flare of MS?

A

Methylprednisolone

60
Q

What is often used 1st line for preventing MS relapse?

A

natalizumab

61
Q

What can be given to manage oscillopsia in MS?

A

Gabapentin or memantine

62
Q

What can be given to manage urge incontinence in MS?

A

Antimuscarinic medications e.g., solifenacin

63
Q

What can be given to manage neuropathic pain in MS?

A

Amitriptyline or gabapentin

64
Q

What can be given to manage spasticity in MS?

A

Baclofen or gabapentin

65
Q

Management of fatigue in MS?

A

amantadine, modafinil or SSRIs

66
Q

Before prescribing anticholinergics for bladder dysfunction in MS, what should you do?

A

Get an US of bladder first to assess bladder emptying - anticholinergics may worsen symptoms in some patients

67
Q

What is the most common type of MND?

A

Amyotrophic lateral sclerosis (ALS)

68
Q

What are 4 types of MND?

A

1) Amyotrophic lateral sclerosis (ALS)

2) Progressive bulbar palsy

3) Progressive muscular atrophy

4) Primary lateral sclerosis

69
Q

What does progressive bulbar palsy primarily affect?

A

The muscles of talking and swallowing (the bulbar muscles).

70
Q

Weakness in MND typically affects what first?

A

Upper limbs

71
Q

Signs in MND?

A

Mix of UMN & LMN signs.

UMN:
- increased tone or spasticity
- brisk reflexes
- upgoing plantar

LMN:
- muscle wasting
- reduced tone
- fasciculations
- reduced reflexes

72
Q

What is the most common presenting symptom in ALS?

A

Asymmetric limb weakness

73
Q

Does MND affect affect external ocular muscles?

A

No

74
Q

Investigations in MND?

A

1) Nerve conduction studies –> will show normal motor conduction and can help exclude a neuropathy

2) Electromyography: shows a reduced number of action potentials with increased amplitude

3) MRI: usually performed to exclude the differential diagnosis of cervical cord compression and myelopathy

75
Q

What may an electromyography show in MND?

A

Reduced number of action potentials with increased amplitude

76
Q

Which MND carries the worst prognosis?

A

Progressive bulbar palsy

77
Q

Which MND has UMN signs only?

A

Primary lateral sclerosis

78
Q

Which MND has LMN signs only?

A

Progressive muscular atrophy

79
Q

Which MND carries the best prognosis?

A

Progressive muscular atrophy

80
Q

1st line management of slowing MND progression?

A

Riluzole

81
Q

What can be used to support breathing when the respiratory muscles weaken in MND?

A

NIV - usually BIPAP

82
Q

What is preferred way to support nutrition and has been associated with prolonged survival in MND?

A

PEG feeding

83
Q

MND prognosis?

A

poor: 50% of patients die within 3 years

84
Q

What class of medication is ropimerole?

A

Dopamine agonist

85
Q

What is Creutzfeldt-Jakob disease characterised by? (2)

A

1) rapid onset dementia
2) myoclonus

86
Q

UMN or LMN in ALS?

A

Mixed

87
Q

cognition in LBD?

A

Fluctuating (unlike other types of dementia)

88
Q

What does a head impulse test result: Loss of fixation with corrective saccades when head turned to the right

indicate?

A

Peripheral cause of vertigo

89
Q

When should you use cyclzine with caution?

A

in patients with HF as it may cause a fall in cardiac output

90
Q

What are the features of multiple system atrophy?

A

1) parkinsonism

2) autonomic disturbance:
- ED (often early feature)
- postural hypotension
- atonic bladder

3) cerebellar signs

91
Q

What does an MS diagnosis require?

A

MRI that shows demyelinating lesions that are disseminated in time & space

92
Q

What is the most common hereditary peripheral neuropathy?

A

Charcot-Marie-Tooth disease

93
Q

What does Charcot-Marie-Tooth disease result in?

A

Primarily motor loss

94
Q

features of Charcot-Marie-Tooth disease?

A
  • There may be a history of frequently sprained ankles
  • Foot drop
  • High-arched feet (pes cavus)
  • Hammer toes
  • Distal muscle weakness
  • Distal muscle atrophy
  • Hyporeflexia
  • Stork leg deformity
95
Q

What can acute withdrawal of levodopa precipiate?

A

Neuroleptic malignant syndrome

96
Q

MRI with or without contrast in MS?

A

With contrast

97
Q

What is spastic paresis?

A

Describes an UMN pattern of weakness in the lower limbs

98
Q

Cause of spastic paresis?

A

Demyelination e.g. MS

99
Q
A

Yr 5 - Neuro (13 decks)

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