0904 Bradykinetic Movement Disorders

Question 1

List the cardinal features of Parkinson’s disease.

Answer 1

tremor (resting),
rigidity/stiffness (cogwheel joints),
bradykinesia (slow, shuffling movements),
loss of balance (postural instability)

Question 2

List NON-motor symptoms associated with Parkinson’s disease.

Answer 2

anosmia (loss of smell - possibly first symptom!), depression, dementia (onset after motor symptoms), psychosis, hallucinations, pain, constipation, fatigue, sleep disturbance.

Question 3

List MOTOR symptoms associated with Parkinson’s disease.

Answer 3

tremor, stiffness, bradykinesia, instability, mask-like face, decreased blinking, hypophonia, dysarthria, dysphagia, micrographia, gait abnormalities (shuffling, reduced armswing, festination)

Question 4

List some diseases that are Parkinson mimics.

Answer 4

Vascular Parkinsonism, Normal pressure hydrocephalus, Drug-induced Parkinsonism, Dementia with Lewy Bodies, Corticobasal degeneration, Progressive Supranuclear palsy, Mutlisystem atrophy.

Question 5

Describe the pathophysiology of Parkinson’s disease.

Answer 5

Destruction of dopaminergic neurons in the substantia nigra with accumulation of Lewy bodies (aggregates of alpha synuclein and ubiquitin)

Question 6

List medications used in the treatment of Parkinson’s disease.

Answer 6

Levodopa, dopamine agonists, COMT inhibitors, MOAB inhibitors, Amantadine.

Question 7

What is the purpose of giving Levodopa (L-dopa) in PD?

Answer 7

As a precursor to dopamine, increases the amount of dopamine available in the body.

Question 8

What is the action of Catechol-O-methyltransferase inhibitors?

Answer 8

To prevent the degradation of dopamine and thus increase the availability of dopamine at the synapse.

Question 9

What is the action of Mono-amine oxidase B inhibitors?

Answer 9

To prevent the degradation of dopamine and thus increase the availability of dopamine at the synapse.

Question 10

What is the action of amantadine?

Answer 10

To increase dopamine release, blocking cholinergic receptors (NMDA antagonist)

Question 11

Describe stiff-person syndrome.

Answer 11

axial muscle stiffness, rigidity, spasm due to autoimmune dysfunction of GABAergic system.

Question 12

What is the action of carbidopa?

Answer 12

To prevent peripheral breakdown of levodopa so more is available for uptake into the brain.