Parkinson Disease

Question 1

Management of Parkinson Disease

Answer 1

• Hold off from any pharmacological or stimulation management until disease causes functional impairment
• Once necessary - Commence Levodopa (Dopamine Agonist)
  
  • Start low and titrate gradually over days to weeks to reduce AE
  • Clear response can take 2-3 weeks.
  • Madopar - Levodopa+ Benserazide (50+12.5mg) PO TDS
  • Sinemet - Levodopa + Carbidopa 50+12.5mg PO TDS
  • 2nd line
    
    • Can’t swallow? Rotigotine 2mg transdermal once daily.
    • Once-daily preferred? Pramipexole 0.375mg PO OD
• Avoid Metoclopramide and Prochlorperzine as can make parkinsons worse*
• If use causes acute dystonia / akathysia / sedation / postural hypotension, oculogyric crisis, larygneal spasm
• Use Benztropine 1-2mg IM/IV as a single dose.

Nausea mediation in Parkinsons?
- Domperidone 10mg PO TDS for up to 7 days.

Question 2

Parkinson’s Disease Overview

Answer 2

Syndrome diagnosed with bradykinesia plus one of the following features:
- Muscular Rigidity
- 4 to 6 Hz rest tremor
- Postural instability not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction.

Non-motor complications
- Fatigue, depression, anxiety, psychosis, sleep disturbance, orthostatic hypertension, bladder dysfunction, constipation, sexual dysfunction, pain, dysphagia, dementia)