Parkinson's Disease Flashcards
** TO FINISH WITHE LECTURE NOTES AND OTHER
wMean age of diagnosis
70 years
Cardinal features of PD
Tremor
Bradykinesia
Rigidity
Postural instability
Other features
• Masked facies (Loss of spontaneous facial movement and expressivity)
• Speech monotonous, low volume
• No resting tremor
• Asymmetrical cogwheel rigidity and bradykinesia
- Slow, hesitant foot tapping
- Normal power and sensation in limbs
- Unable to fasten button, tie laces
Parkinsonian gait characteristics
- Reduced speed, stride length
- Narrow base of support
- Forward trunk flexion
- Reduced arm swing
- Short, shuffling steps
- Festination (CoG ahead and chasing it)
- freezing (esp at doorways, change in surfaces)
- Difficulty turning, changing direction, stepping over or moving around objects
What is the pull test?
Warn pt you will be pulling them back, pull back with quick pull at the shoulders.
+ve sign: staggers backwards multiple steps when pulled - retropulsion
What is dyskinesia?
- Reversible levodopa-induced motor complication (too much levodopa)
- Present in 30-40% of patients on levodopa for 5 year, nearly 60% by 10 years
- Abnormal involuntary movements (choreic, dystonic, ballistic, myotonic)
- Treat by adjusting levodopa dosing (increasing dose frequency)
What is dystonia?
- Involuntary muscle contraction involving abnormal movements and postures
- More sustained abnormal posture than dyskinesia
- Can be an undertreated PD motor symptom or a complication of levodopa treatment
Describe the mainstay Rx of PD?
Direct replacement of levodopa for symptomatic therapy
Most effective for hyponetic motor symptoms also tremor and reigidity (postural instability elss responsive)
Sinemet (carbidopa- levodopa) or Madopar (levodopa/benserazide)
* levodopa is always combined with peripheral decarboxylase inhibitor to minimise peripheral conversion to dopamine (adverse effects)
Adverse effects of levodopa
Adverse effects • Nausea, abdominal cramping, diarrhea • Somnolence • Dizziness and headache • Confusion, hallucination, delusions, agitation and psychosis • Orthostatic hypotension
What are the Levodopa-related complications
a. Wearing-off
- end-of-dose effect
b. On-Off syndrome
- Episodes of unpredictable ‘off’, alternating with ‘on’ (+/- dyskinesia)
ON: relatively normal movement
OFF: rigid, tremor and difficulty with spontaneous movement
c. Failure to turn ‘on’, (‘no-on’ response to levodopa)
- Due to excessively prolonged or severe ‘off’ period
d. Acute akinesia
- sudden exacerbation of PD,
- akinetic state lasting for days and not responding to antiparkinson medications
What are the other PD medications?
- COMT inhibitors
- Selective Monoamine Oxidase Type B inhibitors (MAO-I)
- Dopamine agonists (DA): pramipexole (sifrol, rotisotine, apomorphine)
- Anticholinergics
- Amantadine
Main AFx of dopamine agonist
Very emetic!
Use with domperidone anti emetic
What are the non-motor Sx of PD?
• Orthostatic hypotension – A few near falls – Feels “dizzy” (light-headed) when changing positions • Urine frequency • Constipation
How do you reduce the ‘wearing-off” of levodopa?
1) change madopar regimen, dose route of admin
2) consider apomorphine
What are the side effects of apomorphine?
Continue madopar, aim to decrease dose and frequency as ampoorphine is increased
SE similar to thsoe of levodopa:
N/V, somnolence, orthostatic hypotension, confusin, hallucinations, impulse control disorders, cehst pain, angina
