Akinetic-Rigid Movement Disorders

Question 1

Which parts of the brain make up the extra-pyramidal system?

Answer 1

Basal ganglia

Thalamus

Question 2

What characterises akinetic-rigid movement disorders?

Answer 2

Reduced movements and increased muscle tone

Question 3

Briefly describe the pathophysiology in Parkinson’s

Answer 3

Loss of dopaminergic neurons in the substantia nigra pars compacta

Question 4

What is the peak age of presentation of Parkinsons?

Answer 4

70s

Question 5

How does Parkinson’s present?

Answer 5

Bradykinesia
Rigidity
Resting tremor
Small, shuffling gait
Dementia

Question 6

“Spidery handwriting” is a buzzword for what?

Answer 6

Parkinsons

Question 7

Describe how the bradykinesia in Parkinson’s shows itself clinically

Answer 7

Fixed facial expression
Reduced blinking
Soft, slow speech
Slowness

Question 8

Describe the rigidity in Parkinson’s disease

Answer 8

Lead-pipe - when tone sustained throughout movement

Cogwheel - rigidity imposed on tremor

Question 9

How is the Parkinson’s tremor classically described?

Answer 9

Pill-tremor

Question 10

Why are Parkinson’s patients more susceptible to falls?

Answer 10

Loss of postural righting reflex

Question 11

How is Parkinson’s investigated?

Answer 11

Usually a clinical diagnosis

MRI to rule out Parkinson plus

Question 12

How is Parkinson’s managed?

Answer 12

Dopamine agonists

Levodopa

Question 13

Give examples of dopamine agonists

Answer 13

Ropinirole

Pramipexole

Question 14

What is levodopa given in combination with?

Answer 14

Decarboxylase inhibitors (carbidopa)

Question 15

What do decarboxylase inhibitors do?

Answer 15

Prevent conversion of dopamine outside of brain

Question 16

How does amantadine work?

Answer 16

Antagonises glutamate

Question 17

What is amantadine used for?

Answer 17

Levodopa-associated dyskinesias

Question 18

What do COMT inhibitors do in Parkinson’s disease?

Answer 18

Prevent breakdown of levodopa

Question 19

What drugs are given for tremor in Parkinsons? Give examples.

Answer 19

Clomipramine
Chlorpromazine
Biperiden
Diphenhydramine

Question 20

What is an absolute last resort treatment in Parkinsons?

Answer 20

Stereotactic neurosurgery

Question 21

Domperidone is safe to given in Parkinsons

true/false

Answer 21

True as it does not cross the BBB

Question 22

Which class of drugs are known to cause Parkinsonism?

Answer 22

Anti-psychotics

Question 23

How does drug induced Parkinson’s differ from Parkinsons disease?

Answer 23

Symmetrical in drug induced

Question 24

What are the Parkinson Plus syndromes?

Answer 24

Group of conditions which cause Parkinsonism
Progressive supranuclear palsy
Multisystem atrophy
Corticobasal degeneration

Question 25

How does progressive supranuclear palsy present?

Answer 25

Symmetrical parkinsonism Eye movements abnormality Rigidity Cognitive impairment

Question 26

What is multi-system atrophy?

Answer 26

Cerebellar ataxia | Autonomic dysfunction

Question 27

How does cerebellar degeneration present?

Answer 27

Parkinsonism Myoclonus Dysphagia Alien limb