Clinical: Parkinson's

Question 1

Pathology of Parkinsons

Answer 1

Depletion/degeneration of dopaminergic neurons of the substantia nigra. Can be due to an accumulation of misfolded proteins (alpha synuclein?) May have Lewy bodies

Question 2

What are the cardinal clinical features of someone with Parkinson’s?

Answer 2

Asymetrical condition (at least starts that way) -Rest tremor, slow frequency - Bradykinesia, reduced arm swing, reduced rapid alternating movement, movements start with arge amplitude and peters out *(decrement) - Rigidity (cogwheel rigidity) - Postural abnormalities: stooped posture, difficulty arising from chair

Question 3

How do you diagnose Parkinsons?

Answer 3

Must have atleast two of the cardinal features May do a response to levodopa

Question 4

Non motor symptoms of Parkinsons

Answer 4

Anosmia; constipation; REM sleep behaviour disorder; depression Onset is insidious

Question 5

Pathogenesis

Answer 5

Typically a genetic susceptibility, such as mutation on c4 causing early onset. Viral infectionencephalitis lethargica

Question 6

What are the types of drug treatment?

Answer 6

L-DOPA- precursor for dopamine that crosses BBB. Don’t use dopamine for peripheral side effects. May also use MAO B inhibitor and COMT inhibitors to prolong the half life of dopamine

Question 7

What are some surgical treatments?

Answer 7

Stereotactic thalamotomy an pallidotomy. Deep brain stimulation to inhibit overactive neruons.

Question 8

What are some late complications of Parkinsons?

Answer 8

-Cognitive abnormalities- confusion -Depression -Postural hyopotension - Fluctuations: Due to short half life of drug and neurodegeneration get a mix of effects such as dyskinesia

Question 9

REM sleep behaviour disorder

Answer 9

Acting out of dreams, and can precede motor symptoms of Parkinsons by years. Does dont respond to L-DOPA but clonazepan works