Parkinson's Flashcards Preview

Internal Medicine > Parkinson's > Flashcards

Flashcards in Parkinson's Deck (12):
1

Etiology

1. Sporadic
Oxidative stress to dopaminergic neurons
Toxins
Accelerated ageing
Genetics
2. Familial
Alpha synuclei protein
Parkin gene
3. MPTP neurotoxin

2

Pathophysiology

1. Loss of dopaminergic neurons in substantia nigra
2. DIsinhibition of indirect pathway and decreased activation of direct pathway= increased inhibition of motor pathways
3. Alpha synuclein accumulated in lewy bodies and causes neruotoxicity

3

Epidemiology

1. Mean age of onset is 65 years

4

Risk factors

1. Family history
2. Male
3. Head injury
4. Exposure to neurotoxins

5

Protective factors

1. Coffee
2. Smoking
3. NSAID
4. HRT in post=menopausal

6

Clinical presentation

1. Bradykinesia
2. Rigidity
3. Resting tremor
4. Postural instability
5. Shuffling gait
6. Masked facies
7. Hypophonia
8. Monotonous speech
9. Micrographia
10. Cognition, behaviour
11. Autonomic: constipation, urinary retention, sexual dysfunction, orthostatic hypotension
12. REM sleep disorder

7

Management

1. Multidisicplinary
Neurologist
Physiotherapist
Nursing
Occupational therapist
GP
Social worker
Parkinsons QLD Inc for support and information
2. Assess disability
3. Medication
L-dopa (Levodopa/Carbidopa)
Dopamine agonist->Ropinirole and pramipexole, bromocriptine, pergolide, cabergoline
Amantadine
MAOI
Anticholinergics->not in elderly
COMT inhibitors
Anticholinersterases->Rivastigmine
Apomorphine
4. Neuropsychiatric
5. Respite
6. Surgery
Surgical lesions
Deep brain stimulation

8

What are parkinson's plus syndromes

1. Progressive supranuclear palsy
Early postural instability
Falls
Vertical gaze palsy
Rigidity of trunk > limbs
2. Multiple system atrophy (Shy Drager)
Early autonomic symptoms
Postural hypotension
Bladder dysfunction
Cerebellar and pyramidal signs
Rigidity > tremor
3. Cortico-basal degeneration
Akinetic degeneration involving one limb
Sensory loss
Apraxia
4. Lewy body dementia
Visual hallucinations
Fluctuating
5. Vascular parkinsonism
Worse in legs than arms
Pyramidal signs
Prominent gait abnormality

9

Counselling use of Levodopa

1. Works to replace some of the DA no longer producing
2. Help to reduce your symptoms->particularly the rigidity and bradykinesia (slow movem)
3. Given with carbidopa to inhibit peripheral levodopa degeneratioin
4. 3-4 times with food to reduce nausea/vomiting
5. Taken for as long as effective, after 5 years there is end dose deterioration->works for shorter, on and off, fluctuating effect
6. DevelopM of dyskinesia, painful dystonias and response fluctuations
7. Fast acting medication
8. Side effects
N/V->use domperidone
Psychosis
Dyskinesia
Postural hypotension
Other drugs can be used to help with the side effects
9. Contraindicated in glaucoma

10

Criteria for diagnosis

1. Bradykinesia + at least one of
2. Muscular rigidity
3. 4-6Hz rest tremor
4. Postural instability not caused by visual/cerebellar dysfunction

It is unilateral onset, resting, progressive
70-100% response to levodopa

11

Division of symptoms

1. Premotor
REM sleep abnormalities
Constipation
Hyposomnia
Depression
2. Motor
3. Non-motor
Psychosis
Cognitive->Alzheimers, LBD
Sleep-wake

12

Exclusion criteria

1. Repeated strokes, head injury, encephalitis
2. Neuroleptic treatment at onset of symptoms
3. Poor response to levodopa->MSA, SNP
4. Essential tremor
5. Early, severe dementia
6. Cerebral tumor or hydrocephalus on CT
7. MPTP exposure