Parkinson's Disease & movement disorders

Question 1

What are the basal ganglia responsible for?

Answer 1

Involved in initiation and modulation of movement

Question 2

What is the mechanism of the basal ganglia?

Answer 2

1- Receive input from cerebral cortex
2- process it
3- relay back to cerebral cortex via thalamus

Question 3

What does hypokinetic mean?

Answer 3

Too little movement

Question 4

What does hyperkinetic mean?

Answer 4

Too much movement

Question 5

Does Parkinson’s disease come under hypo- or hyperkinetic disease?

Answer 5

Hypokinetic

Question 6

What is characteristic of a hypokinetic disease?

Answer 6

Stiffness, slow movement and loss of amplitude of movement

Question 7

What percentage of Parkinson’s disease is idiopathic and familial (genetic)?

Answer 7

95% idiopathic
5% familial

Question 8

What characterizes Parkinson’s disease?

Answer 8

Bradykinesia - (slowness of initiation of movement & performing movement as well as loss of amplitude)

Question 9

What are the pathological hallmark’s of Parkinson’s disease?

Answer 9

• Loss of pigmentation in substantia nigra and locus coeruleus
• Lewy bodies

Question 10

What are the motor symptoms of Parkinson’s disease?

Answer 10

• Involuntary tremors
• Bradykinesia
• Rigidity
• Postural instability

Question 11

What are the non-motor symptoms of Parkinson’s disease?

Answer 11

• Sleep disorders
• Hallucinations
• GI dysfunction
• Cognitive impairment / Dementia
• Anosmia

Question 12

How is Parkinson’s disease diagnosed?

Answer 12

Clinical diagnosis

Question 13

What is the mechanism of symptomatic treatments in Parkinson’s disease?

Answer 13

Enhance intracerebral dopamine concentrations or stimulate dopamine receptors

Question 14

Does tremor respond well to typical symptomatic treatment?

Answer 14

NO

Question 15

What is the main drug used for Parkinson’s?

Answer 15

Levadopa

Question 16

When are dopamine agonists/MAOB inhibitor considered?

Answer 16

• Patient is young
• Mild motor symptoms
• Parkin mutation (avoid early dyskinesia)
• Patient preference

Question 17

What are some side effects of dopamine agonist and levodopa?

Answer 17

• Nausea
• Daytime drowsiness
• Oedema

Question 18

What are some long term complications of dopaminergic treatment for PD?

Answer 18

• Motor fluctuations
• Non-motor fluctuations
• Dyskinesia
• Drug induced psychosis

Question 19

When is deep brain stimulation indicated?

Answer 19

Marked motor fluctuation despite levadopa

Question 20

What would indicate drug induced parkinsonism?

Answer 20

Symmetrical postural tremor

Question 21

How is an essential tremor identified?

Answer 21

Symmetric, postural tremor
Much higher frequency
Also have an action tremor

Question 22

Name the Parkinson plus conditions?

Answer 22

• Multiple system atrophy
• Progressive supranuclear palsy

Question 23

When is Parkinson’s Disease most common?

Answer 23

50’s-60’s

Question 24

What is the core triad of multiple system atrophy?

Answer 24

• Dysautonomia
• Cerebellar features
• Parkinsonism

Question 25

Does multiple system atrophy respond to levadopa?

Answer 25

NO

Question 26

What are some symptoms of progressive supranuclear palsy?

Answer 26

• Gait & balance issues (falls)
• Inability to move eyes