Parkinson's/Epilepsy Flashcards
(64 cards)
How is Parkinson’s diagnosed?
Bradykinesia +1 of:
- 4-6 Hz tremor
- Mucular rigidity
- Postural instability
ASSYMETRICAL
If these symptoms are bilateral, how does this change the diagnosis?
More likely to be SECONDARY PARKINSONISM caused by drugs (e.g. neuroleptics, antiemetics), CVD, infections etc
Name some non-motor symptoms of parkinson
- REM behaviour disorder (acting out dreams) and other sleep disorders
- Reduction in olfactory function (ANOSMIA IN 90%!!!!)
- Depression/anxiety/hallucinations
- Parasthesia
- Fatigue
- Sexual dysfunction
- Bladder dysfunction
If you see a patient with rapid onset parkinsonism and dementia, what is the most likely diagnosis?
Lewy Body Dementia
What is Parkinson’s Disease?
A progressive neurodegenerative disease with two main features:
- Loss of pigmented dopaminergic neurons in the substantia nigra
- Increase in Lewy Bodies
Name some other relevant motor features of PD
Dysphagia
Dysarthria
Hypersalivation
Blurred vision
Micrographia
Dystonia
Stooped posture
Shuffling gate
Freezing
Festinant
FALLS
What does festinant mean?
Having short stride and quickened gait
What is a parkinson plus syndrome?
A group of syndromes that exhibit the same symptoms as parkinsons but with additional features:
- Multiple system atrophy
- Corticobasal degeneration
- Progressive supranuclear palsy
What are the typical pre-motor symptoms?
- Impaired olfaction
- REM behaviour disorder
- Depression
- Constipation
What imaging technique is used in parkinson diagnosis?
SPECT - measures loflupane (DaTSCAN) uptake in presynaptic dopamine transporters
What does a DaTSCAN look like in a PD patient?
More like .. than the usual “
What are the pros and cons of DaTSCANS?
PRO - high sensitivity and specificity
CON - expensive
Describe the onset and progression of PD
Insidious onset (latent period can be up to 3 decades)
Long clinical course (10-30 years)
Incurable, decreased life expectancy
Name the 7 classes of drugs used to treat PD?
- L-dopa (give with decarboxylase inhibitor)
- Dopamine agonists
- MAOB inhibitors
- COMPT inhibitors
- Amantadine
- Anticholinergics
- Oestrogen
Name two examples of L-Dopa with decarboxylase inhibitor
Madopar, Sinemet
Name two examples of MAOB inhibitors
Selegiline, Rasagiline
Name three examples of dopamine agonists
Ropinirole, Pramipexole, Rotigotine, Apomorphine
How do L-Dopa and decarboxylase inhibitors work?
L-dopa is converted to dopamine in the brain
How do COMT inhibitors work, and what is an example?
Entacapone They stop L-dopa from being converted to 3-0 methydopa (must be used alongside)
How do MAOB inhibitors work?
They stop dopamine from being converted to its inactive metabolite
Which of the drug treatments is best for symptom control?
L-dopa, however it has motor complications, unlike the others
Why is L-Dopa used in older patients and dopamine agonists used in younger ones?
L-dopa is the best for symptomatic treatment but DAs are best in delaying onset of motor complications
Also DA causes orthostatic hypotension, which could contribute to falls in the elderly
Which members of the MDT are involved in Parkinsons care?
PD nurse specialist, physiotherapy, occupational therapy, SALT, support groups
What drug is primarily used in early PD?
MAOB inhibitors (best at stopping progression of disease, but not that good at symptom control)
