Parkinsons

Question 1

What is the pathophysiology of Parkinson’s disease?

Answer 1

Loss of dopaminergic neurones in the substantia minibar within the basal ganglia

Question 2

What is the role of the basal ganglia?

Answer 2

Regulates movement

Question 3

What forms lewy bodies in lewy. Body dementia?

Answer 3

Aggregates of alpha synuclein

Question 4

What is the classic triad of Parkinson’s?

Answer 4

Brady Kinesia
Pil rolling rest tremor
Lead pipe rigidity

Question 5

How does Bradykinesia present in a patient with Parkinson’s?

Answer 5

Shuffling gait
Reduced facial movements (hypomimia)

Question 6

What are some non motor symptoms of Parkinson’s?

Answer 6

Fatigue
Sleep disturbance
Cognitive impairment
Loss of smell
Pain
Depression/anxiety
Constipation
Incontinence

Question 7

What is the scale used to score the severity of Parkinson’s?

Answer 7

Hoehn and Yahr scale

Question 8

What are the 4 stages of Parkinson’s?

Answer 8

Early/diagnosis
Maintenance
Advanced/complex Parkinson’s (Drugs less effective/more side effects)
Palliative

Question 9

What are the 4 types of causes of Parkinsonism?

Answer 9

Idiopathic Parkinson’s disease
Parkinson plus syndrome
Drug induced
Other pathology

Question 10

What are some types of drugs that can induce Parkinsonism?

Answer 10

Anti-psychotics
Anti-emetics (metoclopramide)
Lithium
Methyldopa

Question 11

What are some alternate pathologies that can cause Parkinsonism?

Answer 11

Post encephalitis
Tumor
Vascular issue

Question 12

What is a Parkinson plus syndrome?

Answer 12

A syndrome the affects a wider area of the nervous system not just the basal ganglia

Question 13

What are the 4 main Parkinson plus syndromes?

Answer 13

Multisystem atrophy (MSA)
Lewy body dementia
Progressive supra nuclear palsy
Corticobasal degeneration

Question 14

What is multisystem atrophy (MSA)?

Answer 14

Parkinson’s plus syndrome

Neurodgeneration of various areas of the brain including the basal ganglia
+
Autonomic dysfunction

Question 15

How does multisystem atrophy (MSA) present?

Answer 15

Parkinsonism
+
Autonomic dysfunction = POSTURAL HYPOTENSION, constipation, sexual dysfunction

+

Cerebellar dysfunction = ATAXIA

Question 16

What is Lewy body dementia?

Answer 16

Type of dementia leading to deposition of Lewy bodies in the hippocampus causing dementia then basal ganglia causing Parkinsonism

Question 17

What are some symptoms/ presentations of lewy Body dementia?

Answer 17

Parkinsonism
+
Hallucinations
Delusions
REM sleep disorders
Fluctuating consciousness

Question 18

What is progressive supra nuclear palsy?

Answer 18

Parkinson plus syndrome with vertical gaze dysfunction, dysarthria and cognitive dysfunction

Question 19

What is corticobasal degenration?

Answer 19

Parkinson’s plus syndrome

Progressive dementia, Parkinsonism and limb apraxia

Can also have alien hand syndrome

Question 20

How do you make a diagnosis of Parkinson’s?

Answer 20

Done by a specialist

Clinical diagnosis but tmay consider CT/MRI head if unsure or string suspicion of secondary cause

PET or DAT scan?

Question 21

What are the 4 main types of medications used to manage Parkinson’s?

Answer 21

Levodopa
Dopamine agonists
MAOB inhibitors
COMT inhibitors

Also have glutamate agonists

Question 22

What is Levodopa?

Answer 22

It is a synthetic dopamine that is used to replace the lack of dopamine in the brain

Question 23

What is levodopa typically taken with?

What is an example?

Answer 23

Peripheral decarboxylase inhibitor preventing it being metabolised outside of the brain

Carbidopa

Levodopa + Carbidopa = co-carelodopa

Question 24

What is the brand name of co-carelodopa?

Answer 24

Sinemet -> (levodopa + Carbidopa = co-carelodopa)

Question 25

Why is levodopa typically saved for when other medications aren’t controlling symptoms ?

Answer 25

It’s very effective but the body develops a resistance/tolerance to it

Question 26

What are the side effects of levodopa?

Answer 26

Dyskinesia N+V Compulsive behaviours Withdrawal Anxiety+depression

Question 27

What is dyskinesia?

Answer 27

Abnormal movements associated with excessive motor. Activity

Question 28

What are some examples of dyskinetic movements?

Answer 28

Dystonia Chorea Athetosis

Question 29

What is dystonia?

Answer 29

Excessive muscle contraction

Question 30

What is chorea?

Answer 30

Abnormal involuntary jerky movements

Question 31

What is athetosis?

Answer 31

Abnormal twisting or writhing movements

Question 32

What medication is can be given to help manage the dyskinesia associated with giving levodopa?

Answer 32

Glutamate antagonist

Question 33

What glutamate antagonist can be given to manage the dyskinesia associated with levodopa?

Answer 33

Amantadine

Question 34

What is the function of a COMT inhibitor?

Answer 34

Inhibits the break down of levodopa peripherally and in the brain extending its function

Question 35

What are the side effects of a COMT inhibitor?

Answer 35

Orange urine Worse dyskinesia N+V

Question 36

What are some dopamine agonists?

Answer 36

BROMOCRIPTINE CABERGOLINE Ropinirole Rotigotine

Question 37

What are some side effects of dopamine agonists like rotigotine or BROMOCRIPTINE?

Answer 37

Compulsive behaviours N+V Sleepiness Dizziness

Question 38

Why would you use dopamine agonists?

Answer 38

Delay having to use levodopa for when symptoms are more severe

Question 39

What are some MAOB inhibitors?

Answer 39

Rasagiline Selagiline

Question 40

How do monoamine oxidase inhibitors work? (MAOB inhibitors)

Answer 40

Prevent breakdown of neurotransmitters like dopamine, serotonin and adrenaline

Question 41

What medications cant you give MAO-B inhibitors with like rasagaline?

Answer 41

SSRIs Or SNRIs Serotonin syndrome Since the medication already leads to higher levels of serotonin

Question 42

What are the side effects of MAOB inhibitors like rasagiline?

Answer 42

Worsens dyskinesia Compulsive behaviour

Question 43

What are some surgical managements of Parkinson’s?

Answer 43

Deep brain stimulation Duodopa

Question 44

What are some complications of Parkinson’s disease?

Answer 44

Dyskinesia Freezing of gait Osteoporosis Falls Wearing off phenomena Aspiration pneumonia Dysphagia Sexual dysfunction Pressure ulcers Postural hypotension Depression Impulsive behaviour Sleep problems Nocturia

Question 45

How does an essential tremor present?

Answer 45

Symetrical Worse with intentional movement Goes with rest No other Parkinson’s/neurological symptoms Improves with alcohol

Question 46

How does a Parkinson’s tremor present?

Answer 46

Asymmetrical Pil rolling tremor Rest tremor Improves with movement No changes with alcohol

Question 47

What is myoclonus?

Answer 47

Sudden brief involuntary jerks

Question 49

When are dopamine agonists used to manage Parkinson’s?

Answer 49

Used to delay the use of levodopa

Question 50

What are some side effects of dopamine agonists like rotigotine, bromocritpine or ropinirole?

Answer 50

Compulsive behaviours N+V Sleepiness Dizziness

Question 51

What are some MAO-B inhibitors?

Answer 51

Rasagaline Selegeline