Parkinsons Disease - OB

Question 1

Efficient drug treatment is available for what 3 movement disorder ??

Answer 1

• Parkinson’s disease
• Essential tremor
• Dystonia

Question 2

Age related prevalence increases with

Answer 2

Age

Question 3

What is referred as a “Hardware problem”m

Answer 3

PD and HD

Question 4

What is referred as a software problem ??

Answer 4

• Essential tremor
• Dystonia
• Tourette

Question 5

What are the three cardinal features of symptoms in PD ??

Answer 5

• Brady/Akinesia
• Tremor
• Rigidity

Question 6

Brady/Akinesia

Answer 6

– Problems with doing up buttons, keyboard etc
– Writing smaller
– Walking deteriorated: Small stepped, dragging one foot etc

Question 7

Tremor

Answer 7

– At rest

– May be unilateral

Question 8

Rigidity

Answer 8

– Pain- dull ache can be associated

– Problems with turning in bed

Question 9

Classic symptoms/Presentation

Answer 9

• Small stepped gait with:
– stooped posture, reduced armswing, L > R
• Increased tone = rigidity
– Tone increased over entire radius of joint movement
• Rest tremor
– Often asymmetrical, also some postural tremor
• Decreasing amplitude/accuracy of repetitive movements
– Much better at the beginning, gradual worsening

Question 10

What happens when tests are repeated ??

Answer 10

symptoms worsen

Question 11

PD pathology

Answer 11

Lewy body
Substantia Nigra
Loss

Question 12

DatSCAN

Answer 12

The reduced dopamine supply to the striatum
can be made visible in living patients.
More dopaminergic there is the brighter the signal

Question 13

What type of progression is PD ?/

Answer 13

Slow progression and doesnt change its nature over night

Question 14

Is PD curable ?

Answer 14

No

Question 15

How do you treat PD?

Answer 15

Compensate for loss of dopamine

L- dopa oldest but best drug

Question 16

Dopamine agonists

Answer 16

second class of drugs act direct and post synaptice dopamine receptors 
MAOis 
Increase dopamine 
Reduce break down

Question 17

When should treatment start?

Answer 17

• Nobody knows

Question 18

• Factors to take into consideration when looking at treatment ??

Answer 18

o	Severity of motor impairment/QoL
o	Side effects
o	Myths
o	L-Dopa - phobia
o	Neuroprotection???

Question 19

Motor complications of late stage PD

Answer 19

wearing off/ On and off Dyskinesias and Freezing