motor symptoms of parkinsonism
bradykinesia (slowness of movement)
hypophonia (soft speech/ lack of coordination)
lead pipe/ cogwheel rigidity ** (NOT CLASP KNIFE)
tremors
non-motor symptoms of parkinsonism
depression
dementia
fatigue - excessive daytime sleepiness
dysautonomia: constipation, sialorrhea (excessive drooling)
parkinsonism treatment
- increase dopamine availability
- stimulate dopamine receptors
types of parkinsonism treatment
- dopamine agonist: rotigotine, ropinorole, pramipexole, amantadine
- MOA inhibitor: rasagiline, selegeline
- COMT inhibitor (COMT methylates dopamine): entacapone, tolcapone
- L-DOPA + DOPA decarboxylase inhibitor (carbidopa): sinemet, madopar
(L-tyrosine -> L-DOPA -(DOPA decarboxylase)-> Dopamine)
why cant just take dopamine directly
dopamine too large to cross BBB
gets absorbed in gut -> circulation -X-> brain
- remains in circulation: negative CVS & renal effects
why need DOPA decarboxylase inhibitor
if take just L-DOPA - gets converted to dopamine immediately -> same thing wont cross BBB
need to take DOPA decarboxylase inhibitor so it remains as L-DOPA until it crosses
doesnt stop conversion to dopamine IN the brain: it itself (DOPA decarboxylase inhibitor) cannot be able to cross BBB
myoclonus differential diagnosis
myoclonus = instantaneous contraction of muscles
- epilepsies
- also seen in many brain conditions - may not be basal ganglia
tremor differential diagnosis/ causes
tremor = rhythmic oscillation affecting upper limbs/ jaw/ neck
- medications - beta agonists
- endocrine: hyperthyroidism
- dystonia (uncontrolled contractions of muscles)
choreoathetosis differential diagnosis
choreoathetosis = irregular jerky movements
- medication: L-DOPA
- genetic cause: huntington’s chorea
- infection: sydenham chorea
- autoimmune: lupus
- stroke
- pregnancy
