Parkinson's

Question 1

What is the simple pathophysiology of Parkinsons?

Answer 1

Progressive reduction of Dopamine in Basal Ganglia –> movement disorders

Question 2

Where in the Basal Ganglia is Dopamine produced?

Answer 2

Substantia nigra

Question 3

Are the symptoms of Parkinsons symmetrical or asymmetrical?

Answer 3

Asymmetrical

Question 4

What are the classic of Parkinsons symptoms? (4 things)

Answer 4

1. Tremor
2. Rigidity
3. Akinesia
4. Postural instability

TRAP

Question 5

Who is the typical person to have Parkinsons?

Answer 5

70 year old Man

aka Mohammed Ali RIP

Question 6

When is the Tremor better / worse in Parkinsons?

Answer 6

• Better @ voluntary movement
• Worse @ distracted

Question 7

What is the Rigidity in Parkinsons reffered to?

Answer 7

Cogwheel rigidity

Question 8

How do you see Cogwheel rigidity @ examination? (2 steps)

Answer 8

1. Passively flex + extend pt arm
2. Arm gives way in small increments (little jerks)

Question 9

What does Akinesia / Bradykinesia in Parkinsons refer to?

Answer 9

Movements get Smaller + Slower

Question 10

How does Bradykinesia present in Parkinsons? (4 things)

Answer 10

1. Handwriting gets smaller (classic exam q)
2. Can only take small steps (everyday im shuffling)
3. Difficulty initiating movement (standing à walking)
4. Reduced facial expressions (hypomimia)

Question 11

What are the differences between Parkinsons Tremor vs Benign Essential Tremor? (4 things)

Answer 11

1. Parkinsons: Asymmetrical // BET: Symmetrical
2. Parkinsons: 4-6 per second // BET: 5-8
3. Parkinsons: Worse @ rest // BET: Better @ rest
4. Parkinsons: Presents w other symptoms // BET: N/A

Question 12

How is the Dx of Parkinsons made?

Answer 12

Clinically

Question 13

What does NICE guidelines recommend using to Dx Parkinsons?

Answer 13

UK Parkinsons Disease Society Brain Bank Clinical Diagnostic Criteria

Question 14

Is there a cure for Parkinsons?

Answer 14

No :(

Question 15

What is the aim of Mx of Parkinsons? (2 things)

Answer 15

1. Control symptoms
2. Minimise side fx

Question 16

What are the medications available for Parkinsons Mx?

Answer 16

1. Levodopa
2. COMT inhibitors
3. Dopamine agonists
4. Monoamine Oxidase B inhibitors

Question 17

What is Levodopa?

Answer 17

Synthetic dopamine to boost dopamine levels

Question 18

What is Levodopa often given with?

Answer 18

Peripheral Decarboxylase Inhibitors (e.g Carbidopa)

Question 19

What is the point of Peripheral Decarboxylase Inhibitors (e.g Carbidopa)?

Answer 19

Stops Levodopa being broken down peripherally b4 reaches brain

Question 20

Even though Levodopa is the most effective Parkinsons meds, why is it reserved and for who?

Answer 20

Reserved bc becomes less effective over time

Reserved for when other meds aren’t controlling symptoms properly

Question 21

What is the main Side effect of too much Dopamine?

Answer 21

Dyskinesias (aka excessive motor activity)

Question 22

What are examples of Dyskinesias? (3 things)

Answer 22

1. Dystonia
2. Chorea
3. Athetosis

Question 23

What is Dystonia?

Answer 23

Excessive muscle contraction –> abn postures / exagg movements

Question 24

What is Chorea?

Answer 24

Abn invol movements (e.g jerking)

Question 25

What is Athetosis?

Answer 25

Invol twisting / writhing movements (usually in fingers / feet)

Question 26

What is an example of a COMT inhibitor?

Answer 26

Entacapone

Question 27

How do COMT inhibitors (e.g Entacapone) work? (3 steps)

Answer 27

1. COMT Enzyme metabolises Levodopa in Body + Brain 2. COMT Inhibitor slows this down 3. Extends effective duration of Levodopa

Question 28

What do Dopamine Agonists do?

Answer 28

Mimic dopamine --\> stimulate dopamine receptors

Question 29

What is the point of Dopamine Agonists? (2 things)

Answer 29

1. To delay use of Levodopa 2. To reduce dose of Levodopa needed to control symptoms

Question 30

What is a Side fx of prolonged use of Dopamine Agonists?

Answer 30

Pulmonary Fibrosis

Question 31

What are examples of Dopamine Agonists? (2 things)

Answer 31

1. Bromocryptine 2. Cabergoline

Question 32

What is an example of a Monoamine Oxidase B inhibitor?

Answer 32

Rasagiline

Question 33

How do Monoamine Oxidase B inhibitors (e.g Rasagiline) work? (3 steps)

Answer 33

1. Monoamine Oxidase B Enzyme metabolises Dopamine 2. Monoamine Oxidase B Inhibitor slows this down 3. Delays use of Levodopa + Reduces required dose of Levodopa when it’s used