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Brief pathogenesis of Parkinson's disease?
Degeneration of the dopaminergic pathways in the substantia nigra.
Parkinson's disease is characterised by which 3 clinical features?
- Tremor at rest
Definition of rigidity?
- Increased resistance to passive movement.
- May be increased by asking patient to perform movements with opposite limb: contralateral synkinesis.
Definition of bradykinesia?
Slowness of voluntary movement and reduced automatic movement.
Early signs of Parkinson's disease?
- Impairment of dexerity.
- Slight dragging of foot.
- Fixed facial expression.
- Increased blinking.
Later signs of Parkinson's disease?
- Festinant (shuffling) gait.
- Difficulty rising from a sitting position and starting to walk.
- Unsteadiness on turning.
Differential diagnoses of Parkinson's disease?
- Benign essential tremor- tremor worse on movement, rare at rest.
- Iatrogenic tremor- SSRIs, amphetamines, B-blockers, anti-psychotics (chlorpromazine).
- Huntington's- usually chorea (involuntary movements) is 1st presentation.
Investigations for Parkinson's disease?
- Clinical diagnosis.
- CT scan if fail to respond to L-dopa within 12 weeks.
- MRI to exclude rare secondary causes such as supratentorial tumours.
Management of Parkinson's diease?
- MAOI- selgiline, rasagiline.
- Oral or transdermal dopamine agonist- Pramipexole. 1st line in younger patients.
- Levodopa- most effective symptomatic drug.
What drug needs to be prescribed with Levodopa and why?
A peripheral dopa-decarboxylase inhibitor- Sinemet/Madopa.
Prevents peripheral conversion to dopamine.