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Extrapyramidal & Movement Disorders
 
Extrapyramidal & Movement Disorders
 

Parkinson's Disease

 
 
 
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Overview

  • Ask About

  • Diagnosis - when the diagnosis was made
  • Manifestations - tremor, bradykinesia, rigidity, postural instability
  • Management - dopamine replacement, MAO-B inhibitors, COMT inhibitors

Differential Diagnosis

  • Causes of Parkinsonism

  • Parkinson’s disease - Parkinsonism, anosmia, REM sleep behavioural disturbance, frontal executive dysfunction, depression
  • Parkinson’s Plus Syndromes

  • Progressive supranuclear palsy (PSP) - Parkinsonism with supranuclear downward gaze palsy (inability to look down)
  • Multiple systems atrophy (MSA) - Parkinsonism, autonomic dysfunction, cerebellar involvement and pyramidal signs
  • Dementia with Lewy Bodies (DLB) - Parkinsonism, visual hallucinations, fluctuating cognition
  • Corticobasal degeneration (CBD) - rigidity, dystonia, focal myoclonus, ideomotor apraxia, alien limb syndrome
  • Others

  • Drugs - antipsychotics, metoclopramide, lithium
  • Normal pressure hydrocephalus
  • Hypoxic brain injury
  • Wilson’s disease

Manifestations

  • Manifestations of Parkinson’s Disease

  • Muscular

  • Tremor
  • Slowless of movement (bradykinesia)
  • Dysarthria
  • Muscular stiffness
  • Hypophonia (quiet voice)
  • Shuffling gait
  • Gait freezing
  • Micrographia
  • Non-Muscular

  • Anosmia
  • REM sleep behavioural disorder (acting out dreams)
  • Autonomic dysfunction - constipation, postural hypotension, urinary hesitancy
  • Depressive symptoms - low mood, anhedonia, fatigue

Management

  • Management Options for Parkinson’s Disease

  • Levodopa / decarboxylase inhibitor combos - levodopa / carbidopa, levodopa / benserazide
  • Dopamine agonists - bromocriptine, pramipexole, rotigotine
  • Monoamine oxidase-B inhibitors - rasagiline, selegiline
  • Catecholo-methyltransferase (COMT) inhibitors - entecapone
  • NMDA receptor antagonists - amantadine
  • Anticholinergics - benztropine
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