Neuro History

Parkinson's Disease



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    • 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 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 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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