1. Brief pathogenesis of Parkinson's disease?
    Degeneration of the dopaminergic pathways in the substantia nigra.
  2. Parkinson's disease is characterised by which 3 clinical features?
    • Tremor at rest
    • Rigidity
    • Bradykinesia
  3. Definition of rigidity?
    • Increased resistance to passive movement.
    • May be increased by asking patient to perform movements with opposite limb: contralateral synkinesis.
  4. Definition of bradykinesia?
    Slowness of voluntary movement and reduced automatic movement.
  5. Early signs of Parkinson's disease?
    • Impairment of dexerity.
    • Slight dragging of foot.
    • Fixed facial expression.
    • Increased blinking.
  6. Later signs of Parkinson's disease?
    • Festinant (shuffling) gait.
    • Difficulty rising from a sitting position and starting to walk.
    • Unsteadiness on turning.
  7. 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.
  8. 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.
  9. Management of Parkinson's diease?
    • MAOI- selgiline, rasagiline.
    • Oral or transdermal dopamine agonist- Pramipexole. 1st line in younger patients.
    • Levodopa- most effective symptomatic drug.
    • Amantadine/anti-cholinergic.
  10. What drug needs to be prescribed with Levodopa and why?
    A peripheral dopa-decarboxylase inhibitor- Sinemet/Madopa.

    Prevents peripheral conversion to dopamine.
Card Set
Parkinson's disease