What are the characteristic movement features of someone with ‘Parkinsonism’
Bradykinesia
Rigidity
Tremor
Gait instability
What is dystonia?
Sustained or intermittent muscle contractions causing abnormal and often repetitive movements, postures or both
Describe the tremor seen in Parkinson’s Disease
Initially unilateral Pill-roll 4-7Hz Resting tremor Reduces on movement
List some clinical features seen in Parkinson’s Disease
Tremor Cogwheel rigidity Bradykinesia Reduced facial expression (hypomimia) Reduced spontaneous blinking Festinant gait ('shuffling') Reduced arm swing Non-motor features: Anosmia, anxiety, depression, reduction in cognitive function, sleep disturbance autonomic dysfunction (postural hypotension, urinary incontinence, constipation, etc.)
List some features of progressive supra nuclear palsy
Early postural instability Vertical gaze Falls Rigidity affects trunk > limbs Symmetrical onset Speech difficulty Swallowing problems
What are the pathological features of Parkinson’s disease?
Loss of dopamine containing neurons in the substantial nigra
Lewi bodies
Alpha-synuclein mid folding causing cell death
List some drugs which might be responsible for drug-induced Parkinsonism
Anti-emetics
Calcium channel blockers
Anti-psychotics
What is the treatment for Parkinson’s?
Levodopa alongside peripheral decarboxylase inhibitor e.g. Sinemet or Madopar
Dopamine agonists e.g. Ropinerole, pramipexole, rotigotine, bromocriptine, amantadine, apomorphine
List some types of Parkinson’s Plus syndromes
Vascular Parkinson's Lewy body dementia Corticobasal degeneration Multi-system atrophy Progressive supra nuclear palsy