Parkinson's disease

Background

• Extrapyramidal movement disorder a/w reduced dopaminergic receptors in substantia nigra

Clinical Features

• TRAP mnemonic:
  • Tremor (resting)
    • Initially is unilateral tremor of upper extremity, esp finger and thumb ("pill rolling")
    • Dissipates when intentional movement is performed
  • Rigidity (cogwheel)
    • Elicited by causing passive movement of limb through full range of motion
  • Akinesia
    • Slowness of voluntary movement
  • Posture/equilibrium impairment
    • Impaired ability to turn or change direction while walking

Treatmenthttp://www.wikem.org/w/index.php?title=Parkinson%27s_Disease&action=edit&section=

• Dopamine agonists
  
  • Levodopa  +Carbidopa (peripheral decarboxylase inhibitor) = gold standard
    
  • pramipexole (Mirapex)
    ropinirole (Requip)
    
• Anticholenergics
  
  • Benztropine
    
• Monoamine oxidase inhibitor - blocks DA reuptake
  
  • selegiline (Eldepryl)
    
  • rasagiline (Azilect)
    

Source

Tintinalli