Parkinson disease - Revision history

Aidan: /* Management */

2021-10-21T18:25:36Z

Management

← Older revision		Revision as of 18:25, 21 October 2021
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	== Management ==		== Management ==

	=== Non-~~motor~~ Symptoms ===		=== Non-Motor Symptoms ===

	==== Psychosis ====		==== Psychosis ====
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	* For refractory symptoms, consider [[quetiapine]], [[pimavanserin]], and [[clozapine]]		* For refractory symptoms, consider [[quetiapine]], [[pimavanserin]], and [[clozapine]]
	** Other antipsychotics have higher risk of exacerbating Parkinson disease		** Other antipsychotics have higher risk of exacerbating Parkinson disease

			==== Orthostatic Hypotension ====

			* May be caused by the underlying disease or by medications (including levodopa and MAO B inhibitors) that are used to treat it
			* Non-medical management includes increased oral fluid (possibly with boluses), salt supplementation, physical counter-maneurvers, abdominal banding, stockings, and elevating the head of the bed
			* Pharmacologic treatments include [[droxidopa]], [[fludrocortisone]], and [[midodrine]]

	[[Category:Neurology]]		[[Category:Neurology]]

Aidan at 18:17, 21 October 2021

2021-10-21T18:17:26Z

← Older revision		Revision as of 18:17, 21 October 2021
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	== ~~Definition~~ ==		== Background ==

	* Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability		* Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability

	== Pathophysiology ==		=== Pathophysiology ===

	* Destruction of substantia nigra		* Destruction of substantia nigra

⚫	== Differential Diagnosis ==

	* See [[Parkinson syndrome]]

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	* Change in speech (LR+ 2.6, LR- 0.73)		* Change in speech (LR+ 2.6, LR- 0.73)
	* ...		* ...

		⚫	== Differential Diagnosis ==
			* See [[Parkinson syndrome#Differential Diagnosis\|Parkinson syndrome]]

			== Management ==

			=== Non-motor Symptoms ===

			==== Psychosis ====

			* Usually worsened by antiparkinson medications
			* Evaluate and treat any triggers
			* Consider decreasing any anticholinergic drugs, followed by [[amantadine]], dopamine agonists, monoamine oxidase type B inhibitors, and COMT inhibitors, and finally levodopa (as a last resort)
			* For refractory symptoms, consider [[quetiapine]], [[pimavanserin]], and [[clozapine]]
			** Other antipsychotics have higher risk of exacerbating Parkinson disease

	[[Category:Neurology]]		[[Category:Neurology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:31:19Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:31, 14 July 2020
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	* See [[Parkinson syndrome]]		* See [[Parkinson syndrome]]

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Rest tremor at 4-6 Hz, inhibited by movement and sleep, worsened by stress		* Rest tremor at 4-6 Hz, inhibited by movement and sleep, worsened by stress

Maintenance script: Imported from text file

2020-07-04T01:17:49Z

Imported from text file

New page

== Definition ==

* Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability

== Pathophysiology ==

* Destruction of substantia nigra

== Differential Diagnosis ==

* See [[Parkinson syndrome]]

== Clinical Presentation ==

* Rest tremor at 4-6 Hz, inhibited by movement and sleep, worsened by stress
** Pill-rolling
* Rigidity, with increased tone and cog-wheeling
** No spasticity
** Often worse with repeated flexion
* Bradykinesia
** Short, shuffling gait with festination
** Loss of arm swing
** Micrographia
* Postural hypotension
* Glabellar tap reflex, normally stops after 5-10 taps

== JAMA Rational Clinical Exam ==

* Change in speech (LR+ 2.6, LR- 0.73)
* ...

[[Category:Neurology]]
[[Category:Geriatrics]]