Parkinson disease: Difference between revisions
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== Background == |
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* 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 |
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== Pathophysiology == |
=== Pathophysiology === |
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* Destruction of substantia nigra |
* Destruction of substantia nigra |
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== |
== Clinical Manifestations == |
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* See [[Parkinson syndrome]] |
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== Clinical Presentation == |
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* 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 |
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* Change in speech (LR+ 2.6, LR- 0.73) |
* Change in speech (LR+ 2.6, LR- 0.73) |
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* ... |
* ... |
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== Differential Diagnosis == |
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* See [[Parkinson syndrome#Differential Diagnosis|Parkinson syndrome]] |
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== Management == |
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=== Non-Motor Symptoms === |
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==== Psychosis ==== |
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* Usually worsened by antiparkinson medications |
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* Evaluate and treat any triggers |
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* 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) |
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* For refractory symptoms, consider [[quetiapine]], [[pimavanserin]], and [[clozapine]] |
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** Other antipsychotics have higher risk of exacerbating Parkinson disease |
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==== Orthostatic Hypotension ==== |
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* May be caused by the underlying disease or by medications (including levodopa and MAO B inhibitors) that are used to treat it |
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* 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 |
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* Pharmacologic treatments include [[droxidopa]], [[fludrocortisone]], and [[midodrine]] |
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[[Category:Neurology]] |
[[Category:Neurology]] |
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Latest revision as of 18:25, 21 October 2021
Background
- Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability
Pathophysiology
- Destruction of substantia nigra
Clinical Manifestations
- 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)
- ...
Differential Diagnosis
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
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
