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

Treatment

• 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