Parkinson's disease
| Headline | |
|---|---|
| Etiology | Secondary causes: repeated head trauma, post-infectious, neurosyphilis, metab ⇒ basal ganglia calcification. Drug-induced: 1st gen antipsychotics (haloperidol, risperidone), antiemetics (metoclopramide), valproate |
| Epidemiology | Age of onset 60+ unless young-onset/genetic. |
| Clinical presentation | resting tremor, loss of facial expression, aprosody, low-volume rapid speech Signs: tremor, rigidity, akinesia, postural instability. Pill-rolling tremor 4-7Hz |
| Pathogenesis | alpha-synuclein; Lewy bodies in olfactory tract, dorsal motor ncl of vagus with rostral spread. |
| Diagnostic investigations | Clinical diagnosis usually. |
| Management | L-Dopa is 1st line. See other Parkinson's medications. ➥ Must inform DVLA ➥ See specialist care every 6-12m ➥ Physio, OT, SALT, nutrition support - protein in last meal to reduce off-effects ➥ Advance care planning ➥ Deep brain stimulation to STN, pallidum, thalamus |
troubleshooting
- psychosis
- orthostatic hypotension
- hyperpyrexia
- Serotonin syndrome
- parasomnias
Exclusion criteria
- Antipsychotics, dopamine-depleting drugs, known neurotoxin
- Repeated strokes, repeated head injury
- No improvement on L-dopa
- Cerebellar signs, early severe dementia
- Cerebral tumour (...) and communicating hydrocephalus