Parkinson resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Moises Romo, M.D.
Synonyms and keywords:Parkinson's disease management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment
Overview
Parkinson's disease is a degenerative movement disorder of the central nervous system. It is characterized by motor symptoms such as bradykinesia, rigidity, and tremor, but also cognitive and comunicative symptoms such as facial masking and dysarthria. These primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine. Diagnosis is mainly clinical, it may be supported by MRI findings and dopamine transporter single-photon emission computed tomography (DaT SPECT), but definitive diagnosis is made by autopsy. The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion. Other therapies will depend on comorbidities.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Parkinson's disease is not a life-threatening condition that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- The cause of Parkinson's disease is a dopamine depletion due to a necrosis of dopaminergic neurons in the substantia nigra.
- Factors that may contribute to the developement of Parkinson's disease are:
- Low norepinephrine levels
- The presence of Lewy bodies
- Autoimmune factors
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Parkinson's disease according to the American Academy of Neurology guidelines:[1]
| Gait disturbance | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| When? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Always with movement (may vary in severity) | Intermittently during movement (may vary in severity and frequency) | Continuous and intermittent disturbances are present at least once | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Continuous | Episodic | Mixed | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transient inability to create effective stepping? | Unintentional increase in speed, usually with small steps? | Transient imbalance? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Freezing | Festination | Disequilibrium | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Disequilibrium and hypermetria of stance and gait? | Associated with increased postural tone? | Slow or small steps and/or slow or small postural? | Involuntary movements? | Associated with muscle weakness or paralysis? | Static or axial postural deformities? | Secondary to musculoskeletal or central pain? | Present at a higher level? | Difficult to classify the continuous nature of the gait disturbance? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ataxic | Spastic | Bradykinetic/hypokinetic | Dyskinetic/Choreic/Dystonic | Paretic | Trunkal disturbance | Antalgic | Frontal disturbance | Undetermined | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Use levodopa preparations, dopamine agonists, and monoamine oxidase-B (MAO-B) inhibitors initially for motor symptoms.[1]
- Be aware of cognitive impairment and other side effects when using anticholinergic agents in young people.[2]
- Prescribe an appropriate exercise regimen at the time of diagnosis and throughout the disease.[1]
- Use deep brain stimulation and other surgical approaches when individuals with Parkinson disease experience either the “wearing off” phenomenon or dyskinesias that do not respond to medication.[1]
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 1.2 1.3 Marino, Bianca L.B.; de Souza, Lucilene R.; Sousa, Kessia P.A.; Ferreira, Jaderson V.; Padilha, Elias C.; da Silva, Carlos H.T.P.; Taft, Carlton A.; Hage-Melim, Lorane I.S. (2020). "Parkinson's Disease: A Review from Pathophysiology to Treatment". Mini-Reviews in Medicinal Chemistry. 20 (9): 754–767. doi:10.2174/1389557519666191104110908. ISSN 1389-5575.
- ↑ Fox, Susan H.; Katzenschlager, Regina; Lim, Shen-Yang; Barton, Brandon; de Bie, Rob M. A.; Seppi, Klaus; Coelho, Miguel; Sampaio, Cristina (2018). "International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease". Movement Disorders. 33 (8): 1248–1266. doi:10.1002/mds.27372. ISSN 0885-3185.