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Parkinsonism clinical summary
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Lecture notes on parkinsonism
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Parkinson’s diseasehttps://cks.nice.org.uk/topics/parkinsons-disease/ [NICE guideline ref]
Definition: chronic, progressive neurodegenerative condition resulting from the loss of the
dopamine-containing cells of the substantia nigra.
Parkinsonism is an umbrella term for the clinical syndrome involving bradykinesia together
with at least one of the following: rigidity, tremor, and postural instability.
Signs:
• Akinesia: the absence or reduction of movement
• Bradykinesia: the slowness of movement
• Rigidity: the resistance to passive movement
• Resting tremor
Complications:
Motor complications (usually related to the use of anti-parkinsonian medication),
such as immobility, slowness, communication difficulties, motor fluctuations,
dyskinesia, and freezing of gait.
Non-motor complications, such as depression, anxiety, impulse control disorders,
psychotic symptoms, dementia, sleep disturbance, autonomic dysfunction, falls, and
pain.
Management:
Replace lost dopamine by giving L-DOPA, dopamine agonists, drugs that
reduce dopamine breakdown or reduce dopamine uptake
o Carbidopa, levodopa
o Effectiveness of L-DOPA decreases after 2-5 yrs as neurones still
degenerating
Deep brain stimulation
No treatments address the underlying degeneration of the neurones
Alternatives to L-DOPA:
o Directly-acting dopamine receptor agonists
Bromocriptine/Pergolide (fairly non-selective)
o Pramipexole/Ropinirole (more D2 receptor selective, newer)
Apomorphine (reserved for advanced stage PD)
Problems include: nausea/emetic effects, psychotomimetic
effects
o Drugs which inhibit breakdown of dopamine
Selegiline (MAO-B inhibitor)
o Dopamine releaser
Amantidine
o Muscarinic ACh receptor antagonists
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