Professional Documents
Culture Documents
Parkinsonism is a symptom of
many disorders.
– There are a variety of disorders in which parkinsonism occurs without
obvious cause, but these disorders usually have additional features
that distinguish them from classic PD. Such a distinction is important
because the long-term outlook may differ and the treatment options
may be different.
Parkinsonism
Exclusion criteria for PD
– Neuroleptics
– Toxin exposure (MPTP, CO, Mn, Methanol)
– Encephalitis
– Stroke
– Head injuries
– Early and severe dementia or autonomic
dysfunction
– Levodopa non-responder
Drug-induced Parkinsonism
More common in New and Old
elderly and women Antipsychotics
– Risperdal
– Haldol
Symmetric onset of
bradykinesia, tremor, Benzamides
and/or rigidity – Reglan
Phenothiazines
Onset within a few – Compazine
days to 3 months in – Phenergan
90% of affected
patients Others causing mainly
postural tremors:
Stop drug, try – Lithium
anticholingeric therapy – Depakote
– Amiodarone
How is Parkinson's Disease
Treated?
A number of treatment approaches help
patients with Parkinson's disease.
– General lifestyle modifications (rest and
exercise)
– Dietary considerations
– Physical therapy and speech therapy
– Medications and surgery
Replacethe dopamine, increase the lifetime of the
dopamine at the synapse, or stimulate the dopamine
receptors.
Medications for Parkinson's
disease
Levodopa (carbidopa/levodopa; Sinemet)
– Reduces the symptoms.
– Carbidopa prevents peripheral break down of
levodopa.
Minimum of 75 mg/d to avoid nausea.
– Treatment over a number of years may lead to
variability in an individual's response to
treatment, called "motor fluctuations."
– Another form of motor fluctuation is
uncontrolled writhing movement of the body or
a limb, which is called "dyskinesia."
40% will develop motor fluctuations within six years
of treatment.
Drug Targets
DA is made from
the amino acid L-
tyrosine.
DA is inactivated
after release by
reuptake.
It can be
repackaged or
degraded by MAO-
A & B and COMT.
Levodopa
Levodopa is rapidly absorbed from the small intestine. Most patients
experience improvement in symptoms about 30 minutes after a dose, and
the benefit lasts about 3-5 hours.
Doses:
– Stalevo® 50: 50 mg levodopa, 12.5 mg carbidopa, and 200
mg entacapone
– Stalevo® 100: 100 mg levodopa, 25 mg caridopa and 200 mg
entacapone
– Stalevo® 150: 150 mg levodopa, 37.5 mg carbidopa, and 200
mg entacapone
Anticholinergic medications
– Reduce tremor and/or rigidity.
– Benztropine mesylate (Cogentin®): 0.5 mg, 1 mg, 2 mg tablets or
Trihexyphenidyl (Artane®): 2 mg and 5 mg tablets as well as liquid form.
– Side effects may include dry mouth, blurred vision, sedation, delirium,
hallucination, constipation, and difficulty urinating.
Selegiline
– MAO-B (monoamine oxidase B) inhibitor prolonging the action of dopamine in
the brain. It also has a mild antidepressant effect.
– Eldepryl®: 5 mg capsule.
– Side effects may include heartburn, nausea, dry mouth, insomnia and dizziness.
Confusion, nightmares, hallucinations, and headache occur less frequently and
should be reported to your doctor.
Rasagiline (Agilect ®)
– Soon to be released DA (MAO-B inhibitor) taken once daily in doses of 0.5 or 1
mg.
Deep Brain Stimulation
Unlike lesion procedures, DBS leaves electrodes in place in the
brain to deliver continuous stimulation.
– Parkinsonism
– Tardive dyskinesia
– UPDRS
Progressive Supranuclear Palsy
ALL OF THESE FEATURES
– Onset at age 40 or later
– Progressive course
– Bradykinesia
– Impaired vertical gaze (voluntary downgaze <15o)
PLUS THREE OF THESE FEATURES
– Frequent falls as an early manifestation
– Prominent axial rigidity
(neck rigidity > limb rigidity)
Neck hyperextended
– Early dysarthria
– Dysphagia
– Lack of tremor
May see frontal lobe dementia
Multiple Systems Atrophy
Three presentations:
– Shy-Drager Syndrome
Akinetic,
rigid parkinsonism with early and
prominent autonomic dysfunction (urinary
incontinence, postural hypotension, upper
airway obstruction, arrhythmias).
– Striatonigral Degeneration
Akinetic, rigid parkinsonism unresponsive to
L-dopa.
– Olivopontocerebellar Atrophy
Parkinsonism and cerebellar ataxia.
Corticobasal Ganglionic Degeneration