Parkinson resident survival guide
|Parkinson Resident Survival Guide Microchapters|
Synonyms and Keywords: Parkinson's disease management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment
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.
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.
- 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 development of Parkinson's disease are:
|Possible early symptoms of Parkinson disease
• Known Parkinson disease gene mutation in family
|Physical examination |
Findings must include
• Short step length
|Patient medical history |
Symptoms may include
• Depression and/or anxiety
|Other factors |
• Dopamine transporter single-proton emission computed tomography imaging findings
• Genetic data
|Evaluation consistent with Parkinson disease|
|Assessment of features potentially indicative of atypical parkinsonism
• Cerebellar findings (eg, dysmetria)
|All features present?|
|Evaluate for patient response to levodopa|
|Yes||No||Consider diagnosis of atypical parkinsonism|
|Confirmation of Parkinson disease diagnosis|
(DO NOT MODIFY)
|Parkinson disease motor symptoms|
• Bradykinesia with or without rigidity
|Initial medical therapy|
|Tremor and/or bradykinesia options||Tremor only trihexyphenidyl)|
|Subsequent medical therapy|
|Increasing doses and add-on therapies for “wearing off” dyskinesia)|
|Tremor and/or bradykinesia options||Tremor only|
|• Levodopa carbidopa
enteral suspension infusion
|• Unilateral focused thalamus)|
(DO NOT MODIFY)
- Use levodopa preparations, dopamine agonists, and monoamine oxidase-B (MAO-B) inhibitors initially for motor symptoms.
- Be aware of cognitive impairment and other side effects when using anticholinergic agents in young people.
- Use rivastigmine for Parkinson disease dementia. There is no evidence of memantine usefulness for mild cognitive impairment.
- Use selective serotonin reuptake inhibitors, selective serotonin norepinephrine reuptake inhibitors, and tricyclic antidepressants for depression in Parkinson disease.
- Use anticholinergics, amantadine, dopamine agonists, MAO-B inhibitors for psychosis in Parkinson disease.
- Use fludrocortisone, midodrine, and droxidopa are all possibly useful for orthostatic hypotension in Parkinson disease.
- Prescribe an appropriate exercise regimen at the time of diagnosis and throughout the disease.
- 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.
- Do not use neuroimaging or genetic screening for Parkinson's disease diagnosis.
- Do not confuse Parkinson's disease with a parkinsonian syndrome. Distinguish them by performing a dopaminergic challenge with either levodopa or apomorphine.
- 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.
- Seppi, Klaus; Ray Chaudhuri, K.; Coelho, Miguel; Fox, Susan H.; Katzenschlager, Regina; Perez Lloret, Santiago; Weintraub, Daniel; Sampaio, Cristina; Chahine, Lana; Hametner, Eva‐Maria; Heim, Beatrice; Lim, Shen‐Yang; Poewe, Werner; Djamshidian‐Tehrani, Atbin (2019). "Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review". Movement Disorders. 34 (2): 180–198. doi:10.1002/mds.27602. ISSN 0885-3185.
- Suchowersky, O.; Reich, S.; Perlmutter, J.; Zesiewicz, T.; Gronseth, G.; Weiner, W. J. (2006). "Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)". Neurology. 66 (7): 968–975. doi:10.1212/01.wnl.0000215437.80053.d0. ISSN 0028-3878.
- Albanese, Alberto; Bonuccelli, Ubaldo; Brefel, Christine; Chaudhuri, K. Ray; Colosimo, Carlo; Eichhorn, Tobias; Melamed, Eldad; Pollak, Pierre; Van Laar, Teus; Zappia, Mario (2001). "Consensus statement on the role of acute dopaminergic challenge in Parkinson's disease". Movement Disorders. 16 (2): 197–201. doi:10.1002/mds.1069. ISSN 0885-3185.
- Hughes AJ (1999). "Apomorphine test in the assessment of parkinsonian patients: a meta-analysis". Adv Neurol. 80: 363–8. PMID 10410742.