Rapid review of 'ADVANCED(1)' Pearls on Parkinsonism for MRCP

Parkinson's disease

• Idiopathic parkinsonism= Parkinson's disease (PD)= Asymmetry+ No PPS (parkinson Plus Syndromez0
• PD treatment= medication control symptoms for 4-6 years , then the disease progress
• PD Rx= Surgery= DBS, Pallidotomy; when optimum medical management failed
• Pallidotomy, Thalmotomoy, Subthalmotomy---- unilater+contralateral symptom relieve, not suitable for bilateral
• DBS--- Bilateral
• Transplantation---- ethical issue important
• PD early features= REM sleep behaviour disorder
• Normal movement during REM sleep
• Autonomic ≠ PD ( think of  PPS)
• PD inv: 1. MRI : to exclude other diseases   2. SPECT: loss of nigrostriatal binding, but can't differentiate PD and Parkinson Plus Syndrome (PPS)    3.18 F dopa PET : PD vs MSA 

• Dopamine receptor agonist:

  • Used in PD, newer drug=Ropinirole, pRamipexole
  • Ergot derived DRA=Bromocriptine,Cabergoline,Lisuride and Pergolide=Fibrosis, So Echo+ESR+CXR+Creatinine must before DRA Rx, 
  • Pergolide banned due to TS
  • Transdermal patch = Rotigotine
  • ↓dose frequency than levodopa, as longer half life↓A/E than levodopa, like-dyskinesia,fLuctuation 
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