Pathology: Degeneration of dopaminergic neurons in substantia nigra
Aetiology: Risk factors: male, family history, smoking may be protective
Symptoms: Tremor, Depression, sleep disorders, sexual dysfunction, hallucinations, restless legs syndrome, constipation, dementia
Signs: Resting tremor, rigidity, bradykinesia and postural instability
Motor symptoms: festinant-gait, small hand writing and masked facies
Investigations: Imaging: MRI brain and DaT scan should be considered in atypical cases
Treatment: Dopamine: Levodopa combination with dopa decarboxylase inhibitors (Carbidopa)
Adjuvant medication: Dopamine Agonists: Ropinirole, Pramipexole
MAO-B Inhibitors: Selegiline, Rasagiline
COMT inhibitors: Entacapone, Tolcapone
Advanced PD: Consider apomorphine, and deep brain stimulation
Supportive: Physiotherapy, speech therapy, occupational therapy, respite care
Complications: Depression, falls, postural hypotension
Prognosis: Progresses over 10-15 years.
10-20% are unresponsive to treatment.
