Parkinson’s disease


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.

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