Condition Info - BotMed Application

ConditionName

Parkinson disease

ConditionDescription

Symptoms

Tremor (trembling) in hands, arms, legs, jaw, or head; 
Cogwheel rigidity (slowing of movement on passive flexion or extension of extremity);
Limited facial expression;
Slowness; Difficulty walking;
Can progress to cognitive and behavioral;
Gait disturbance;
Problem with initiating gate, problem with stopping;
Lightheadedness when getting up from seating position;
Depression

PhysicalFindings

Writing is small – micrographic.
Postural instability or orthostatic hypotension.
Inability of pulse and BP to reset.

Pill-rolling tremor.
Resting tremor.
Shuffling gait (difficulty initiating and stopping ambulation, small
steps, no swinging of the arms);
Masked facies, rare blinking, cogwheel rigidity.

ClinicalTests

Clinical diagnosis.
No test.

RiskFactors

Head trauma
Boxing
Antipsychotic medication
Encephalitis
Metoclopramide (MPTP) exposure

Most common: idiopathic
Elderly (50+ y/O)

IsRedFlag

IsNPLEX

Consequence

Death of dopamine-generating cells;
High level of Ach;

ProgressionFromCondition

Loss of substantia nigra -> decrease in dopamine, movement disorder

TreatmentOptions

Deep brain stimulation;
Electrical stimulation;

PharmOptions

Amantadine – for older people >60 intolerant of anticholinergic;
Severe: 
inability to care for themselves, orthostatic
Dopamine agonists (infrequent use b/c AE):
Pramipexole;
Bromocriptine;

Most effective with highest level of toxicity:
Levodopa/carbidopa;
Insufficient dopamine – bradykinesia;
Too much dopamine - dyskinesia;

AVOID tyramine-containing foods (eg, cheese) with MAO;

WebLink

https://www.merckmanuals.com/professional/neurologic-disorders/movement-and-cerebellar-disorders/parkinson-disease