Info
🌱 來自: Huppert’s Notes
Hypokinetic Movement Disorders🚧 施工中
Hypokinetic Movement Disorders
Parkinsonism
• Symptoms: Syndrome of bradykinesia (#1), rigidity, tremor, postural instability
• Physical exam: Slowed responses (bradyphrenia), decreased blink rate, hypomimia (“masked facies”), slowed finger and toe taps, pill-rolling tremor (resting > postural), rigidity (cogwheel rigidity = rigidity with superimposed tremor), stooped posture, shuffling gait, en bloc turning, reduced arm swing
Idiopathic Parkinson’s disease
• Pathophysiology: Gradual loss of dopamine-producing neurons in the substantia nigra due to both genetic and environmental factors
• Symptoms: Asymmetric resting tremor, bradykinesia, postural instability with falls, anosmia (lack of smell, often precedes motor symptoms), REM sleep behavior disorder, constipation, orthostatic hypotension, urinary retention, nocturia
• Treatment:
- Carbidopa-levodopa: Start 0.5–1 tablet TID. Side effects: Worsened orthostatic hypotension, nausea, visual hallucinations. Comes in extended release formulation (good for motor fluctuations)
- Entacapone: COMT inhibitor, prolongs effectiveness of carbidopa-levodopa
- MAO-B inhibitors: Selegiline, rasagiline. Side effects: Hallucinations, orthostasis, insomnia
- Dopamine agonists: Pramipexole, ropinirole, rotigitine. Side effects: Hallucinations, impulse control disorder
Parkinson-plus syndromes (atypical parkinsonism)
• Lewy body dementia (LBD): Parkinsonism + fluctuating mental status + visual hallucinations
• Progressive supranuclear palsy (PSP): Early falls + vertical gaze limitation
• Multiple aystem atrophy (MSA): Parkinsonism + prominent, early autonomic dysfunction
• Corticobasal syndrome (CBS): Asymmetric rigidity/dystonia + cortical signs