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25 Cards in this Set
- Front
- Back
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Discuss the pathological changes that occur in Parkinson's Dz?
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1. Depigmentation and atrophy (loss of niagral cells) of the Substantia nigra
2. Cytoplasmic Inclusions called LEWY bodies in dopaminergic cells 3.Increased number of glial cells 4. Depigmentation of the locus ceruleus |
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What types of transmitters are contained in nigral cells?
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Dopamine and neuromelanin
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What pathway is responsible for the motor symptoms associated with Parkinsons Dz?
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Nigrostriatal pathway is responsible for the motor symptoms. Mesolimbic/mesocortical pathway is responsible for motor symptoms.
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What constitutes the glutamate output system?
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Subthalamic nucleus and the internal segment of the globus pallidus
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What is MPTP? What is its significance in relation to Parkinsons?
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Synthetic form of Demerol responsible for acute onset of permanent parkinsonism in a small group of drug addicts. MPTP is converted to MPP+ via MAO B enters dopaminergic cells as poisons complex 1 of the mitochondrial electron transport chain.
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Describe the typical Parkinsonian patient.
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61 year old male with no racial of socioeconomic designation.
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What are the cardinal motor features associated with Parkinsons Dz?
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1. Resting tremor that diminishes in the face of intentional movement,
2. Cogwheel rigidity- patient complain of miscle stifness aching 3. Bradykinesia/akinesia 4. Postural instability- late onset flexed posture flexing at the neck elbow and knees 5. lose protective reflexes |
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Define Parkinsonian akinesia.
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Motor block or absence of spontaneous movement (patients do not blink)
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Discuss treatment of Parkinsons?
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Treatment is symptomatic
Levidopa- a precursor of Dopamine (DA cannot cross BBB) Carbidopa- inhibits periperal dopa decarboxylation to dopamine preventing orthostatic hypotension and nausea. |
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What is a festination?
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Pathologic shuffle associated with Parksinoniasm in which hyperflexion of limbs precipitates increasing speed and imbalance of gait. The run consisting of small steps is called a festination.
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Discuss the honeymoon phase associated with symptomatic treatment of Parkinsons?
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Last from 2-15 years and is due to a progessive decline of nigral cells comprimising their ability to store dopamine. Synapse dopa elevels start to become a function of plasma levodopa levels, known as end dose failure.
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Discuss amantadine and its clinical use.
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Anti-viral agent thought to enhance the release and prevent the reuptake of dopamine by the brain. Used to treat Parkinsons
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What role do benzotropine and trihexyphenidyl play in treatment of Parkinsons?
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Effective in tremor reduction. Anticholinergics counter the increase in activity of the brain secondary to decrease of dopamine.
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What is the function of Bromocriptine and pergolide?
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Dopamine (D2) agonists. Bromocriptine and pergolide are ergot derivatives used to treat Parkinsons.
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What are some advantages to utilization of dopamine agonists to treat Parkinsons?
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1. Longer duration then levodopa
2, Do not rely on the integrity of dying neurons 3. Can smooth out response and bridge time between dosing of levodopa |
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Describe the syndrome of Parkinsonism.
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Parkinsons is not merely a motor/dopamine disorder. It involves many pathologies that are modulated by non-dopaminergic changes.
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True/False. Parkinsons is almost always asymmetrical.
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True.
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What is a lewy body?
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A histological hallmark of Parkinsons Dz. A pinkish concretion inside dopaminergic cells containing alpha synuclein and ubiquitin.
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What is the significance of PARK genes?
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PARK genes represent a connection between genetics and pathology. PARK I seen in autosomal dominant disorders, PARK II is inovlvded in the ubiquitin system.
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What is the action of COMT? Discuss the use of COMT inhibitors in Parkinsons.
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Catechol-O-methyltransferase degrades levodopa in the periphery and dopamine in the CNS inhibitors of COMT increase the effect of levadopa by increasing its half-life.
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What are some limitations of levodopa in treatment of Parkinsons?
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Does not treat Parkinsonian dementia
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What are some limitations of stereotactic ablative surgery?
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1.Does not improve bradykinesia and rigidity
2.irreversible 3. Thalotomy only done to treat tremor not othe symptoms of PD |
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What specific aspects of the brain are lesioned in stereotactic ablative surgey?
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Subthatlamic Nucleus and the Medial Globus Pallidus which are overactive in PD
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What is the major site of DBS implantation?
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Subthalamic Nucleus
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Describe the ideal patient for STN-DBS.
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1. Robust responsiveness to levodopa
2, intractable motor response fluctuations 3. Free of depression and psychosis 4. Relatively Young 5. Tried alll other medical interventons |
