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Pathology
Degeneration of dopaminergic neurons in substantia nigra
Aetiology
Risk factors: male, family history, smoking may be protective
Signs
Resting tremor, rigidity, bradykinesia and postural instability
Motor symptoms: festinant-gait, small hand writing and masked facies
Symptoms
Tremor, Depression, sleep disorders, sexual dysfunction, hallucinations, restless legs syndrome, constipation, dementia
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
Prognosis
Progresses over 10-15 years.
10-20% are unresponsive to treatment.
Depression, falls, postural hypotension
Key Facts
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Key Images
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Key References
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