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Movement Disorders, MDT Chronic Disease Mangement Early, Middle, Late…

- - - - Very effective for tremor
      - Used in refractory tremor
- - - - D2 blockers
        DA depleteors
    - - CCB
        Anti convulsants
- - - - May have cerebellar syndrome
        Truncal ataxia
        Past pointing
      - Autonomic syndrome
        Bladder
        Orthostatic hypotension
        Marked
    - - Similar to PD but different area
      - Early visual Hallucinations
        Early fluctuating cognitive impairment < 1 yr
      - Spectrum with PD
      - Alpha syn
    - - Supranuclear gaze palsy
        Early falls
        Early postural instability
      - Tau pathology
    - - Tauopathy
      - Apraxia
        Corticaol sensory loss
        Parietal lobe is involved
- - - - Binds to presynaptic dopamine transporters
      - Differentiates IPD and drug induced or essential tremor
        IPD will have abnormal DATscan
        Does not differentiate between other primary parkinson's (parkinson's plus)
  - - - Pontocellerebellar atrophy
      - Hot cross bun sign
      - Glutamalin atrophy??
      - Not freq enough for diagnosis
    - - Midbrain atrophy
- - - - Levodopa
        
        Best
      - Dopamine agonist
        
        Convenience
        Less effective
        Higher S/e
        Specific s/e: Impulse control disorders
    - - MOA inhi
      - COMT inhibitors
      - Prolong dopamine
    - - TRemor reduction
        Poor for cognition
    - - Dyskinesia
  - - - Mild
        Med competing issues
        Motor complications
        Non- motor features emerge
        
        LAte
        Difficult
        Motor symptoms less
        Significant disability related to non motor
- - - - Tremor
    - - Myoclonus
        Fasciluations
- - - - IPD
    - - Meds
        Vascular
  - - - Atypical Parkinsonians
        
        Multiple systems atrophy
        Corticobasal degeneration
        Progressive supranuclear palsy