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Parkinson Disease

Mark Stephens, MD and Elyas Parsa, Osteopathic Doctor Reviewed 05/2023
 


BASICS

DESCRIPTION

  • A progressive neurodegenerative disorder caused by loss of dopaminergic neurons in the substantia nigra and other dopaminergic regions of the brain.

  • Cardinal symptoms include resting ...

DIAGNOSIS

  • Diagnosis is based on clinical features and response to dopaminergic therapy.

  • Gold standard for diagnosis is neuropathologic exam.

  • Generally, bradykinesia plus either tremor or rigidity must b...

TREATMENT

GENERAL MEASURES

Multidisciplinary rehabilitation with standard physical and occupational therapy components to improve functional outcomes 

MEDICATION

  • PD goal: Improve motor and nonmotor defic...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Avoid drug holidays is patient is having "off" time on levodopa.

  • Consider switching to dopamine agonist (non-ergot preferred), MAO-B inhibitors, or COMT inhibitors...

REFERENCES

1
Fan B, Jabeen R, Bo B, et al. What and how can physical activity prevention function on Parkinson's disease? Oxid Med Cell Longev. 2020;2020:4293071.
2
Bailey M, Anderson S, Hall DA. Parkins...

SEE ALSO

  • American Academy of Neurology practice parameter on initiation of treatment of PD: https://n.neurology.org/content/58/1/11.long

CODES

ICD10

  • G21.11 Neuroleptic induced parkinsonism

  • G21.8 Other secondary parkinsonism

  • G21.4 Vascular parkinsonism

  • G21.19 Other drug induced secondary parkinsonism

  • G21 Secondary parkinsonism

  • G21.1 Other dru...

CLINICAL PEARLS

  • The classic description for PD is shaky (pill-rolling tremor at rest), stiff (cogwheel rigidity), slow (bradykinesia), and stumbling (shuffling gait).

  • No cure—goals are to delay disease...

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