Parkinson

Posted On February 13, 2020

Medication induced

• usually symmetrical
• take pt off the offending medication
• can be caused by older neuroleptic and Metoclopropamide (Reglan)
• May use anticholinergic for treatment

Idiopathic:

• one side is worse than other.
• For young onset (<65 years old). start with dopamine agonist, such as ropinirole
• Older patient, use L dopa (sinemet)

Parkinson plus:

• parkinson plus orthostatic hypotension, dementia, eye movement problem ,severe gait problem. 
• May try sinemet, do not respond well. 

Main treatment

• L dopa:
  • Sinemet 25/100
  • Sinemet 25/250
  • Sinemet CR 50/200 (ok to crush, needs 30 percent more mg when converting from regular)
• Dopamine agonist:
  • Ropinirole (Requip): 0.25 mg tid, max 18 mg/day
    • – comes in 0.25, 0.5, 1, 2, 3, 4, 5 mg (cost 1 mg tid, 90 $18/m)
  • Ropinirole ER: start 2 mg qd ($10/m), max 18 mg/d
    • comes in: 2, 4, 6, 8, 12 mg (2 or 4 mg, 30 cost $35)
• Anticholinergic: tends to cause confusion, may help tremor
  • Trihexyphenidyl 0.5 to 1 mg bid
  • Benztropine (Cogentin) 0.5 to 2 mg bid

Adjunctive therapy

• Comtan

From osmosis: full review of Parkinson

2 minute video to explain parkinson

From NeurologyResidents.com – parkinson med table