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Presentation

Tremor,Resting Tremor,Rigidity (Muscle Stiffness),Cogwheel rigidity,Akinesia,Bradykinesia,Postural instability,Parkinson Gait,Fall,REM Sleep Disorder,Constipation,Micrographia,Hypominia (Masked Face),Hypophonia,Dysphagia,Sialorrhea,Anxiety Symptoms,Depression Symptom,Hallucination,Insomnia/Sleep disturbances

DDx

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Parkinson+ Syndromes
- Atypical symptoms that lead to suspicion of an atypical parkinonism syndrome include:
  - early (within first 3 years)
    - postural instability, freezing → PSP
    - hallucinations, dementia → LBD
    - dysautonomia → MSA
  - presence of gaze palsy → PSP
  - lack of robust response to levodopa
Secondary Parkinsonism

Treatment

First line: Levodopa/Carbidopa (Not helpful for Parkinson Gait)

Adjunct:→ reduce Motor fluctuations of L-Dopa and Dyskinesia Dopamine Receptor Agonist (can be used as alternative too) MAOi (A/B) Amantadine (NMDAi) → Only target Dyskinesia COMTi → Only target Motor fluctuation, worsen Dyskinesia

DBS - Deep Brain Stimulation of STN, GPi (Not helpful for Parkinson Gait), address cognitive and affective symptoms as well