Master the board step 3

Neurology
Levodopa/Carbidopa
Dopamine Agonists (pramipexole,
ropinirole, cabergoline)
Advantages Greatest efficacy Fewer adverse effects
Disadvantages
“On-off” phenomena with uneven long-term
effects and more adverse effects
Less efficacy
If these medications cannot control the patient’s symptoms, then use:
··
COMT inhibitors: Tolcapone, entacapone. These medications block the
metabolism of dopamine and extend the effect of dopamine-based medications.
They are not effective by themselves.
··
MAO inhibitors: Selegiline, rasagiline
··
Deep brain stimulation is done when medical therapy does not control
symptoms.
When levodopa causes
psychosis, add quetiapine
to control psychosis.
Tremor
Type of Tremor
Resting Tremor
Tremor with Intention
(Action) Only
Tremor Both at Rest
and with Intention
Diagnosis Parkinson’s disease Cerebellar disorders Essential tremor
Treatment Amantadine Treat etiology Propranolol
Multiple Sclerosis (MS)
MS presents with abnormalities of any part of the CNS; these improve only
to have another defect develop several months to years later. The most common
abnormality to develop is optic neuritis. Other abnormalities are motor
and sensory problems and defects of the bladder, such as an atonic bladder.
Other common features of MS are the following:
··
Fatigue
··
Hyperreflexia
··
Spasticity
··
Depression
Diagnostic Testing
··
Best initial diagnostic test: MRI
··
Most accurate diagnostic test: MRI
··
There is no reason to order a CT scan of the head. The CT is far less sensitive
than an MRI.
229