Parkinson Disease Medical Slides

Present the pharmacokinetic basis: as dopaminergic neurons are progressively lost, the therapeutic window narrows between the levodopa threshold for motor benefit and dyskinesia. Wearing-off (end-of-dose deterioration) occurs first, followed by peak-dose dyskinesia, then unpredictable ON-OFF fluctuations. Management strategies include dose fractionation, adding COMT inhibitors (entacapone, opicapone), MAO-B inhibitors (rasagiline, safinamide), or continuous drug delivery (levodopa-carbidopa intestinal gel).

Create a "red flags" slide listing features suggesting non-PD parkinsonism: early severe autonomic failure (MSA), early falls and vertical gaze palsy (PSP), early dementia and visual hallucinations (DLB), prominent asymmetric cortical signs like apraxia and alien limb (CBD), poor or absent levodopa response, rapid progression, and symmetric onset. These are absolute exclusion criteria in the 2015 MDS diagnostic criteria and guide alternative diagnosis and counseling.

Present the ideal DBS candidate: idiopathic PD with clear levodopa responsiveness (≥30% UPDRS improvement), disabling motor fluctuations or tremor despite optimized medications, no significant cognitive impairment (MMSE >24), no active psychiatric disease, and realistic expectations. Reference the EARLYSTIM trial supporting DBS within 4 years of motor complications onset. Compare STN-DBS (allows medication reduction, bilateral required) vs GPi-DBS (better for dyskinesia, safer with mild cognitive concerns).