ENS 333 Lecture Notes - Lecture 14: Thalamus, Bromocriptine, Carbidopa
30 Nov 2016
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November 28, 2016: unwanted catecholamine production in the periphery, if dopa decarboxylases allowed to run wild. Thus, dopa carboxylase inhibitor administered together with l-dopa (carbidopa) Levodopa-induced dyskinesia (lid: off period dystonia. Akinesia when [l-dopa] is low in blood. Painful foot spasms, but l-dopa reverses: diphasic dyskinesia. Rigidity or ballistic movements in lower limb. Does not respond to lowering l-dopa dose: peak-dose dyskinesia. Usually upper limb, lessens with reduced l-dopa. However, pd may worsen: dopamine agonists. Drug treatment approach: conserve the dopamine you do have: (cid:2870) : thus, tunes inhibition on thalamus through indirect pathway. Implanted electrodes into the basal ganglion: subthalamic nucleus, globus pallidus internus. Neuropsychiatric risks: apathy, depression, euphoria, hypersexuality, hallucinations: potentially reversible. Summary: traditional cpet possible but may require great modification, consider benefit and risk of cpet, alternative exercise tests (6-min walk) may be more appropriate. Contraindications / special considerations: balance, gait, mobility, flexibility tests might be more valuable and required prior to.
