Thursday, February 16, 2012

Experience from a recent candidate in Singapore MRCP PACES exam

As he enters the room of the Neurology station in the Singapore exam in TTSH, he was given a patient who has resting tremors, bradykinesia and rigidity......the diagnosis was obvious- Parkinson disease.
However, he was asked by the examiner.....what do you think is this on the patient ?

How would you answer the examiner ?

8 comments:

Abu Ahmed said...

This patient with parkinson's disease most likely he has a " deep brain stimulation device" for counteracting the intractable tremors...

Wuchereria said...

Yes DBS !
DBS is not only for tremors. The common DBS targets would include STN, GpI and VIM thalamus.

Most commonly STN would be the best target. VIM thalamus is useful mainly for tremors. GPi would be useful for dyskinesias or dystonias.

WJ said...

Sir, for Parkinson's disease, are pallidotomy and thalalotomy work equally effective and both aim at controlling of resting tremor, rigidity and bradykinesia?

Anonymous said...

Other symptoms include sensory, sleep and emotional problems. PD is more common in the elderly, with most cases occurring after the age of 50. Internal medicine specialized on parkinson's related diseases explained this as a degenerative disorder of the central nervous system.

Wuchereria said...

Thalamotomy and pallidotomy are destructive surgery. This means they are irreversible unlike DBS which is reversible. Both the procedures are nowadays replaced by DBS. Thalamotomy is only good for tremors, which can be replaced by DBS VIM thalamus. Pallidotomy has been replaced by DBS GPi.

internal medicine Tampa said...

Good to see the update here.

annie george said...

The general symptoms of Parkinson disease are muscle rigidity, tremors, and changes in speech and gait. This disease is cured by the studies on using stem cells. This disease is caused due to the lack of dopamine due to the loss of dopamine-producing cells in the substantia nigra. MRCP Courses UK

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