Parkinson's disease in the Kenntnisprüfung

Which three symptoms form the classic Parkinson’s triad?

• Intention tremor, spasticity (increased muscle tone) and ataxia (unsteady gait)
• Resting tremor, rigidity (Rigor, muscle stiffness) and bradykinesia (slowness of movement)
• Action tremor, muscle weakness (paresis) and tachykinesia (excessive movement)
• Resting tremor, spasticity (springy muscle tone) and sensory disturbances in the legs

Explanation: Classic triad: rigidity, tremor (resting tremor), akinesia/bradykinesia; plus postural instability as the fourth cardinal symptom (mnemonic TRAP). Important: the tremor occurs at REST and improves with purposeful movement.

Why must L-dopa be given exactly on time?

• Because late doses trigger an overdose with hallucinations — the dose is then omitted
• Because L-dopa works best on an empty stomach in the morning — later doses during the day are much weaker
• Delayed doses lead to off phases with sudden inability to move — the regimen is time-critical
• The exact time is secondary, as long as the total daily dose is given in full

Explanation: The drug level must remain constant; even 30 minutes’ delay can plunge the patient into an off phase. Parkinson’s medicines are the prime example of time-critical doses.