2: Movement Disorders

Question 1

What is a movement disorder

Answer 1

Syndrome caused by excess or paucity of automatic or voluntary movements

Question 2

What are 3 common movement disorders

Answer 2

• Essential tremor
• PD
• Restless leg syndrome

Question 3

What are the 4 types of movement

Answer 3

1. Automatic
2. Voluntary
3. Semi-voluntary
4. Involuntary

Question 4

What is automatic behaviours

Answer 4

Learned motor behaviours performed without conscious effort

Question 5

Give an example of automatic behaviour

Answer 5

Walking to a familiar place

Question 6

What is voluntary behaviour

Answer 6

Behaviour performed in response to an external stimulus

Question 7

What is semi voluntary movement

Answer 7

Behaviour performed in response to an internal stimulus

Question 8

Give two examples of semi voluntary movement disorders

Answer 8

• Tic

- Restless leg syndrome

Question 9

What are involuntary movements

Answer 9

Movements that cannot be surpassed

Question 10

Give 4 examples of non-supressable movement disorders

Answer 10

• Tremor
• Myoclonus
• Chorea
• Dystonia

Question 11

How is normal control of movement divided

Answer 11

Central

Peripheral

Question 12

What are central components of movement

Answer 12

• Motor cortical areas

- Basal ganglia

Question 13

What are peripheral components of movement

Answer 13

• Motor neurone junction
• Muscle
• Spinal Cord

Question 14

What pathways exist in the basal ganglia

Answer 14

Direct and Indirect

Question 15

Explain effect of dopamine on direct pathway

Answer 15

Direct pathway contains D1-receptors. Hence is excited by dopamine release from corticostriatal neutrons

Question 16

Explain effect of dopamine on indirect pathway

Answer 16

Direct pathway contains D2-receptors. Hence is inhibited by dopamine release from corticostriatal neurons

Question 17

What is the role of direct pathway

Answer 17

Increases voluntary movement

Question 18

Explain direct pathway

Answer 18

• Corticostriatal neurons stimulate external pallidum
• External palladium inhibits internal pallidum
• This prevents internal pallidum form inhibiting thalamus
• Excites thalamus and movement

Question 19

Explain indirect pathway

Answer 19

Inhibits movement

Question 20

Explain indirect pathway

Answer 20

• Corticostriatal neurons inhibit external pallidum (D2 receptors)
• This disinhibits sub thalamic nucleus
• Subthalamic nucleus stimulates the internal pallidum
• Internal pallidum inhibits thalamus, inhibiting movement

Question 21

What are the two types of movement disorders

Answer 21

Hyperkinetic

Hypokinetic

Question 22

What are 7 hyperkinetic movement disorders

Answer 22

• Dystonia
• Tremor
• Tic
• Myoclonus
• Akathisia
• Athetosis
• Chorea

Question 23

What are 5 hypo kinetic movement disorders

Answer 23

• Cataplexy
• Bradykinesia
• Rigidity
• Catatonia
• Holding Tic

Question 24

Define tremor

Answer 24

Regular, rhythmic, repetitive movements that affects one or more body parts

Question 25

Define dystonia

Answer 25

Sustained twisting repetitive movements with prolonged abnormal posture involving groups of muscles

Question 26

Define chorea

Answer 26

Involuntary, Irregular, Purposeless, unsustained movement that flow from one body part to another

Question 27

Define myoclonus

Answer 27

Brief electric shock like movements arising from nervous system

Question 28

What is positive myoclonus

Answer 28

Contraction agonist then antagonistic muscle groups

Question 29

What is negative myoclonus

Answer 29

Transient interruption in tonic muscle tone (asterixis)

Question 30

What is a Tic

Answer 30

Repetitive stereotyped behaviour that is difficult to control

Question 31

What is akathisia

Answer 31

Inner restlessness

Question 32

What is cataplexy

Answer 32

Transient loss in muscle tone due to strong emotion

Question 33

Define a tremor

Answer 33

Rythmic involuntary movement of one or more body parts

Question 34

What is the most common cause of tremor

Answer 34

Essential tremor

Question 35

What is the inheritance pattern of essential tremor

Answer 35

Autosomal dominant

Question 36

How does essential tremor present

Answer 36

- Postural tremor - worse with arms outstretched | - Head tremor

Question 37

What improves essential tremor

Answer 37

Alcohol | Rest

Question 38

What is stereotype for essential tremor patient

Answer 38

Young patient with sudden-onset tremor

Question 39

How is essential tremor managed first line

Answer 39

Propanolol

Question 40

What is an alternative to propranolol for managing essential tremor

Answer 40

Primidone

Question 41

What tremor is present in Parkinson's disease

Answer 41

Pill Rolling

Question 42

What type of tremor is pill rolling tremor

Answer 42

Resting

Question 43

What tremor is present in cerebellar lesion

Answer 43

Intention tremor

Question 44

Give 4 organic causes of tremor

Answer 44

- Thyrotoxicosis - CO2 retention - Hepatic encephalopathy - Anxiety

Question 45

How are tremors broadly divided

Answer 45

- Action | - Resting

Question 46

Are resting tremors or action tremors more common

Answer 46

Action tremors

Question 47

What disorder is most commonly associated with resting tremor

Answer 47

Parkinson's disease

Question 48

What is restless leg syndrome

Answer 48

Spontaneous continuous lower limb movement that may be associated with parasthesia

Question 49

In which gender is restless leg syndrome more common

Answer 49

Female

Question 50

How can aetiology of restless leg syndrome be divided

Answer 50

Primary | Secondary

Question 51

What are secondary causes of restless leg syndrome

Answer 51

- IDA - DM - ESRD - Inflammatory: Coeliac, IBD - Neuorlogical: anti-depressants

Question 52

What are 4 risk factors for restless leg syndrome

Answer 52

- Pregnant - IDA - FH - DM - Uraemia

Question 53

What type of movement disorder is restless leg syndrome and why

Answer 53

Akathisia = inner restlessness causes a desire to move leg. Symptoms start at night and then progress to day-time

Question 54

When are symptoms of restless leg syndrome worse

Answer 54

At rest

Question 55

What investigations are ordered in restless leg syndrome

Answer 55

EMG NCS FBC - to exclue IDA

Question 56

How can restless leg syndrome be managed

Answer 56

Stretching and walking | Dopamine agonists