Movement d/o Flashcards
1
Q
Sx of movement d/o
A
- Hypokinesia: too little movement
- Bradykinesia, akinesia, rigidity
- Hyperkinesia: too much movement
- Tremor, chorea, dystonia, myoclonus, tics
- Dyskinesia: abnormal movement
2
Q
Tremor
A
- An oscillatory, rhythmical, and regular movement affecting one or more body parts
- Rest tremor: limb supported against gravity
- Posture tremor: outstretched hands
- Action tremor: when performing an action
3
Q
Chorea
A
- Involuntary, irregular, purposeless, nonrhythmical, rapid jerky movements that flow from one part of the body to another
- Choreoathetosis: chorea seen w/ athetosis (a slower, writhing, less jerky but still random movement)
4
Q
Dystonia
A
- Sustained involuntary abnormal posturing (writer’s cramp)
- Can be focal: single body part
- Segmental: contiguous body parts
- Generalized: leg and other body parts
5
Q
Myoclonus
A
- Sudden, brief, twitch-like, involuntary contractions
- Many different causes from cortex injury to brainstem to SC
- Ex: lance-adams myoclonus. There is diffuse action cyclones following episode of anoxic encephalopathy
- Can be activated by action or sensory stimulation
6
Q
Tics
A
- Simi-voluntary, repetitive, intermittent, stereotypic movements (motor tics), or sounds (phonic tics)
- Tourette’s: need vocal and motor tics w/ onset <21 years
7
Q
Parkinsonism (PD)
A
- 80% idiopathic
- Have hypokenisia (bradykinesia or akinesia, rigidity), a rest tremor, and postural instability
- Many other associated features
- Only risk factor known is age
- Pathophysiology: loss of DA neurons in SNpc, functional loss of DA projections to BG
- Pathologic hallmark: lewy bodies in SNpc neurons
- Can also be caused by tardive syndromes and other lesions/infections
8
Q
Rx of PD
A
- Levodopa (part of sinemet): is converted within neurons to DA
- Gold standard for PD Sx
- Limitations: does not stop disease progression, doesn’t Rx all Sx
- Side effects (nausea, dizziness, sedation, confusion, hallucinations)
- Pts may develop motor fluctuations (3-5 yrs after initial Rx)
- Can also use MAO-B + COMT inhibitors to increase the DA abundance in synapses
- DBS of STN
9
Q
PD vs essential tremor
A
- PD pts are older, have asymmetric Sx, no other neurological signs, respond to levodopa
- Essential tremor (either rest, postural, or action) there is only tremor and no other signs
- Onset of essential tremor at any age, 60% respond w/ EtOH, often family history
- Usually affects upper extremities the most
10
Q
Rx of essential tremor
A
-Primidone, propanolol, BZDs
11
Q
Chorea
A
- Seen in huntignton’s disease (HD), sydenham’s chorea
- Drug-related: tardive syndrome
- Wilson’s disease
- Hyperthyroidism
12
Q
Huntington’s disease (HD)
A
- Clinical triad: psychiatric, cognitive (dementia), movement d/o (chorea)
- Pathology: caudate atrophy
- Psychiatric changes: depression, personality change
- Is inherited (autosomal dominant, 100% penetrance)
- Due to triplet repeat CAG in the huntington gene
- Dx by molecular testing (# of repeats indicates the severity)
- Onset 30-50: westphal variant
- Childhood onset: more parkinsonian
13
Q
Management of HD
A
- Patient and family education
- Support groups
- Rehab services
14
Q
Dystonia
A
- Sustained muscle contractions (generalized or focal)
- Idiopathic torsion dystonia
- Focal dystonia: writer’s cramp, segmental dystonia (contiguous body parts), torticollis
- Torticollis: adult onset, idiopathy, sensory tic common, does not progress
- Rx of torticollis: botox, anticholinergics, BZDs
- DYT1 dystonia: childhood onset in limb, gradual progression over years to involve most of body
- Mentation spared, often in jews, autosomal dominant (incomplete penetrance)
15
Q
Tardive syndromes
A
- Appears after exposure to D2 antagonists (anti-psychotic drugs)
- Tardive dyskinesia most characteristic: oral/buccal movements
- Tardive dyskinesia is chronic, and presents w/ peri-oral chorea, dyskinesia, and dystonia
