Adult Movement Disorders

Question 1

MC Movement D/O

Answer 1

Parkinsons

Question 2

MC Neurodegenerative D/O

Answer 2

AD 
#2 Parkinsons

Question 3

Environmental exposure that put patient at risk for parkinsosn

Answer 3

• herbicide/pesticides
• metals
• well water
• farming, rural
• wood/steel mills

Question 4

% of dopaminergic neurons lost at symptom onset in parkinsons

Answer 4

60-80%

Question 5

Lewy Bodies/Neurites:

appearance

Answer 5

• eosinophilic

- intracytoplasmic inclusions

Question 6

Sleep change assc with Parkinsons

Answer 6

REM Behavior D/O

Question 7

Autonomic changes assc with parkinsons

Answer 7

constipation
urinary frequency 
sweating 
drooling
orthostatic hypotension

Question 8

Only parkinsons drug shown to slow progression of disease

Answer 8

MAO-Bi

selegiline, rasageline

Question 9

Sites for DBS in Parkinsons

Answer 9

• STN (tremor, dyskinesia)
• GPe (dystonia)
• VIM (tremor)

Question 10

In NPH, what should be done before performing LP?

Answer 10

• MOCA
• number steps over 10 meters
• walking speed

(then determine improvement after LP)

Question 11

NPH appearance on imaging

Answer 11

• ventricles dilated

- atrophic cortex

Question 12

PSP Symptoms

Answer 12

• Parkinsonism
• Neck Dystonia
• Pseudobulbar palsy
• Supranuclear ophtalmoplegia

Question 13

Describe ophthalmoplegia

Answer 13

loss of vertical gaze initially

Question 14

HD genetic change

Answer 14

AD CAG repeat chromosome 4 with genetic anticipation

Question 15

Juvenile Onset HD appears as ______

Answer 15

parkinsonism

parkinsonism in kid –> think HD

Question 16

HD = caudate atrophy

What is the microscopic finding?

Answer 16

-loss of spiny striatal neurons with gliosis

Question 17

Treatments for HD

Answer 17

• Tetrabenazine (dopa depleting agent)
• Antipsychotics
• SSRIs

Question 18

ADRs assc with tetrabenazine

Answer 18

• depression (combine with SSRI)

- orthostatic hypotension

Question 19

MC cause action tremor

Answer 19

benign essential tremor (familial)

Question 20

What improves benign essential tremor?

Answer 20

alcohol

Question 21

Contrast PD and BET tremors

Answer 21

• Parkinsons is lower frequency and at rest

- BET is higher frequency and assc with action/ postures

Question 22

DOC for BET

Answer 22

propranolol

Question 23

Secondary treatments for BET

Answer 23

• topiramate

- primidone

Question 24

Drug known to cause parkinsonism

Answer 24

metaclropromide

Question 25

DOC for parkinsonism

Answer 25

Levodopa Carbidopa (sinemet)

Question 26

Drug for parkinsonism to avoid in bipolar patients

Answer 26

dopa agonists
(ronipirole, pramiprexole)