L10: Movement Disorders Flashcards
(112 cards)
1
Q
Def of Extrapyramidal Disorders
A
disorders which impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function.
2
Q
Types of Extrapyramidal Disorders
A
3
Q
Def of Extrpyramidal System
A
Functional system including all nuclei & descending neural pathways outside pyramidal system acting on lower motor neurons.
4
Q
Functions of Extrpyramidal System
A
5
Q
Def of Parkinson’s Disease
A
6
Q
Etiology of Parkinson’s Disease
A
Degeneration of nigrostriatal dopamine system in brain.
7
Q
Epidemeology of Parkinson’s Disease
A
8
Q
- The most common Extra-pyramidal disease is ……
A
PD
9
Q
Epidemeology of Parkinson’s Disease
- Age
A
- 40 - 70 years of age,
- peak age of onset in the 6th decade
- infrequent before 30 years of age.
10
Q
Epidemeology of Parkinson’s Disease
- Sex
A
Men are more affected (3:2)
11
Q
Epidemeology of Parkinson’s Disease
- Ethnicity
A
a) All ethnic groups, all socioeconomic classes are affected more in some countries.
b) Egypt: 2nd in prevalence more in rural and boxers
c) Less prevalent in China and other Asian countries, and in African Americans.
12
Q
Functional Neuroanatomy of Parkinson’s Disease
A
13
Q
Neurochemistry in Parkinson’s Disease
A
14
Q
Neuropathology of Parkinson’s Disease
A
15
Q
Pathogenesis of Parkinson’s Disease
A
16
Q
RF for Parkinson’s Disease
A
17
Q
CP of Parkinson’s Disease
A
18
Q
CP of Parkinson’s Disease
- Face
A
Mask expressionless face.
19
Q
CP of Parkinson’s Disease
- Limbs & trunck
A
Flexed rigid attitude
20
Q
CP of Parkinson’s Disease
- cardinal Symptoms
A
- Resting Iremors (main symptom)
- Bradykinesia
- Muscle Rigidity
- Postural instability
21
Q
what is the most common symptom of Parkinson’s Disease?
A
Resting tremors
22
Q
CP of Parkinson’s Disease
- Tremors
A
23
Q
CP of Parkinson’s Disease
- Bradykinesia
A
24
Q
CP of Parkinson’s Disease
- Voluntary movements
A
24
CP of **Parkinson's Disease**
- Associative Symptoms
Diminution or loss (e.g. loss of swinging of arms in walking).
25
CP of **Parkinson's Disease**
- Speech
slow, quite & monotonous.
26
CP of **Parkinson's Disease**
- Writing
becomes progressively smaller (Micrographia).
27
CP of **Parkinson's Disease**
- Muscle Rigidity
28
CP of **Parkinson's Disease**
- Postural Instability
D2 loss of postural reflexes.
29
CP of **Parkinson's Disease**
- Gait
30
CP of **Parkinson's Disease**
- Propulsion, Retropulsion & Lateropulsion
patient is unable to stop quickly when pushed forwards, backwards, or laterally.
31
CP of **Parkinson's Disease**
- Fesinating Gait
spontaneous propulsion during walking
32
CP of **Parkinson's Disease**
- kinesia Paradox
patient can do rapid movements better than slow ones e.g. He can walk only very slowly, but may be able to run quite fast.
33
CP of **Parkinson's Disease**
- Reflexes
34
CP of **Parkinson's Disease**
- sensation
Intact: in most cases..
35
CP of **Parkinson's Disease**
- Autonomic System
Impaired GIT motility, bladder dysfunction, sialorrhea, excessive head and neck sweating, and orthostatic hypotension.
36
CP of **Parkinson's Disease**
- Depression
Mild to moderate depression in 50% of patients.
37
CP of **Parkinson's Disease**
- Cognitive Impairment
38
Dx of **Parkinson's Disease**
39
TTT of **Parkinson's Disease**
medical & surgical
40
Medical Options for **Parkinson's Disease**
Dopamenrigic Thrapy:
- DOPA subs.
- Dopamine receptor Agonist
- Metabolism Inhibitors
Others:
- Amantadine
- Anticholinergic Drugs
41
Dopamenergic Therapy for **Parkinson's Disease**
...
42
TTT of **Parkinson's Disease**
- DOPA subs
43
Cornerstone for TTT of **Parkinson's Disease**
DOPA Substitution L-dopa + decarboxylase inhibitor (Sinemet)
44
TTT of **Parkinson's Disease**
- DOPA subs
45
Mechanism of L-dopa & decarboxylase inhibitor
46
TTT of **Parkinson's Disease**
- Limitations of DOPA Subs
47
Examples of Dopamine Receptor Agonists
48
TTT of **Parkinson's Disease**
- Metabolism Inhibitors
49
TTT of **Parkinson's Disease**
- Other therapies
50
TTT of **Parkinson's Disease**
- MOA of Amantadine
51
TTT of **Parkinson's Disease**
- SE of Amantadine
as L-dopa but milder
52
TTT of **Parkinson's Disease**
- MOA of Anticholinergic Drugs
Effective on tremor
53
TTT of **Parkinson's Disease**
- SE of Anti-cholinergics
Dry mouth, blurring of vision, constipation, urinary retention, confusion state, hallucinations & impairment of memory.
54
TTT of **Parkinson's Disease**
- Surgical TTT
55
Def of **Myoclonus**
Sudden, brief, shock-like involuntary movements.
56
Types of **Myoclonus**
57
Types of Generalized Myoclonus
58
Types of Generalized Myoclonus
- Physiologic
59
Types of Generalized Myoclonus
- essential
60
Types of Generalized Myoclonus
- Epileptic
61
Types of Generalized Myoclonus
- Symptomatic
62
Causes of **Segmental Myoclonus**
63
Examples of **Segmental Myoclonus**
64
TTT of **Myoclonus**
1. Valproic acid is drug of choice.
2. May respond to benzodiazepines e.g. clonazepam.
65
Notes
66
Def of **Hemiballismus**
67
Etiology of **Hemiballismus**
Usually due to a CVA in contralateral subthalamic nucleus
68
CP of **Hemiballismus**
69
Characters of **Chorea**
70
Causes of **Chorea, Dystonia & Athetosis**
71
Causes of **Chorea, Dystonia & Athetosis**
- Hereditary
72
Causes of **Chorea, Dystonia & Athetosis**
- Drugs
73
Causes of **Chorea, Dystonia & Athetosis**
- CVD
(schemia, hemorrhage) Most common acquired cause of chorea
74
Causes of **Chorea, Dystonia & Athetosis**
- Structural Lesions
subthalamic nucleus)
75
Causes of **Chorea, Dystonia & Athetosis**
- 2ry to medical Disorders
76
Causes of **Chorea, Dystonia & Athetosis**
- Miscellaneous
77
RF for **Rheumatic (Sydenham's) Chorea**
78
Infections predisposing for **Rheumatic (Sydenham's) Chorea**
79
CP of **Rheumatic (Sydenham's) Chorea**
80
Clinical Varities of **Rheumatic (Sydenham's) Chorea**
81
Chorea Gravidarum
82
TTT of **Rheumatic (Sydenham's) Chorea**
83
TTT of **Rheumatic (Sydenham's) Chorea**
- Bed Rest
(physical & mental) for 4 weeks, longer stay is necessary in carditis.
84
TTT of **Rheumatic (Sydenham's) Chorea**
- Sedatives
phenobarbitone,
85
TTT of **Rheumatic (Sydenham's) Chorea**
- corticosteroids
for active carditis, rheumatic fever& failure of other lines of treatment.
86
TTT of **Rheumatic (Sydenham's) Chorea**
- Tonsilectomy
if there is a history of recurrent tonsillitis & sore throat, performed after convalescence from chorea.
87
TTT of **Rheumatic (Sydenham's) Chorea**
- Long-acting penicillin
(prophylactic against streptococcal infection).
88
Wilson's disease
89
Idiopathic torsion dystonia
90
Dopa-responsive dystonia
91
Site of **Athetosis**
- distal parts of limbs (hands, fingers).
- Can also affect face and tongue
92
Characters of movements of **Athetosis**
Involuntary movements characterized by :
- Slow, flowing, often twisting
- Continuous
- Snake-like movements
93
choreoathetosis
Often use term " choreoathetosis" due to overlap () syndromes ( chorea referring to less smooth, more jerky movements)
94
Characters of **Dystonia**
Condition in which the patient assumes a sustained, abnormal posture or limb position
95
Pathology in **Dystonia**
Due to co-contraction of agonist and antagonist muscles in part of body
96
Types of **Dystonia**
1. Generalized (Torsion) dystonia.
2. Focal dystonia.
97
Def of **Generalized (torsion) Dystonia**
Involuntary torsion movements of trunk & proximal segment of limbs.
98
CP of **Generalized (torsion) Dystonia**
99
CP of **Generalized (torsion) Dystonia**
- Age
childhood or adolescence (Familial type).
100
CP of **Generalized (torsion) Dystonia**
- No ....
pyramidal signs or wasting.
101
CP of **Generalized (torsion) Dystonia**
- Normal .....
Reflexes, sensations, mentality & speech.
102
CP of **Generalized (torsion) Dystonia**
- tone
Hypertonia during spasms & hypotonia in-between them.
103
Examples of **Focal Dystonia**
104
Managment of **Focal Dystonia**
105
Def of **TICS**
Recurrent, stereotyped abnormal movements
106
Etiology of **TICS**
1. Primary; Tourette's syndrome.
2. Secondary: Huntington's disease.
107
Characters of **TICS**
A. May be suppressed voluntarily or with distraction
B. Voluntary suppression leads to anxiety and a build-up of internal unrest.
C. Worsen under
108
Def of tremors
109
Classification of tremors
110
Clinical class. of tremors
111
TTT of tremors
