a state of restlessness
akathisia
inability to coordinate movements of the trunk or limbs
ataxia
involuntary writhing limb movements
athetosis
flailing, ballistic, involuntary movements in a limb
ballism
quick, involuntary, dance-like movements
chorea
involuntary movements, chorea-like or tic-like
dyskinesias
abnormal muscle tone with sustained posture
dystonia
involuntary, spasmodic, jerky movements
myoclonus
habitual, semi-voluntary, spasmodic, quick, brief movements
tics
involuntary, rhythmic, repetitive movement
tremor
2nd most common neurodegenerative disease following alzheimer’s
idiopathic parkinson’s disease
when do motor complications appear in idiopathic parkinson’s disease
~5-7 years after disease
do you see an overactive or underactive indirect pathway in IPD?
overactive
4 cardinal features of IPD
- rest tremor (unilateral)
- rigidity
- akinesia-bradykinesia
- postural instability (later sx)
unified parkinson’s disease rating scale
I: mentation, mood, and behavoir
II: ADLs
III: motor exam
IV: complications of therapy
drug-induced parkinsonism
- offending drug (anti-nausea, anti-psychotics)
- absence of rest tremor
- SYMMETRIC sxs
vascular disease (diff. from parkinsonism)
- GAIT DISTURBANCE (magnetic gait)
- SPASTICITY
- hyper-reflexia
- pseudobulbar affect
normal pressure hydrocephalus
-APRAXIA OF GAIT
-regidity
urinary incontinence
corticobasal degeneration
- COGNITIVE DISORDER
- limb apraxia
- dystonia or myoclonus
progressive supranuclear palsy
- pseudobulbar affect
- supranuclear gaze palsy
- early falls
- absence of tremor
multi-system atrophy
- falls
- axial dystonia
- resp. stridor
- absence of rest tremor
- prominent autonomic features early on
dementia with lewy bodies
- cognitive disorder
- hallucinations
workup for suspected parkinsonism
- none if typical presentation
- MRI if gait disorder/falling, cognitive disorder
hot cross bus sign
MSA (multi-system atrophy)
hummingbird sign (thinning of midbrain)
PSP (progressive supranuclear palsy)
when should you r/o wilson’s disease?
any pt
workup for wilson’s ds
urine copper and serum ceruloplasmin
-ophth=K-F rings
lab study for any pt with a tremor
thyroid studies
lab you should get in all patients you follow with PD
vitamin D
study for pts with dysphagia
swallow study
study for all pts with a voice change
speech evaluation
tx for IPD
- Sinemet (L-dopa and carbidopa)
- DA agonists (pramipexole, ropinirole, rotigotine)
who should take sinemet
all pts with IPD over the age of 70
unique SE of DA agonists
impulse control disorders
indications for DA agonists
pts
sx tx for IPD
- MCI/dementia= anticholinesterases
- depression/anxiety= antidepressants
- constipation=increase fiber
- orthostatic hypoTN=caffeine, water, stockings
- sialorrhea= robinul (caution) or botulinum
IPD surgical tx
- ablative
- DBS
indications for DBS
-significant disability, motor fluctuations with max medications, still levodopa responsice, no cognitive impairment
indication for Vim DBS
ET or tremor predominant PD
indication for STN DBS
PD
indication for GPi DBS
dystonia or rigidity prominent PD
autosomal dominant inheritance with variable penetrance
essential tremor
features of essential tremor
- typically BUE
- rest tremor later on
- may improve with alcohol
treatment for ET
wrist weights, propranolol, primidone, gabapentin, topiramate, etc
criteria for RLS
- abnl sensations with urge to move the legs
- occurs at rest
- alleviated by movement
- sxs worse at night
secondary causes of RLS
neuropathy, Fe deficient, pregnancy, renal failure
Tx of RLS
- only use at night!
- Fe replacment, DA agonists, anti-epileptics, benzos, opioids,
chromosome involved with huntington’s disease
chromosome 4
-trinucleotide repeat (CAG)
autosomal dominant with HIGH penetrance
huntington’s disease
butterfly appearance of ventricles
huntington’s disease
manifestations of HD
- chorea, motor impersistence
- cognitive deficits
- psych (depression, suicide rate 5x general population)
tx of HD
- anti-dopaminergic drugs
- benzos
- anti-depressants
Tics are a/w which other disorders
OCD and ADD
etiology of Tics
- primary: tourette’s
- drug induced: stimulants, steroids, neuroleptics
- post-infectious: post-strep
tx of Tics
- clonidine
- neuroleptics
- benzo
criteria for tourette’s syndrome
- motor tics and phonic tics for >1 year
- no secondary causes
- onset before age 18
- copralalia (swearing)
tx of tourette’s syndrome
meds, botox, DBS
types of primary dystonia
- generalized (childhood onset)
- focal (adult onset)
types of secondary dystonia
- neurocog. disorders
- medication
tx of dystonia
- dopaminergic
- muscle relaxers
- benzos
- anticholinergics
what is a hemifacial spasm
involuntary, intermittent spasms of half of the face
triggers of hemifacial spasm
bright light, wind, fatigue, stress, smiling, speaking
most common cause of HFS
CN 7 compression
dx of HFS
clinical and MRI
tx of HFS
botox
clinical features of functional/psychogenic movement disorders
- abrupt onset with rapid progression
- bizzare movement
- spontaneous remissions
- self inflicted injuries
- give wat weakness
- lateralization of tuning fork on frontal bone
- hoover sign
- astasia-abasia
