Lecture 3: Mvmnt Disorders Flashcards Preview

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Flashcards in Lecture 3: Mvmnt Disorders Deck (23):
1

Benign Essential Tremor

-postural tremor of hands, head or both
-fam Hx
-gets better with alcohol
- no other abnormal findings
-tx: propanolol or primidone

2

Parkinsonism: essentials of dx

any combo of tremor, rigidity, BRADYKINESIA, progressive postural instability

3

Most common variety of Parkinsonism

Idiopathic Parkinson Dz: begins btwn 45-65 y/o

4

Other causes of Parkinsonism

-rarely family basis
-postencephalic parkinsonism= rare
-toxin exposure (C disulfide, manganese dust, CO poisoning)
-MPTP use
-Reversible parkinsonism: use of neuroleptic drugs

5

Idiopathic Parkinson Dz etiology

dopamine depletion due to degeneration of dopaminergic nigrostriatal system leads to an intolerance of Dopa and Ach

6

Risk factors for Idiopathic Parkinson

Age, fam hx, male sex, ongoing herbicide/pesticide exposure, significant prior head trauma

7

Parkinson Clinical Findings:

-tremor: usually one limb or one side of body for many yrs before becoming more generalized; decreases with voluntary mvmnts
-rigidity
-bradykinesia: most disabling of sx's: ***decrease arm swinging

8

Park: Clinical Dx

-immobile face w/ widened palpebral fissures; infrequent blinking; fixity of facial expression
-blepharoclonus and tremor at mouth/lips
-repetitive tapping at bridge of nose prides sustained blinking = Myerson sign

9

Other Park findings:

gait: shuffling of feet, slow to turn, no swinging of arms
-impairment of fine rapid alternating mvmnts and micrographia
-NO muscle weakness, alteration in reflexes or plantar response

10

Park Tx:

Amatadine: mild sx's, help with side effects of l-dopa
Anticholinergic agents: better balance with dopa levels
L-dopa: improves all major features of parkinsonism; long term use increase side effects
Dopamine Agonist: directly act on dopa receptors and help with SE of Ldopa
Selective MOIs: rasagiline: inhibit breakdown of Dopa
COMT inhibs: reduce metab of Ldopa, decrease SE due to increase levels of Ldopa = entacapone
Atypical antipsychs
Brain stimulation

11

Ldopa side effects

Occurs wit=h prolonged use
-dyskinesia, restlessness, confusion, and other behavioral changes
-"on/off" phenomenon: abrupt transient fluctions in severity throughout day with marked bradykinesia

12

Huntington Dz main features:

***Chorea and dementia and family hx
Other findings: onset 30-50, fatal in 15-20 yrs; very debilitating; CT: atrophy
-NO cure

13

Idiopathic Torsion Dystonia

dystonic mvmnts and postures; NORMAL birth and development: no other neurological signs

14

Dystonic mvmnts in Idiopathic Torsion Dystonia

-mvmnts of head and neck: torticollis, blepharospasm, facial grimacing, forced open/closing of mouth

15

DDX Idiopathic Torsion

-birth trauma, kinecterus, prenatal anoxia all cause dystonia, but all have abnormal early development

16

Guilles de la Tourette Syndrome : features

-multiple motor tics or phonic tics
-sx's begin before 21 y/o
-tics occur frequently for 1 ye
-tics vary in #, frequency and nature over time

17

Features of tics

-motor tics: initial manifestation (80%), involve face, head and shoulders
-phonic tics: 20%, grunts, barks, hisses, throat clearing, coughs; may be verbal utterances; echolalia or palilalia
-some can be self harming

18

Essential of dx

Tic like character of abnormal mvmts and absence of neurological signs

19

Tics Tx

-symptomatic
-Alpha adrenergic agonists: clonidine
-typical antipsychs: haloperidol
-atypical antipsychs: risperidone, apripazole

20

Chorea

involuntary, continuous, abrupt, rapid, brief, unsustained, irregular mvmnts that flow from randomly from one body part to another
**dance-like mvmnt of feet and hands

21

Disorders/Drugs that cause Chorea

Disorders: Huntington dz, Wilson's dz

Drugs: Dopaminergics, anti-dopaminergics, anticonvulsants

22

Dystonia:

neurologic syndrome characterized by involuntary, sustained, patterned, and often repetitive muscle contractions of opposing muscle movements or abnormal postures
***longer duration than chorea, twisting of body parts, younger age at onset

23

Drugs that cause Dystonia

Dopamine blocking agents, neuroleptics, certain nausea meds