Movement D/o Flashcards
Cerebellar d/o signs & causes
Signs: ataxia, dysarthria, dysdiadochokinesia, dysmetria
traumatic brain injury, stroke, MS, toxin exposure
Pyramidal tract d/o signs & causes
signs: weakness, paralysis, loss of dexterity
MS, malignancies, autoimmune diseases, infection, stroke, spinal cord injury
extrapyramidal tract d/o signs & causes
signs: involuntary movement, postural abnormalities
Parkinsons, huntingtons
Essential tremor
bilateral action tremor mostly in hands/arms
gets better with alcohol and worse with anxiety, excitement
women tend to have head/voice tremor
Essential tremor pathogenesis
abnormal activity in cerebellothalaocortical circuitry
autosomal dominant
how do you evaluate essential tremors
get labs for calcium & thyroid levels
get labs to rule out Wilson’s disease
only do imaging if w/ focal deficit or suspect stroke, etc.
First line tx for essential tremors
Beta blocker– propanolol
– not for asthma, heart failure, DM 1
2nd line for essential tremors
anticonvulsants—
primidone– not for porphyria
topiramate
gabapentin
Tx Classes for essential tremors
- beta blockers
- anticonvulsants
- BZD
3rd line for essential tremors
BZD– clonazepam, alprazolam
4 Non-medication tx for essential tremors
OT
assistive devices
deep brain stimulation
MRI guided US
pathogenesis of restless legs
iron deficiency!
dopaminergic deficiency, thalamic issue, peripheral pathology
restless legs evaluation
check iron levels
review meds for antihistamines, antipsychotics, antidepressants
restless legs treatment
- iron supplement
- replace offending meds
- dopamine agonists (pramipexole, ropinirole)
- Levodopa
- gabapentin
parkinsons risk factors
vitamin D deficiency
pesticide exposure
rural living/ag work
exposure to heavy metals, well water
age & genetics
parkinsons pathophysiology
no dopamine in substantia nigra causing communication disruption btwn basal ganglia and motor cortex
features of parkinson’s
TRAP— tremor (pill rolling), rigid (cog wheeling), akinesia, postural instability
non motor sx of parkinson’s
olfactory dysfx
fatigue
REM sleep d/o
cognitive changes
psychosis
mood d/o
autonomic sx— hypotension, constipation, urinary sx, sexual dysfx
parkinson’s diagnosis
bradykinesia is required! plus tremor or rigidity
supportive— benefit from dopaminergic meds, unilateral sx at onset, olfactory loss, levodopa induced dyskinesia
mostly diagnosed in 60s
imaging for parkinson’s
DAT scan to see density of dopamine neurons
Parkinson’s medication
C SALAD
COMT inhibitors
Selegiline (MAO-B inhibitors)
Anticholinergics
Levodopa
Amantadine
Dopamine agonist
Gold standard med for Parkinson’s disease
Levodopa
Class of meds that must be taken w/ Levodopa & what it addresses
COMT inhibitors for motor fluctuations
signs that it is NOT idiopathic parkinson’s
rapid progression of gait sx needing wheelchair <5yrs
bulbar dys (dysphonia,-phagia-arthria) w/in 5 yrs
bilateral parkinsonism
