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Flashcards in Movement d/o Deck (18)
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Sx of movement d/o

-Hypokinesia: too little movement
-Bradykinesia, akinesia, rigidity
-Hyperkinesia: too much movement
-Tremor, chorea, dystonia, myoclonus, tics
-Dyskinesia: abnormal movement



-An oscillatory, rhythmical, and regular movement affecting one or more body parts
-Rest tremor: limb supported against gravity
-Posture tremor: outstretched hands
-Action tremor: when performing an action



-Involuntary, irregular, purposeless, nonrhythmical, rapid jerky movements that flow from one part of the body to another
-Choreoathetosis: chorea seen w/ athetosis (a slower, writhing, less jerky but still random movement)



-Sustained involuntary abnormal posturing (writer's cramp)
-Can be focal: single body part
-Segmental: contiguous body parts
-Generalized: leg and other body parts



-Sudden, brief, twitch-like, involuntary contractions
-Many different causes from cortex injury to brainstem to SC
-Ex: lance-adams myoclonus. There is diffuse action cyclones following episode of anoxic encephalopathy
-Can be activated by action or sensory stimulation



-Simi-voluntary, repetitive, intermittent, stereotypic movements (motor tics), or sounds (phonic tics)
-Tourette's: need vocal and motor tics w/ onset <21 years


Parkinsonism (PD)

-80% idiopathic
-Have hypokenisia (bradykinesia or akinesia, rigidity), a rest tremor, and postural instability
-Many other associated features
-Only risk factor known is age
-Pathophysiology: loss of DA neurons in SNpc, functional loss of DA projections to BG
-Pathologic hallmark: lewy bodies in SNpc neurons
-Can also be caused by tardive syndromes and other lesions/infections


Rx of PD

-Levodopa (part of sinemet): is converted within neurons to DA
-Gold standard for PD Sx
-Limitations: does not stop disease progression, doesn't Rx all Sx
-Side effects (nausea, dizziness, sedation, confusion, hallucinations)
-Pts may develop motor fluctuations (3-5 yrs after initial Rx)
-Can also use MAO-B + COMT inhibitors to increase the DA abundance in synapses


PD vs essential tremor

-PD pts are older, have asymmetric Sx, no other neurological signs, respond to levodopa
-Essential tremor (either rest, postural, or action) there is only tremor and no other signs
-Onset of essential tremor at any age, 60% respond w/ EtOH, often family history
-Usually affects upper extremities the most


Rx of essential tremor

-Primidone, propanolol, BZDs



-Seen in huntignton's disease (HD), sydenham's chorea
-Drug-related: tardive syndrome
-Wilson's disease


Huntington's disease (HD)

-Clinical triad: psychiatric, cognitive (dementia), movement d/o (chorea)
-Pathology: caudate atrophy
-Psychiatric changes: depression, personality change
-Is inherited (autosomal dominant, 100% penetrance)
-Due to triplet repeat CAG in the huntington gene
-Dx by molecular testing (# of repeats indicates the severity)
-Onset 30-50: westphal variant
-Childhood onset: more parkinsonian


Management of HD

-Patient and family education
-Support groups
-Rehab services



-Sustained muscle contractions (generalized or focal)
-Idiopathic torsion dystonia
-Focal dystonia: writer's cramp, segmental dystonia (contiguous body parts), torticollis
-Torticollis: adult onset, idiopathy, sensory tic common, does not progress
-Rx of torticollis: botox, anticholinergics, BZDs
-DYT1 dystonia: childhood onset in limb, gradual progression over years to involve most of body
-Mentation spared, often in jews, autosomal dominant (incomplete penetrance)


Tardive syndromes

-Appears after exposure to D2 antagonists (anti-psychotic drugs)
-Tardive dyskinesia most characteristic: oral/buccal movements
-Tardive dyskinesia is chronic, and presents w/ peri-oral chorea, dyskinesia, and dystonia



-Syndrome of involuntary large amplitude flinging limb movements (ballism) affecting one side
-Frequently associated w/ lesions of the contralateral STN and/or its connections
-Usually from hemorrhage and infarction


Wilson's disease

-Inherited d/o of copper metabolism (autosomal recessive)
-Onset @ childhood or young adult
-Copper deposition in tissues, leading to hepatic dysfunction and behavioral/cognitive dysfunction
-Can mimic any movement d/o (variable presentation)
-Common: wing-beating, vacuous smile
-Kaiser-fleischer rings in descemet membrane of cornea
-Check cornea of any young person w/ movement d/o
-Rx: copper chelation, liver Tx


Tic d/o

-Semi-voluntary movements preceded by urge to perform movement, followed by relief
-Can be motor or phonic
-Dx criteria: onset <21, both phonic and motor tics, tics present for 12 mo
-Associated w/ ADHD and OCD
-Rx is neuroleptics (anti-psychotics, can lead to tardive syndrome) to suppress tics

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